A   PRACTICAL   TREATISE   ON 

MATERIA   MED1CA   AND 

THERAPEUTICS 


\ 


BY 

ROBERTS   BARTHOLOW,   M.  A.,   M.  D.,   LL.  D. 

Professor  Emeritus  of  Materia   Medica,  General   Therapeutics,  and  Hygiene,  in  the  Jefferson 
Medical  College  of  Philadelphia ;   formerly  Professor  of  Materia  Medica  and  Therapeutics 
and  of  the  Practice  of  Medicine  in  the  Medical  College  of  Ohio ;  Fellow  of  the  College 
of  Physicians  of  Philadelphia ;    Member  of   the  American    Philosophical   Society ; 
Honorary  Fellow  of  the  Royal  Medical  Society  of  Edinburgh  ;  Honorary  Member 
of  the  Societe  Medico-pratique  de  Paris,  and  of  various  National,  State,  and 
County  Medical   Societies.     Author  of  a  Treatise  on   the   Practice   ot 
Medicine ;  of  a  Treatise  on   Medical   Electricity  ;  of  a  Manual  of 
Hypodermatic    Medication ;    of    the    Russell   and    Jewett    Prize 
Essays,  and  Prize   Essays  of  the  American   Medical   Asso- 
ciation and  of  the  Rhode  Island  Medical  Society,  etc. 


ELEVENTH  EDITION,  REVISED  AND  ENLARGED 


NEW  YORK  AND  LONDON 

D.    APPLETON    AND    COMPANY 

1903 


COPYRIGHT,  1876, 1877,  1879,  1881,  1883,  1887,  1889,  1893,  1896,  1899,  1903, 
BY  D.  APPLETON  AND  COMPANY. 


PRINTED   AT  THE   APPLETON    PRESS, 
NEW   YORK,    U.  S.  A. 


TO   THE   MEMORY    OF 

FATHER,    MOTHER,    AND    BROTHERS, 

BY     THE     8TJEVITOB. 


c 


PREFACE  TO  THE  ELEVENTH  EDITION. 


IN  preparing  ihiB  edition  I  have  corrected  some  typographical 
and  other  errors,  and  have  added  various  new  articles  which  will, 
I  hope,  improve  the  interest  and  value  of  the  work.  In  this,  as 
in  all  previous  issues,  the  practical  character  of  the  work  as  a  store- 
house of  facts  relating  to  Materia  Medica  and  Therapeutics  has 
been  preserved. 

I  have  not  been  unmindful  of  the  present  tendency  of  pharma- 
cological literature.  An  increasing  disposition  is  discernible  to 
develop  the  physiological  side,  to  enlarge  the  domain  of  experi- 
mental work,  and  to  interpret  conditions  in  man  by  hasty  and 
sometimes  crude  observations  on  the  inferior  animals.  On  the 
other  hand,  empirical  knowledge,  supported  by  careful  clinical 
work,  and  improved  by  sound  induction,  should  continue  to  be 
an  important  element  in  the  structure  of  any  therapeutical  system. 

I  have  again  to  thank  my  readers  and  constant  friends  for  their 
approval  of  the  successive  issues  of  my  Treatise. 

E.  B. 

PHILADELPHIA,  PA.,  1903. 


PREFACE  TO  THE  TENTH  EDITION. 


IN  sending  forth  the  tenth  edition  of  this  work,  I  can  do  no  less 
than  thank  my  readers  for  this  evidence  of  the  esteem  in  which 
they  continue  to  hold  it.  To  render  this  edition  still  more  worthy, 
I  have  added  accounts  more  or  less  full  of  the  newer  remedies, 
have  inserted  a  special  article,  though  succinct,  on  prescription 
writing,  and  have  made  changes  at  various  points  to  correct  errors 
that  have  been  overlooked,  and  to  supply  omissions  of  necessary 
matter.  To  accomplish  these  objects  with  as  little  increase  of  space 
as  possible,  I  have  stricken  out  references  at  various  places.  These 
are  the  less  to  be  deplored  as  medical  libraries  are  becoming  more 
numerous  and  readily  accessible,  and  this  kind  of  information  is 
sufficiently  conveyed  to  the  intelligent  reader  by  the  mention  of 
the  names  of  the  more  important  contributors. 

In  the  prefaces  to  the  eighth  and  ninth  editions  respectively, 
my  views  regarding  the  admission  to  the  work  of  the  rapidly  in- 
creasing new  remedies  have  been  sufficiently  given.  As  the  next 
decennial  revision  of  the  United  States  Pharmacopoeia  is  near  at 
hand  (1900),  we  may  look  for  some  authoritative  action  then, 
whereby  the  present  state  of  uncertainty  may  be  finally  terminated. 

ROBEKTS  BAETHOLOW,  M.  D. 

1627  LOCUST  STREET,  PHILADELPHIA, 
July,  1899. 


PREFACE  TO  THE  NINTH  EDITION. 


IN  preparing  the  ninth  edition  it  has  been  found  necessary  to 
enlarge  the  work  by  forty-five  pages.  Additions  and  alterations 
have  been  made  at  all  points  to  dispose  of  the  new  material  which 
the  rapid  development  of  pharmacology  has  contributed  to  the  sci- 
ence and  art  of  therapeutics.  Much  of  this  matter  consists  of 
accounts,  more  or  less  full,  of  the  synthetical  remedies  which  or- 
ganic chemistry  has  produced  and  is  producing  in  increasing  num- 
bers. For  the  most  part  these  medicaments  are  proprietary,  and 
are  not  therefore  to  be  found  in  the  official  list  of  the  United  States 
Pharmacopoaia.  Receiving  special  designations  often  suggestive  of 
their  mode  of  action,  they  cease  to  be  known  by  the  technical 
nomenclature,  and,  under  patent  protection,  are  the  property  of  the 
manufacturing  chemist.  When,  by  the  substitution  process,  a  rem- 
edy is  evolved  that  seems  likely  to  possess  certain  powers,  it  is 
placed  in  the  hands  of  some  friendly  investigator  to  study  its  physi- 
ological actions,  and  it  is  then  duly  exploited  by  the  manufacturer. 
It  is  undeniable  that  many  important  contributions  have  been  thus 
made  to  practical  medicine ;  but  it  is  equally  true  that  many  have 
not  sustained  the  pretensions  of  their  promoters,  and  have  either 
failed  entirely  of  recognition  or  have  only  in  part  justified  the  ex- 
travagant claims  made  for  them.  The  whole  subject  is  yet  hardly 
hi  a  state  to  select  out  of  the  mass  those  that  time  and  further 
clinical  experience  must  justify.  As  in  nearly  every  instance  these 
remedies  are  derived  from  the  aliphatic  (fatty)  and  aromatic  series 
of  organic  compounds,  it  is  not  surprising  that  there  should  be  in 
respect  to  many  of  them  considerable  similarity  in  the  mode  and 


x  PREFACE   TO   THE  NINTH   EDITION. 

character  of  their  actions.  In  the  absence  of  an  authoritative  tri- 
bunal to  decide  on  the  remedies  for  recognition  and  use,  I  have 
employed  my  own  judgment  in  selecting  those  for  treatment  in 
this  work.  Time  will  determine  the  value  of  those  taken  up  for 
consideration :  some  will  continue  in  favor ;  the  failures  will  be 
eliminated. 

I  must  again  give  expression  to  the  gratitude  I  feel  over  the 
long-continued  success  of  the  work ;  for  the  disappearance  of  suc- 
cessive large  editions  is  the  best  evidence  of  appreciation  by  my 
readers  and  of  approval  by  the  organs  of  professional  opinion. 


ROBERTS  BARTHOLOW,  M.  D. 


1527  LOCUST  STREET,  PHILADELPHIA, 
August,  1896. 


PREFACE  TO  THE  EIGHTH  EDITION. 


THE  decennial  revision  of  the  United  States  Pharmacopoeia 
involves  so  many  changes  in  remedies  and  formulae,  that  a  treatise 
on  Materia  Medica  must  of  necessity  be  newly  edited  to  make  it 
conform  to  the  only  official  standard.  I  have,  accordingly,  revised 
my  work,  have  changed  the  formulae  as  required  by  the  new  Phar- 
macopoeia, and  have  added  to  the  list  of  remedies  many  that  have 
only  recently  appeared.  In  so  doing  I  was  brought  face  to  face 
with  the  important  question  of  admitting  proprietary  medicaments. 
The  Convention  for  the  Revision  of  the  Pharmacopoeia,  at  its  last 
session  in  Washington,  instructed  the  committee  to  whom  the  work 
of  revision  was  intrusted  to  omit  from  the  work  all  proprietary  reme- 
dies or  preparations.  Those  instructions  were  obeyed,  and  only  those 
synthetical  products  not  proprietary  were  given  a  place  in  the  list 
of  remedies.  As  a  member  of  the  Revision  Committee  I  coincided 
in  the  propriety  of  this  action,  and  I  may  seem  inconsistent  now 
that  in  my  treatise  I  have  admitted  many  of  the  remedies  in  ques- 
tion. But  the  functions  and  sphere  of  the  two  works  differ.  The 
Pharmacopoeia  is  an  official  guide  for  pharmacists  and  physicians, 
and  must  therefore  pursue  a  conservative  course  in  admitting  new 
remedies,  and  refuse  its  countenance  to  those  of  proprietary  origin, 
either  secret  or  protected  by  letters  patent.  A  treatise  on  Materia 
Medica  should,  as  a  rule,  be  governed  by  the  same  considerations ; 
but  in  the  case  of  the  new  synthetical  products,  so  important  are 
their  attributes,  so  largely  have  they  come  into  use,  and  so  great  is 
the  demand  for  true  information  regarding  them,  that  a  text-book 
would  be  considered  wanting  in  thoroughness  and  completeness  if 


xii  PREFACE   TO   THE   EIGHTH   EDITION. 

it  contained  no  reference  to  the  more  important  of  them  at  least. 
I  have  therefore  given  an  account,  more  or  less  complete,  of  various 
members  of  the  group.  It  is  the  less  necessary  to  include  all  that 
have  been  proposed  and  used  to  some  extent  in  medical  practice, 
since  not  all  have  proved  useful,  and  many  agree  so  closely  in  their 
actions  that  one  may  be  substituted  for  another  in  the  treatment  of 
the  morbid  states  to  which  they  are  adapted. 

As  the  new  Pharmacopoeia  has  employed  the  metric  system  in 
its  weights  and  measures,  it  becomes  necessary  for  all  systematic 
works  treating  of  the  Materia  Medica  to  follow  its  example.  That 
my  readers  unacquainted  with  the  metric  system  may  have  no  diffi- 
culty, I  have  added  in  a  brief  appendix  a  tabular  statement  of  the 
equivalents  of  weights  and  measures  from  one  Troy  ounce  down, 
for  which  I  am  indebted  to  the  Pharmacopoeia. 

I  venture  the  expression  of  my  belief  that  this  new  edition  will 
prove  still  more  worthy  of  the  remarkable  favor  which  the  work 
has  enjoyed  from  its  first  appearance. 

KOBEBTS  BABTHOLOW,  M.  D. 
1527  LOCUST  STREET,  PHILADELPHIA,  October,  1893. 


PREFACE  TO  THE  FIRST  EDITION. 


To  offer  to  the  medical  profession  a  new  treatise  on  Materia 
Medica  and  Therapeutics  may  appear  to  be  a  labor  of  supereroga- 
tion. The  medical  literature  of  this  country  is  already  well  pro- 
vided with  able  and  elaborate  works  on  this  subject.  The  learned 
and  encyclopedic  volumes  of  Stille,  based  on  the  empirical  method, 
and  the  modern  and  scientific  work  of  H.  C.  Wood,  based  on  the 
physiological  method,  leave  almost  nothing  to  be  desired.  Enter- 
taining such  a  profound  respect  for  the  work  of  my  American 
colleagues,  it  may  well  be  inquired  why  I  have  ventured  to  add  a 
new  book  to  those  already  existing  in  this  department  of  medical 
knowledge.  A  belief,  which  I  trust  will  not  be  regarded  as  ego- 
tism, that  I  have  earned  the  right  to  address  the  medical  profession, 
has  moved  me  to  the  preparation  of  this  work.  Several  years  a 
teacher  of  Materia  Medica  and  Therapeutics,  I  have  necessarily 
formed  opinions  as  to  the  kind  of  information  which  should  be 
contained  in  a  treatise  on  this  subject.  As  far  as  such  a  course  of 
experiment  is  practicable,  I  have  demonstrated  in  my  lectures  the 
actions  of  remedies  on  animals.  I  have  conducted  in  my  private 
laboratory  many  independent  investigations,  and  have  contributed 
in  this  way,  I  submit  with  diffidence,  some  original  knowledge  to 
the  subject  of  therapeutics.  The  information  thus  acquired  has 
been  supplemented  by  twenty-two  years  of  clinical  experience  as 
a  practitioner  of  medicine.  Under  these  circumstances,  I  am  in- 
duced to  believe  that  my  professional  brethren,  and  medical  stu- 
dents, will  hold  that  I  am  entitled  to  a  hearing. 

A  volume  on  Materia  Medica  and  Therapeutics  should,  in  these 
days,  present  some  new  features  of  importance  if  it  would  worthily 
occupy  a  place  alongside  of  the  excellent  works  now  accessible  to 
American  readers.  An  examination  of  this  treatise  will  disclose  the 
fact  that  it  differs  from  other  works  in  its  scheme  of  classification, 


xiv  PREFACE   TO   THE   FIRST   EDITION. 

in  the  subjects  discussed,  and  in  the  very  practical  character  of  the 
information.  In  the  present  state  of  our  knowledge,  it  is  impossible 
to  make  a  classification  free  from  defects,  and  I  do  not  claim  for 
mine  that  it  is  superior  to  others — only  that  its  simplicity  is  a  point 
in  its  favor.  As  respects  the  subjects  treated  of,  it  will  be  seen  that 
the  most  elaborate  section  is  that  on  aliment,  and  that  remedies  have 
been  introduced  not  usually  referred  to  by  therapeutical  writers. 
In  the  treatment  of  individual  agents,  I  have,  usually,  adopted  the 
description  of  the  "  United  States  Pharmacopeia,"  and  have  omitted 
botanical  and  chemical  details,  unless  they  are  necessary  to  elucidate 
physiological  questions,  or  to  facilitate  intelligent  prescription-writ- 
ing. All  pharmaceutical  questions  are  most  thoroughly  handled  in 
the  "  Dispensatory "  of  Wood  and  Bache,  and  this  kind  of  knowl- 
edge is  more  the  province  of  the  druggist  than  of  the  physician. 

In  describing  the  physiological  action  of  drugs,  two  methods 
may  be  pursued :  to  present  in  chronological  order  a  summary  of 
the  opinions  of  various  authorities  on  the  subject  in  question ;  or, 
to  condense  in  a  connected  description  that  view  of  the  subject 
which  seems  to  the  author  most  consonant  with  all  the  facts.  I  have 
adopted  the  latter  plan,  from  a  conviction  of  its  advantages  for  the 
student,  and  of  its  utility  for  the  practitioner.  The  authorities 
which  I  have  utilized  in  making  up  my  opinions  are  placed  at  the 
end  of  each  article,  in  order  to  avoid  interruptions  in  the  methodical 
descriptions. 

As  respects  the  therapeutical  applications  of  remedies,  I  have,  as 
far  as  practicable,  based  them  on  the  physiological  actions.  Many 
empirical  facts  are,  however,  well  founded  in  professional  experience. 
Although  convinced  that  the  most  certain  acquisitions  to  therapeu- 
tical knowledge  must  come  through  the  physiological  method,  I  am 
equally  clear  that  well-established  empirical  facts  should  not  be 
omitted,  even  if  they  are  not  explicable  by  any  of  the  known  physi- 
ological properties  of  the  remedies  under  discussion. 

My  best  acknowledgments  are  due  to  John  Chatto,  Esq.,  the 
learned  Librarian  of  the  Royal  College  of  Surgeons,  London,  for 
numerous  courtesies  extended  to  me  during  my  visits  to  Lincoln's- 
Inn-Fields.  ROBERTS  BABTHOLOW. 

120  WEST  SEVENTH  STREET,  ) 

CINCINNATI,  OHIO,  June,  1876. ) 


TABLE    OF    CONTENTS. 


PAGK 

Schema 1 

PART  I. 

Eoutes  by  which  Medicines  are  introduced  into  the  Organism  .        .        .        .  5 

1.  Through  the  External  Integument 5 

2.  Through  the  Internal  Integument 6 

Insufflation 6 

Inhalations 8 

Atomization 9 

Forms  of  Medicines 11 

Enteroclysis 14 

3.  By  the  Subcutaneous  Areolar  Tissue  .  .        .        .    ,     .        .        .16 

Injection  of  Organic  Liquids    .        .        . 21 

Hypodermatoclysis 23 

Infiltration  Anaesthesia  (Schleich's  Method) 24 

4.  By  the  Veins 25 

Transfusion  of  Blood 27 

Arterial  Transfusion 30 

Transfusion  of  Milk 30 

Peritoneal  Transfusion 31 

PART   II. 

The  Actions  and  Uses  of  Remedial  Agents 33 

Those  used  to  promote  Constructive  Metamorphosis 33 

Aliments 33 

Animal 35 

Vegetable 47 

Special  Plans  of  Diet 51 

Denutrition 51 

Dry  Diet 54 

Vegetable  Diet 55 

Animal  Diet 56 

Milk  Diet 57 

Infant  Feeding 60 

Alimentation  in  Diseases 63 

Aliment  in  Acute  Inflammations  and  Fevers 63 

Formulas  for  Animal  Broths 64 

Formulae  for  Diet  Drinks ...  64 

2  xv 


xvi  TABLE   OF  CONTENTS. 

PAGE 

Aliment  in  Diseases  of  the  Digestive  Organs 65 

Aliment  in  Cachectic  States 66 

Formulae  for  Articles  of  Diet 68 

Artificial  Digestion 69 

Nutrient  Enemata 70 

Supplementary  Rectal  Alimentation 71 

Forced  Alimentation 

Beverages  

Coffee 

Tea 

Cocoa  

Milk 

Water 

Aqua 

Fluvialis 77 

Fontana 77 

Modes  of  applying  Water 79 

Russian  Bath 79 

The  Wet  Pack 80 

The  Douche 81 

The  Hip  or  Sitz  Bath 81 

Hydrotherapy 81 

Heat 90 

Modes  of  applying  Heat 91 

Solar  Heat 91 

Artificial  Heat 91 

Moist  Heat 91 

Dry  Heat 91 

The  Turkish  Bath 92 

Air .93 

Pure  Air 94 

Impure  Air 94 

Effects  of  Compressed  Air 9ft 

Therapy  of  Compressed  Air 97 

Massage 100 

Digestion  Ferments 104 

Pepsin 104 

Ingluvin 104 

Pancreatin 105 

Carica  Papaya 107 

Acidum  Lacticum 110 

Mineral  Acids 112 

Oils  and  Fats 121 

Phosphorus  and  some  of  its  Compounds 128 

Phosphites  and  Phosphates 137 

Iron  and  its  Preparations 141 

Ferratin 153 

Hasmol 154 

Hsemogalol 154 

Manganum — Manganese 154 

Potassium  Permanganate 155 

Chalybeate  Mineral  Springs 159 


TABLE   OF   CONTENTS. 

MM 

Bismuth 161 

Dermatol 164 

Arsenic 165 

The  Simple  Bitters 178 

Aromatic  Bitters 182 

Oleum  Erigerontis 183 

Eucalyptus 185 

Hydrastis 188 

Cinchona  and  its  Preparations 191 

Agents  promoting  Destructive  Metamorphosis  or  increasing  Waste .        .        .  211 

Alkalies 211 

Potassium  and  its  Preparations 211 

Sodium  and  its  Preparations 219 

Calcium  and  its  Preparations 221 

Lithium  and  its  Preparations 223 

Alkaline  Mineral  Springs .  227 

Saline  Mineral  Springs 230 

Ammonia  and  its  Preparations 234 

Barium  and  its  Preparations 240 

Vegetable  Acids 243 

Oxalic  Acid 245 

Sulphurous  Acid  and  the  Sulphites 246 

Sulphur  and  Sulphides  (Sulphurets) 248 

Sulphurous  Mineral  Waters 250 

Iodine  and  its  Preparations 253 

lodic  Acid 265 

Ether  Hydriodicus 266 

lodoform 267 

lodol 273 

Loretin 275 

Xosophen 276 

Europhen 276 

Sozoiodol 277 

Aristol        .                         277 

Airol 278 

Mercury  and  its  Preparations 278 

Aurum  (Gold)  and  its  Preparations 296 

Argentum  (Silver)  and  its  Preparations 298 

Cuprum  (Copper)  and  its  Preparations 306 

Plumbum  (Lead)  and  its  Preparations 310 

Zincum  (Zinc)  and  its  Preparations 316 

Antimonium  (Antimony)  and  its  Preparations 321 

Cadmium  Sulphate 325 

Strontium  and  its  Preparations 326 

Cerium  Oxalate 328 

Uranium  and  its  Salts 329 

Metallotherapy 331 

Alumen  (Alum)  and  its  Preparations 334 

Alumnol 338 

Boral,  Cutol,  Cutolum  Solubile 338 

Acidum  Tannicum 339 

Acidum  Gallicum       ....                                                          .  339 
B 


xyiii  TABLE   OF   CONTENTS. 

PAGE 

Galla  (Nutgall) 339 

Catechu      .        .        . .        .339 

Kino 340 

Krameria  (Rhatany) 340 

Haematoxylon  (Logwood) 340 

Geranium  (Cranesbill) 340 

Quercus  Alba  (White  Oak) 340 

Quercus  Tinctoria  (Black  Oak) 340 

Eosa  Gallica  (Red  Rose) 341 

Rubus  (Blackberry) 341 

Myrica  Cerifera  (Bayberry) 341 

Alnus  Serrulata  (Alder) 341 

Statice  Limonium  (Marsh  Rosemary) 341 

Heuchera  (Alum-Root) 341 

Hamamelis  Virginica  (Witch-Hazel) 341 

Nymphaea  Odorata 342 

Castanea  Vesca 342 

Pyrogallol 347 

Tannigen 349 

Ichthyol 349 

Colchicum  and  its  Preparations 351 

Sarsaparilla  and  its  Preparations 354 

Guaiacum  and  its  Preparations 356 

Stillingia  and  its  Preparations  .        .  • 357 

Sanguinaria  (Blood-Root) 359 

Xanthoxylum 362 

Fraxinus  Americana 363 

Viburnum  Opulus 364 

Prunifolium 364 

Remedies  used  to  destroy  Microbes,  or  Morbific  Germs,  and  to  prevent  or  ar- 
rest Septic  Processes  (Antiseptics  or  Germicides) 365 

Antiseptics 365 

Oxygen 366 

Ozone 368 

Chlorine 369 

Bromine 371 

Gaseous  Enemata  and  Inhalations 372 

Carbolic  Acid 375 

Creosote 387 

Guaiacol 387 

Benzoyl-Guaiacol 388 

Benzosol 388 

Benzoate  of  Guaiacol 388 

Creosotal .  388 

Phenosalyl 388 

Sulphocarbolates 389 

Salix .389 

Salicin 389 

Salicylic  Acid 390 

Resorcin 401 

Phenoresorcin 404 

Hydroquinon  and  Pyrocatechin 404,  405 


TABLE   OF   CONTENTS. 


XIX 


PAGE 

Kairin  and  Kairolin 404,  405 

Chinolin 404,  405 

Thaliin 406 

Creolin 407 

Salol 407 

Antipyrin 410 

Exanthem 413 

Methylene  Blue 413 

Naphtalin 415 

Naphtol 416 

Beta-Naphtol 416 

Asaprol 416 

Pyridine 417 

Phenacetin 418 

Saccharin 418 

Boric  Acid 419 

Benzoin 421 

Benzoates 421 

Acetanilid 424 

Exalgin 427 

Antiseptic  Oils 427 

Gaultheria 427 

Thyme 427 

Cajeput 427 

Thymol 428 

Thymacetin 429 

Myrtol 429 

Menthol 430 

Teucrin 431 

Animal  Extracts 432 

Ptomaines  and  Leucomaines 432 

Toxins  and  Antitoxins 436 

Orchitic  or  Testicular  Extract 433 

Spermine 433 

Renal  Extract 434 

Thyroid  Extract 434 

Pancreatic  Extract 436 

Bone  Marrow 436 

Immunity 437 

Agents  used  to  modify  the  Functions  of  Organs 439 

A.    Of  the  Nervous  System 439 

Those  exciting  the  Functional  Activity  of  the  Spinal  Cord  and  Sympa- 
thetic    "...  440 

Electricity 440 

Static  Electricity 440 

Magnetism 442 

Galvanism 443 

Faradism 450 

Storage  Cells,  Accumulators,  etc.  . 453 

Public  Supply  of  Electricity 454 

Galvano-Faradization 454 

Electric  Baths    .  .  455 


XX 


TABLE   OF   CONTENTS. 


PAGE 

Electro-Physiology 455 

Electro-Diagnosis 459 

Therapy 462 

Electrolysis 471 

Cataphoresis 472 

Galvano-Cautery 473 

Static  Electricity 474 

Trouve's  Polyscope 474 

Nux  Vomica  and  its  Preparations 475 

Strychnine 476 

Ignatia 488 

Cocculus 488 

Picrotoxin 489 

Ergota  (Ergot)  and  its  Preparations 492 

Ustilago  Maydis  (Corn  Ergot) 505 

Digitalis  and  its  Preparations 506 

Convallaria 514 

Strophanthus 517 

Sparteine 518 

Adonidin 519 

Cimicifuga  and  its  Preparations 520 

Belladonna  and  its  Preparations 523 

Atropine 523 

Homatropine 534 

Stramonium  and  its  Preparations 535 

Hyoscyamus  and  its  Preparations 536 

Hyoscine 536,  539 

Duboisia 541 

Scopolamine 543 

B.  Agents  exciting  the  Functional  Activity  of  the  Cerebrum    .        .        .  544 

Camphor  and  its  Preparations 545 

Camphoric  Acid 548 

Asafcetida  and  its  Preparations 549 

Ammoniacum  and  its  Preparations 552 

Valerian  and  its  Preparations 552 

Cannabis  Indica 554 

Coca 557 

Combinations  of  Cocaine 562,  563 

Caffeine 564 

Ethoxy-Caffeine 564 

Guarana 566 

Theobromine 567 

Duretin 567 

Remedies  which  diminish  or  suspend  the  Functions  of  the  Cerebrum  after  a 

Preliminary  Stage  of  Excitement 568 

Alcohol 568 

Vinum  (Wine) 578 

Beer,  Ale,  and  Porter 583 

Extract  of  Malt 584 

Paraldehyde 584 

Methylal 585 

Chloride  of  Methyl 586 


TABLE  OF  CONTENTS.  xxi 

MOD 

Urethan 586 

Phenyl-urethan 588 

Chloral-urethan 588 

Ethyl-chloral-urethan 588 

Acetyl-hydroxy-phenyl-urethan 588 

Hypnone 590 

Hypnal       .        .     •  .     ' 590 

Ether         .        .     •  »                .        .     • 591 

Chloroform 595 

Chlorodyne 598 

Anaesthetics  and  Anaesthesia 599 

Ether  and  Chloroform 599 

Ethyl  Bromide 608 

Bichloride  of  Methylene 609 

Local  Anaesthesia 610 

Nitrous  Oxide 611 

Chloral 613 

Croton  Chloral  Hydrate 619 

Chloralmide 620 

Sulphonal 621 

Somnal       .        ." 621 

Chloralose • 622 

Trional  and  Tetronal 622 

Amylen  Hydrate        .        .        .        .        .-...        .        .        .  622 

Opium  and  its  Preparations 624 

Morphine  and  its  Salts •    .        .        .        .  626 

Codeine .        .    •   .        .        .        .632 

Narcotine 633 

Cotarnine 633 

Narceine 634 

Cryptopine 634 

Humulus  (Hops) 646 

Lupuline 646 

Lactucarium 647 

Bromides 647 

Bromoform 658 

Bromal 661 

Bromal  Hydrate 661 

BromaJin 661 

Bromamide 661 

Formanilide 661 

Agents  which  depress  the  Motor  Functions  of  the  Spinal  Cord  and  Sympa- 
thetic    662 

Conium  and  its  Preparations 662 

Conine  and  Morphine 666 

Curara  or  Woorara 667 

Curarine 667 

Gelsemium  and  its  Preparations 671 

Arnica  and  its  Preparations 676 

Trimethylamine 677 

Pilocarpus 679 

Physostigma  and  its  Preparations 686 


xxii  TABLE   OF   CONTEiNTS. 

PAGH 

Tabacuru  (Tobacco)  and  its  Preparations 692 

Lobelia  and  its  Preparations 696 

Acidum  Hydrocyanicum 698 

Potassii  Cyanidum 702 

Amyl  Nitrite 704 

Nitro-glycerin 707 

Aconite  and  its  Preparations 711 

Veratrum  Viride  and  its  Preparations 716 

Pulsatilla  and  its  Preparations .  721 

Grindelia  and  its  Preparations 722 

Phytolacca  and  its  Preparations 724 

Ailanthus 725 

Agaricin 726 

Muscarine 726 

Quebracho 730 

Remedies  used  to  modify  the  Functions  of  Organs  (continued)         .        .        .  783 

B.  Of  the  Gastro-intestinal  Canal 73& 

Emetics 733 

Emetics  by  Local  Action 733 

Systemic  Emetics 735 

Apomorphine 735 

Apocodeine 735 

Ipecacuanha  and  its  Preparations 737 

Tartar  Emetic 74& 

Cathartics 744 

Laxatives 744 

Manna 744 

Sulphur 745 

Pulvis  Glycyrrhizas  Compositus 745 

Magnesia 745 

FelBovis 746 

"      Purif 747 

"        "      Inspissatum .        .        .  747 

Cascara 747 

Oleum  Ricini 747 

Saline  Purgatives 749 

Sulphate  of  Magnesia 749 

Mercurial  Purgatives 752 

Calomel 752 

Massa  Hydrargyri 752 

Tonic- Astringent  and  Resin-bearing  Purgatives 75& 

Senna  and  its  Preparations 753 

Rheum  and  its  Preparations 754 

Aloes  and  its  Preparations 756 

Jalap  and  its  Preparations 759 

Scammony  and  its  Resin 760 

Colocynth  and  its  Preparations 760 

Podophyllum  and  its  Preparations 761 

Leptandra 762 

Iris . .        .        .763 

Euonymus 763 

Baptisia 764 


TABLE  OF  CONTENTS.  xxiii 

PAGE 

Hydragogue  Cathartics 764 

Gamboge -     .        .        .  764 

Croton-Oil .  765 

Elaterium 767 

Elaterin 767 

Enemata 768 

Anthelmintics 770 

For  Ascarides 771 

Mucuna 771 

Santonica 771 

Santonin 771 

Spigelia  and  its  Preparations 773 

Chenopodium 773 

Oleum  Chenopodii 773 

For  Taeniae 774 

Filix-Mas  (Male  Fern) 774 

Oleo-resina  Filicis 774 

Granati  Fructus  Cortex 774 

Brayera 775 

Camala 775 

Pepo  (Pumpkin-Seeds) 775 

Urino-Gen'tal  Remedies 776 

Terebinthina 776 

Oleum  Terebinthinae 776 

Terebinthine 782 

Terpine 782 

Terpin  hydrate 781 

Terpinol 781 

Terebene 782 

Copaiba  and  its  Preparations 783 

Cubeb  and  its  Preparations 785 

Piper 786 

Oleo-resina  Piperis 786 

Capsicum  and  its  Preparations .        .        .  787 

Juniper  and  its  Preparations 788 

Fix  Liquida 789 

Balsam  of  Tolu 789 

Buchu  and  its  Preparations 790 

Uva  Ursi  and  its  Preparations 790 

Pareira  and  its  Preparations 790 

Chimaphila  and  its  Preparations 790 

Scoparius 790 

Carota 791 

Taraxacum  and  its  Preparations 791 

Scilla  and  its  Preparations 792 

Petroselinum 794 

Polygonum  Hydropiperoides 795 

Euta 795 

Sabina 796 

Cantharis  .                                                                               ....  797 


2* 


XXIV 


TABLE   OF   CONTENTS. 


PART  III. 

PAGE 

Topical  Remedies 801 

Theory  of  Counter-Irritation 801 

Counter-irritants 803 

Rubefacients 803 

Sinapis  Alba 803 

Sinapis  Nigra 803 

Charta  Sinapis 803 

Emplastra 804 

Linimenta 804 

Epispastics 805 

Ceratum  Cantharidis 805 

Ceratura  Extracti  Cantharidis 805 

Charta  Cantharidis 805 

Collodium  cum  Cantharide 805 

Linimentum  Cantharidis 805 

Acupuncture 808 

Baunseheidtismus 808 

Aquapuncture 809 

Jequirety 810 

Bloodletting 812 

Escharotics 815 

Acidum  Chromicum 815 

Emollients,  Protectives,  and  Demulcents 816 

Glycerin  and  its  Preparations 816 

Collodium 818 

Liquor  Gutta-Perchae 818 

Chondrus  (Irish  Moss) 819 

Cetraria  (Iceland  Moss) 819 

Acacia  and  its  Preparations 830 

Tragacanth 820 

Mucilago  Tragacanthae 820 

Sassafras  Medullas 820 

Mucilago  Sassafras  Medullse 820 

Linum  (Flaxseed)  and  its  Preparations 820 

Ulmus  (Slippery  Elm) 820 

Mucilago  Ulma 820 

Glycyrrhiza  and  its  Preparations 821 

Poultices 821 

Appendix — Equivalents  of  Weights  and  Measures 823 


ADDENDA. 

Chloretone 623 

Dormiol 624 

Roentgen  or  X-Rays 474 

Yohimbin  ,732 


A    TEEATISE 


ON 


MATERIA  MEDICA  AND  THERAPEUTICS. 


SCHEMA. 

PART  I. — Modes  in  which  Medicines  are  introduced  into  the  Or- 
ganism. 

PART  II. —  The  Actions  and  Uses  of  Remedial  Agents. 
I.  SYSTEMIC  REMEDIES  : 

1.  Those  used  to  promote  the  constructive  tissue  metamorphosis 
(Tonics). 

2.  Those  used  to  increase  the  retrograde  tissue   metamorphosis 
(Alteratives). 

3.  Those  used  to  destroy  micro-organisms  or  morbific  germs,  and 
to  prevent  or  arrest  septic  processes  (Antiseptics). 

4.  Those  used  to  modify  the  functions  of  organs  : 
A.  Of  the  Nervous  System : 

Increasing  Action, 
Diminishing  Action. 
£.  Of  the  Gastro-Intestinal  Canal : 
Emetics, 
Cathartics, 
Anthelmintics. 

C.  Of  the  Genito-Urinary  Organs : 
Diuretics, 

Eramenagogues,  etc. 
II.  TOPICAL  REMEDIES  : 
Rubefacients, 
Epispastics, 
Escharotics,  etc. 


2  SCHEMA. 

In  this  scheme  the  medicament  is  followed  from  its  introduction 
into  the  stomach  to  its  elimination  by  the  organs  of  excretion.  One 
group  of  remedies  is  used  for  an  action  on  the  primary  assimilation — 
to  promote  digestion  and  absorption — the  first  step  in  the  great  pro- 
cess of  blood-making.  Of  this  kind  are  pepsin,  the  bitters,  but,  above 
all,  foods. 

Some  remedies  are  employed  both  to  increase  the  activity  of  the 
primary  assimilation  and  the  utilization  of  materials  in  the  construc- 
tion of  tissues  ;  others,  to  hasten  the  retrograde  metamorphosis,  or  the 
processes  of  waste  and  excretion.  The  action  of  iron  furnishes  a  typi- 
cal example  of  the  one,  and  mercury  of  the  other  mode  of  influencing 
the  function  of  assimilation. 

An  important  group  of  remedial  agents  is  constituted  of  those 
having  the  power  to  act  on — to  inhibit  or  destroy — pathogenic  organ- 
isms, and  to  prevent  or  arrest  septic  processes.  As  these  remedies 
are  also  antipyretic,  there  is  supposed  to  be  a  relation  between  this 
attribute  and  the  germ-destroying  and  antiseptic  powers.  As  sub- 
stances having  the  chemical  reactions  and  toxic  activity  of  alkaloids, 
and  known  as  ptomaines,  are  produced  by  septic  decomposition  in 
the  intestinal  canal  under  certain  conditions,  and  as  similar  agents 
are  developed  in  the  organism  in  the  course  of  infectious  diseases, 
remedies  possessed  of  such  powers  must  necessarily  occupy  an  impor- 
tant place  in  therapeutics. 

Besides  the  foregoing,  there  are  several  groups  of  remedial  agents, 
that  are  used  not  to  affect  metamorphosis  of  tissue  in  any  manner, 
but  to  modify  the  functions  of  organs.  As  the  most  influential  and 
widely  connected  are  the  functions  of  the  nervous  system,  the  reme- 
dies affecting  them  are  appropriately  considered  first.  They  may  be 
conveniently  grouped  in  two  classes  :  those  that  exalt,  those  that  de- 
press function — as  excito-motor,  depresso-motor.  Of  these,  strych- 
nine is  a  type  of  the  former,  conium  of  the  latter. 

Other  functions  are  affected  by  remedies  in  several  modes  :  by 
coming  in  contact  with  the  anatomical  elements  of  organs  engaged 
in  their  elimination,  or  being  so  irritant  as  to  excite  action  for 
their  expulsion.  The  diuretics,  for  the  most  part,  illustrate  the  for- 
mer mode  of  action,  and  some  emetics  and  purgatives  the  latter. 
The  actions  cease  with  the  expulsion  or  elimination  of  the  offending 
matters. 

Remedies  that  are  truly  topical  should  make  a  local  impression 


SCHEMA.  3 

only,  but  it  is  probable  that  no  action  can  be  confined  to  the  part 
acted  on.  Absorption  is  not  necessary  to,  and  indeed  hinders,  the 
local  effect  ;  hence  the  systemic  impression  made  by  them  is  accom- 
plished through  the  agency  of  the  nervous  system.  Some  of  the  most 
important  of  their  therapeutical  effects  are  due  to  the  influence  of  the 
peripheral  excitation  on  the  nervous  centers  in  anatomical  connection 
with  the  part  irritated.  A  superficial  neuritis  may  excite  extensive 
secondary  lesions  in  the  spinal  cord.  The  vaso  -  motor  and  trophic 
systems  are  peculiarly  impressionable  to  peripheric  irritation,  and 
hence,  through  the  intermediation  of  this  nervous  apparatus,  impor- 
tant changes  may  be  wrought  by  slight  counter-irritation. 


PART    I. 

R  0  UTES  B  Y  WHICH  MEDICINES  ARE  INTR  OD  UCED 
INTO   THE  ORGANISM. 


I. 

THROUGH  THE  EXTERNAL  INTEGUMENT. 

BY  this  tissue  medicines  are  applied  in  the  following  modes  : 

Enepidermatic. 

Epidermatic. 

Endermatic. 

ENEPIDERMATIC. — In  this  method,  the  medicament  is  placed  in 
contact,  only,  with  the  epidermis,  and  friction,  to  hasten  absorption,  is 
not  employed.  Although  the  epidermis  opposes  a  strong  obstacle  to 
absorption,  it  does  not  entirely  prevent  diffusion  into  the  blood,  as 
numerous  facts  show.  The  skin  may  be  considered  a  colloidal  sep- 
tum. The  rate  and  degree  of  absorption  of  any  medicine  will  depend, 
in  large  part,  on  its  power  of  diffusion.  Various  circumstances  influ- 
ence this — for  example,  the  chemical  position  of  the  agent  to  be  dif- 
fused. On  one  side  of  the  colloidal  septum — the  skin — lie  the  blood- 
vessels, containing  an  alkaline  fluid.  An  acid  fluid  on  one  side  of  the 
dialysing  membrane,  and  an  alkaline  fluid  on  the  other,  are  conditions 
most  favorable  to  diffusion.  Experiments  are  wanting  on  this  point, 
but  it  is  a  reasonable  presumption  that  solutions  of  medicinal  sub- 
stances, acid  in  reaction,  will  find  their  way  most  readily  into  the 
blood. 

Besides  the  epidermis,  the  sebaceous  matter  of  the  skin  offers  more 
or  less  positive  obstruction  to  cutaneous  absorption.  Medicinal  sub- 
stances in  solution  in  water,  therefore,  very  slowly  permeate  the  skin 
to  enter  the  vessels.  Waller,  who  has  made  very  careful  experiments, 
has  ascertained  that  alkaloids  dissolved  in  chloroform  are  readily  trans- 
ferred through  the  skin  into  the  blood,  and  produce  characteristic  phe- 
nomena, while  "  alcoholic  and  aqueous  solutions  are  either  not  at  all,  or 
very  slowly,  absorbed." 


6  HOW   MEDICINES   ARE   INTRODUCED. 

His  observations  were  made  with  chloroformic  solutions  of  aconi- 
tine,  atropine,  strychnine,  and  morphine.  Waller  further  ascertained 
that  alcohol  mixed  with  chloroform  did  not  retard  absorption,  but  al- 
cohol alone  caused  an  outward  osmotic  flow.  It  follows  from  these 
facts  that,  if,  in  the  application  of  a  medicinal  agent  to  the  skin  by 
the  enepidermatic  method,  the  object  be  to  promote  absorption,  the 
remedy  should  be  dissolved  in  chloroform,  or  in  a  mixture  of  alcohol 
and  chloroform,  and  not  in  alcohol  alone,  or  in  water. 

EPIDERMATIC. — This  method  differs  from  the  enepidermatic  in  that 
friction  is  employed  to  promote  absorption  by  forcing  the  medicament 
between  the  cells  of  the  epidermatic  layer.  Many  agents  are  used  in 
this  way,  as  mercurial  ointment  in  syphilis,  cod-liver  oil,  and  other 
fats,  in  wasting  diseases,  and  ointments  of  various  kinds  for  the  relief 
of  local  lesions,  etc.  The  evidence  is  conclusive  that  by  this  mode 
systemic  effects  are  produced. 

ENDERMATIC. — As  the  epidermis  is  the  chief  obstacle  to  cutaneoua 
absorption,  it  is  sometimes  removed  by  blistering,  so  that  the  medica- 
ment may  come  into  immediate  contact  with  the  derma.  The  mode 
of  proceeding  by  the  endermatic  method  is  as  follows  :  a  piece  of  flan- 
nel, patent  lint,  or  cotton  cloth,  is  moistened  with  aqua  ammonice,  and 
when  placed  on  the  skin  is  covered  with  oiled  silk  to  prevent  evapora- 
tion. When  the  blister  is  raised,  the  epidermis  is  removed  with  scis- 
sors. A  less  painful,  but  slower  method,  is  the  application  of  a  can- 
tharides-plaster,  followed  by  a  poultice  to  raise  the  blister.  The 
medicinal  agent,  in  a  finely-powdered  state,  is  sprinkled  over  the  raw 
surface,  and  is  rapidly  absorbed.  Morphine,  atropine,  strychnine,  and 
quinine,  are  the  most  important  agents  used  in  this  way. 

The  endermatic  method  is  a  useful  resource  to  the  therapeutist, 
but  the  opinion  of  Brown-Sequard  is  hardly  admissible,  that  the  exten- 
sive use  of  the  hypodermatic  method  has  caused  the  endermatic  to  be 
unwisely  neglected.  There  are  decided  objections  to  the  endermatic 
method  :  it  is  painful  ;  absorption  is  somewhat  uncertain  ;  ulceration 
of  an  intractable  character  may  occur.  It  has  these  advantages  in  its 
favor  :  it  may  be  used  in  cases  of  irritable  stomach  ;  it  may  be  con- 
joined with  counter-irritation  ;  it  is  sometimes  quite  effective. 

n. 

THROUGH  THE  INTERNAL  INTEGUMENT. 

APPLICATIONS  TO  THE  BRONCHO-PULMONARY  Mucous  MEM- 
BRANE.— By  the  method  of  INSUFFLATION  solid  medicinal  agents  in 
a  finely-divided  state  are  applied  to  various  parts  of  the  respiratory 
tract.  Insufflation-tubes  with  a  rubber  air-bag  attached  are  now 
found  at  the  instrument-makers.  The  powder,  contained  in  a  chamber 
intended  for  its  reception,  is  forced  by  the  compression  of  the  air-bag 


BY   THE   BRONCHO-PULMOXARY   MUCOUS   MEMBRAXE.  7 

through  the  straight  or  curved  delivery-tube  of  the  instrument.  Pow- 
ders may  be  projected  by  such  an  apparatus  into  fauces,  larynx,  and 
anterior  and  posterior  nares.  In  the  absence  of  an  insufflator,  a  sim- 
ple glass  tube  or  goose-quill  may  be  used  for  the  purpose — the  powder 
being  blown  in  by  the  operator,  or  drawn  in  by  a  forcible  inspiration 
by  the  patient. 

The  method  of  insufflation  is  a  useful  mode  of  making  local  appli- 
cations to  the  nares,  fauces,  epiglottis,  and  the  aryteno-epiglottidean 
folds,  but  it  is  of  little  utility  as  a  means  of  reaching  the  larynx  and 
trachea,  for,  as  is  well  known,  the  glottis  is  exceedingly  intolerant  of 
foreign  bodies  whether  solid  or  gaseous.  By  this  method  we  can  use 
tannin,  the  zinc  salts,  nitrate  of  silver,  alum,  morphine,  etc.  Any 
remedy  thus  applied  should  be  in  small  quantity,  should  be  minutely 
subdivided  and  mixed  with  some  unirritating,  impalpable  powder,  so 
as  to  insure  uniform  distribution  over  the  surface  to  be  acted  upon. 

The  nasal  douche  is  a  mode  of  applying  remedies  to  the  nasal  pas- 
sages now  much  practiced.  This  consists  of  a  bottle  or  funnel-shaped 
reservoir  to  contain  the  medicated  fluid,  and  a  flexible  rubber  tube  to 
which  is  attached  a  hard-rubber  or  glass  nose-piece.  The  reservoir  be- 
ing placed  on  a  higher  level  than  the  head,  the  nose-piece  adjusted 
and  the  mouth  being  kept  open,  the  fluid  is  permitted  to  flow.  As  when 
the  mouth  is  open,  the  patient  breathing  quietly,  the  palate  applies 
itself  closely  to  the  posterior  wall  of  the  pharynx,  it  is  obvious  that  the 
fluid  will  be  conducted  from  the  one  to  the  other  nostril  and  thus  make 
its  exit.  Not  every  patient  can  succeed  perfectly  in  the  performance 
of  this  feat.  In  some  persons,  even  when  breathing  quietly  through 
the  open  mouth,  the  veil  of  the  palate  does  not  apply  itself  perfectly 
to  the  posterior  fauces  and  the  fluid  flows  into  the  oasophagus.  Other 
persons  can  not  refrain  from  attempts  at  swallowing  when  the  fluid 
reaches  the  posterior  nares.  It  happens  not  infrequently  that  the 
fluid,  or  the  insufflation  powder,  gets  into  the  Eustachian  tube  and 
middle  ear,  so  that  pain  and  inflammation  follow  with  impaired  hear- 
ing, and  sometimes  cause  destructive  inflammation  and  suppuration. 
If  pain  in  the  ears  follows  its  use,  it  is  quite  certain  that  mischief 
will  result  if  the  douche  be  persisted  in.  The  following  rules  should 
be  adhered  to  in  making  applications  by  this  method  : 

The  fluid  used  must  be  tepid. 

The  first  applications  must  be  bland  and  unirritating. 

The  applications,  if  strong  enough  to  excite  irritation,  must  not  be 
used  frequently. 

Under  the  most  favorable  circumstances  this  mode  of  treating  dis- 
eases of  the  nasal  passages  has  very  limited  utility,  for  the  fluid 
reaches  but  a  part  of  the  Schneiderian  mucous  membrane.  It  is  a 
useful  means  for  cleansing  the  nares,  and  for  applying  deodorizing 
agents  to  correct  fetor.  Chlorides  of  sodium,  potassium,  and  am- 


8  HOW   MEDICINES  ARE   INTRODUCED. 

monium,  permanganate  of  potassa,  carbolic  acid,  iodine,  and  many 
other  agents  of  the  same  kind,  are  applied  by  means  of  the  nasal 
douche. 

An  ordinary  Davidson's  syringe,  made  to  act  as  a  siphon,  may  be 
used  in  the  same  way  as  the  Weber's  or  Thudichum's  nasal  douche. 
The  mode  of  proceeding  with  this  instrument  is  as  follows  :  the  vessel 
containing  the  medicated  fluid  is  placed  on  a  higher  level  than  the 
patient's  head  ;  the  syringe  is  filled  by  compressing  the  bulb  to  expel 
the  air,  and  then  inserting  the  suction-pipe  in  the  fluid  ;  the  nozzle  of 
the  delivery-pipe  is  put  into  the  nose,  when  a  steady  stream  will  dis- 
charge into  the  nostril  and  escape  by  the  other. 

INHALATIONS. — Vapors  of  medicinal  substances,  and  gases,  are  con- 
ducted with  the  air  into  the  bronchial  tubes  and  the  air-sacs.  Vapor 
of  creosote,  carbolic  acid,  iodine,  ethyl  iodide,  iodoform,  bromine,  etc., 
are  thus  employed  with  excellent  effect.  Those  that  require  heat  to 
be  vaporized  can  be  put  in  a  warm  vial  or  bottle,  and  the  vapor  then 
conducted  to  the  nose  or  mouth  by  a  cone  of  stiff  paper,  the  base  of 
the  cone  being  large  enough  to  cover  the  vessel  in  which  the  vapor 
is  forming.  Of  the  compounds  of  iodine,  the  most  convenient  and 
effective  for  inhalation  is  ethyl  iodide.  It  requires  no  special  con- 
trivance, and  does  not  have  an  anaesthetic  effect  that  will  narcotize. 
The  warmth  of  the  hand  is  sufficient  to  vaporize  it,  and  hence  it  may 
be  inspired  from  the  vessel  containing  it.  A  few  drops  (ten  to  thirty) 
may  be  put  on  a  folded  napkin  or  handkerchief  and  inhaled,  or  the 
same  quantity  can  be  dropped  in  a  vial  previously  warmed,  and  im- 
mediately inhaled.  Ethyl-iodide  vapor  can  be  readily  mixed  with  a 
proper  proportion  of  nitrous  oxide,  or  combined  with  the  vapor  of 
iodine,  iodoform,  creosote,  carbolic  acid,  and  with  other  antiseptics. 
Whatever  difficulties  are  encountered  are  merely  mechanical.  In  a 
recent  issue  of  the  "JEsclepiad"  (1886),  Dr.  B.  W.  Richardson,  of 
London,  calls  attention  to  the  remarkable  powers  of  ozonic  ether  as 
a  remedy  in  pulmonary  diseases — a  recommendation  which  he  holds 
is  the  most  valuable  he  has  ever  contributed  to  practical  medicine. 
His  mode  of  procedure  is  described  in  the  article  referred  to,  and  an 
abstract  may  be  found  in  the  "  New  York  Medical  Journal  "  of 
March  13,  1887. 

Pyridin  vapor  has  been  brought  out  by  Professor  Se"e,  as  an  in- 
halant of  remarkable  efficacy  in  asthma  and  other  neuroses  of  the 
respiratory  apparatus.  The  air  of  an  apartment  of  suitable  size  can 
be  made  by  diffusion  to  contain  a  proper  amount  of  pyridin  vapor. 
As  persons  vary  in  susceptibility  to  the  action  of  such  a  vapor,  the 
necessary  quantity  must  be  ascertained  by  trial.  Various  permanent 
gases  are  now  used  by  inhalation,  in  diseases  of  the  respiratory  mucous 
tract.  An  improvement  warmly  received,  yet  already  waning,  is  the 
rectal  injection  of  sulph-hydric  and  carbonic-acid  gases.  Bernard 


ATOMIZATION   OR  PULVERIZATION.  9 

having  shown,  experimentally,  that  these  gases  when  introduced 
into  the  rectum,  escaped  by  the  lungs  without  penetrating  to  the 
nervous  centres,  Bergeon,  of  Lyons,  utilized  this  fact,  and  in  this 
way  proposed  to  act  on  the  bacilli  of  tuberculosis  of  the  lungs. 
The  method  was  received  with  extraordinary  favor,  and  in  a  few 
weeks  was  employed  in  all  parts  of  the  world.  It  was  presently  as- 
certained, however,  that  the  bacilli  were  not  destroyed,  and  the  bene- 
fits derived  did  not  compensate  for  the  disagreeable  incidents  of  the 
injections. 

The  suggestion  of  Dupont  that  the  inhalation  of  the  carbonic-acid 
gas  should  take  the  place  of  the  rectal  injection  of  the  gases,  and  the 
growing  belief  in  the  superiority  of  inhalations,  have  quite  occupied 
the  field,  and  hence  the  rectal  injections  are  no  longer  practiced. 
Prolonged  inhalation  of  volatile  materials  is  a  mode  rapidly  growing 
in  favor,  and  is  supplanting  douches,  insufflation,  and  other  kinds 
of  topical  applications.  As  air  is  a  natural  vehicle  for  access  to  the 
lungs,  and  as  gases  and  volatile  substances  can  pass  into  the  air-sacs 
by  means  of  it,  the  method  of  introducing  medicaments  by  respiration 
is  naturally  superior  to  the  various  mechanical  contrivances.  Volatile 
medicines  capable  of  diffusion  through  the  air,  and  gases,  may  be  thus 
used  with  success.  The  most  powerful  of  these  preparations  is  the 
liquid  of  the  French  chemist,  Pictet.  The  sulphurous  and  carbonic- 
acid  gases  are  liquefied  by  pressure  and  stored  up  in  siphon  bottles, 
from  which  they  are  readily  obtained  by  a  mere  touch  on  the  valve. 
It  is  obvious  that  such  an  arrangement  is  highly  convenient,  but  the 
power  for  mischief  must  not  be  overlooked  in  estimating  the  curative 
value. 

Atomization  or  Pulverization. — Air  or  steam  is  the  motive  power 
in  the  various  forms  of  apparatus  used  for  reducing  solutions  of  me- 
dicinal agents  into  spray.  Of  those  now  in  use,  the  hand-ball  ap- 
paratus for  air,  and  Siegel's  apparatus  for  steam,  are  the  principal. 
Whether  air  or  steam  be  used  for  pulverizing  the  medicated  fluid,  the 
essential  parts  of  an  atomizing  apparatus  consist  of  a  cup  for  contain- 
ing the  solution  to  be  pulverized,  a  vertical  tube  terminating  in  a  fine 
capillary  extremity  and  dipping  into  the  medicine-cup,  and  a  tube 
communicating  with  the  steam-boiler  or  air-bulb,  and  placed  at  right 
angles  to  the  vertical  tube.  When  air  or  steam  is  forced  through  the 
horizontal  tube,  over  the  capillary  orifice  of  the  vertical  tube,  the  air 
in  the  latter  is  rarefied  and  the  fluid  rises  into  it,  until,  reaching  the 
top  of  the  tube,  it  is  broken  up  into  fine  spray  by  the  impact  of  the 
horizontal  column  of  air.  It  is  obvious  that,  provided  with  suitable 
tubes,  spray  may  be  applied  to  the  nares,  anterior  and  posterior,  to 
the  pharynx,  epiglottis,  and  larynx.  The  utility  of  applications  made 
in  this  way  to  these  parts  is  now  conclusively  established.  Although 
it  has  been  a  question  whether  any  quantity  of  medicated  spray  passes 


10  HOW   MEDICINES   ARE   INTRODUCED. 

the  chink  of  the  glottis,  it  has  been  proved  experimentally  that  a  mi- 
nute quantity  does  actually  enter  the  trachea.  The  efficacy  of  inhala- 
tions of  subsulphate  of  iron  in  pulmonary  haemorrhage  is  a  clinical  fact 
confirmatory  of  the  experimental  demonstrations.  The  inhalations  of 
substances  in  a  state  of  vapor,  and  atomized,  in  affections  of  the  parts 
beyond  the  larynx,  have  thus  far  been  rather  disappointing,  except, 
it  may  be,  the  treatment  of  pulmonary  haemorrhage  by  iron  inhala- 
tions. 

In  using  these  topical  remedies,  some  precautions  must  be  taken  to 
avoid  harm.  Strong  applications  should  not  be  made  in  the  begin- 
ning of  the  treatment.  The  mucous  membranes  should  be  accustomed 
to  the  impact  of  such  unirritating  substances  as  warm  water  and  tepid 
solutions  of  common  salt  and  chloride  of  ammonium,  before  commenc- 
ing the  use  of  tannin,  the  zinc,  copper,  and  silver  salts,  etc.  For 
cleansing  the  mucous  membrane  and  removing  fetor,  common  salt, 
carbolic  acid,  iodine,  and  the  sulphides  are  useful,  and  as  astringents 
and  deodorizers,  the  sulpho-carbolates  of  zinc,  soda,  tannin,  etc.  One 
of  the  more  effective  applications  for  the  cure  of  diseased  states  is  nitrate 
of  silver,  but  it  should  be  kept  in  mind,  in  using  this  agent,  that  the 
handkerchiefs  and  linen  of  the  patient  will  be  soiled.  Solutions  of 
nitrate  of  silver  are  best  applied  by  means  of  the  hand-ball  atomizer, 
tubes  of  various  shapes,  according  to  the  locality,  being  inserted  into 
the  anterior  and  posterior  nares,  pharynx,  or  glottis,  as  the  case  may 
be.  Should  the  steam  atomizer  be  used  for  making  application  of  the 
various  salts  named  above,  the  face  of  the  patient  should  be  protected 
by  a  shield. 

As  iodoform  is  so  offensive  because  of  its  diffusive  and  persistent 
odor,  it  is  now  being  supplanted  by  iodol,  which  is  odorless,  and  at  the 
same  time,  containing  as  it  does  as  much  iodine  nearly,  has  proved  to 
be  quite  as  effective.  In  using  the  method  of  insufflation  with  iodol, 
combinations  of  the  same  agents  can  be  made  with  it  as  with  iodo- 
form. Dr.  J.  Solis-Cohen,  a  laryngologist  of  great  eminence,  main- 
tains that  the  combinations  of  these  iodine  preparations  with  tannin 
are  more  efficient  in  the  treatment  of  the  various  morbid  states  than  any 
other.  The  nature  of  the  curative  action,  in  large  part,  consists  in  the 
detention  of  the  iodol  or  iodoform  on  the  seat  of  disease,  for  the  tan- 
nic  acid  combines  with  the  mucus,  and  thus  holds  the  medicament  in 
contact  with  the  affected  surface. 

APPLICATION  TO  THE  GASTROINTESTINAL  Mucous  MEMBRANE. — 
The  stomach  is  the  organ  most  usually  selected  for  procuring  absorp- 
tion of  remedial  agents.  Diffusion  through  the  walls  of  the  stomach 
into  the  blood  is  by  no  means  definite  in  rate,  or  in  the  quantity  passed 
even  with  the  same  medicament  and  in  the  same  individual.  The 
presence  of  fluid  or  food,  the  chemical  reactions  which  may  ensue,  the 
state  of  the  mucous  membrane,  the  blood-pressure  in  the  veins,  and  the 


BY   TEE   GASTRO-IXTESTIXAL   MUCOUS   MEMBRANE.  11 

condition  of  annexed  organs,  are  circumstances  modifying  the  rate  and 
degree  of  absorption.  The  stomach  empty,  the  mucous  membrane  in  a 
healthy  state,  veins  not  turgid,  are  the  conditions  most  favorable  for 
rapid  and  perfect  absorption.  Crystalloidal  substances  in  solution, 
which  pass  by  simple  osmosis  into  the  vessels,  are  taken  up  more  rap- 
idly and  perfectly  than  colloidal  substances  which  require  preliminary 
digestion  and  solution.  It  follows,  therefore,  that  medicines  in  solu- 
tions not  intended  for  a  merely  local  action  on  the  stomach  mucous 
membrane,  and  not  irritant  in  character,  as  salines,  alkaloids,  etc., 
should  be  administered  when  the  stomach  is  empty.  Substances  that 
are  irritant,  or  that  require  digestion  and  solution,  or  that,  like  iron,  are 
.intended  to  supply  a  material  to  the  blood  in  which  it  is  deficient,  are 
best  administered  during  the  process  of  digestion.  On  the  other  hand, 
many  of  the  metallic  salts  precipitate  pepsin  and  thus  derange  diges- 
tion, whence  it  follows  that  they  should  not  be  given  after  food,  if  un- 
impaired digestion  be  essential  to  the  safety  of  the  patient. 

Although  it  is  true  that  medicines  in  solution  are  more  readily 
taken  up  than  solids,  yet  many  of  the  latter  are  absorbed  with  great 
facility,  as  metallic  iron,  calomel,  etc.,  which  are  rendered  soluble  by 
the  gastric  fluids.  The  chemical  changes  induced  in  medicines  by  the 
gastric  juice  are  by  no  means  well  understood.  How  individual 
agents  are  affected  is  a  subject  to  be  considered  hereafter. 

The  following  are  the  chief  forms  in  which  medicines  are  adminis- 
tered by  the  stomach  : 

Powders  are  medicines  reduced  by  mechanical  subdivision,  or  by 
precipitation,  to  various  degrees  of  fineness.  The  Pharmacopoeia  of 
U.  S.  advises  several  grades  ;  a  very  fine  powder  is  one  triturated  to 
that  degree  that  it  should  pass  through  a  sieve  having  eighty  or  more 
meshes  to  the  linear  inch  ;  a  fine  powder  is  one  which  should  pass 
through  a  sieve  having  sixty  meshes  to  the  linear  inch  ;  a  moderately 
fine  powder  is  one  which  should  pass  through  fifty  meshes  ;  a  moder- 
ately coarse  powder  through  one  having  forty  meshes,  and  a  coarse 
powder  through  one  having  twenty  meshes  to  the  linear  inch.  These 
powders  are  designated  respectively  No.  80,  No.  60,  No.  50,  No.  40  and 
No.  20.  Those  soluble  in  water  are  usually  administered  in  that  men- 
struum. If  insoluble,  they  may  be  suspended  in  water  by  means  of 
sugar,  sirup,  solution  of  gum,  glycerin,  or  they  may  be  rubbed  up 
with  some  innocuous  powder,  as  sugar,  sugar  of  milk,  liquorice-pow- 
der, etc. 

Triturationes  are  made  by  triturating  10  grm.  of  the  drug  with 
90  grm.  of  sugar  of  milk. 

Pills  are  small  masses  of  medicine  made  into  a  globular   shape, 

by  means  of  an  extract,  conserve  of  roses,  sirup,  or  glycerin.     A  pill 

should  not  exceed  five  grains  in  weight,  including  the  excipient,  and, 

as  a  rule,  it  should  be  smaller  than  this.     To  cover  the  taste,  pills  may 

3 


12  HOW   MEDICINES   ARE   INTRODUCED. 

be  coated  with  sugar,  gum,  gelatin,  silver  or  gold  foil.  It  should  not 
be  overlooked  that  pills  too  long  kept,  especially  when  sugar-coated,  be- 
come very  hard  and  insoluble,  and  therefore  without  activity.  Extem- 
poraneously, pills  may  be  covered  with  fine  tissue-paper,  or  enveloped 
in  a  raisin,  to  cover  the  taste  of  the  ingredients. 

A  Mixture  is  a  suspension  of  one  or  more  insoluble  substances  in 
the  vehicle,  by  means  of  sugar,  gum,  glycerin,  treacle,  albumen,  etc. 
The  term  emulsion  is  restricted  in  application  to  the  mixture  of  oil 
and  water,  in  which  the  oily  particles  are  suspended  mechanically  by 
rubbing  them  up  with  water  and  gum. 

Extracts  are  solid  and  fluid.  The  solid  extract  may  be  aqueous 
or  alcoholic  ;  in  the  one  case  water,  in  the  other  alcohol,  being  the 
menstruum  employed  to  extract  the  active  and  soluble  principles.  An 
extract  is  solid  when  evaporation  is  carried  far  enough  to  produce  a 
soft  paste  or  a  dry  mass  ;  it  is  fluid  when  sufficient  alcohol  and  water 
are  retained  to  give  the  proper  fluidity.  The  strength  of  the  fluid 
extract  (Pharmacopoeia,  1890)  is  as  follows:  One  thousand  grm.  of  the 
medicament,  and  to  this  alcohol,  or  alcohol  and  glycerin,  or  alcohol 
and  water,  added  in  sufficient  quantity  to  make  1,000  c.  c.  The 
powder  (usually  No.  60)  is  packed  in  a  cylindrical  percolator,  and  a 
portion  of  the  menstruum  is  poured  over  it.  It  is  then  allowed  to 
macerate  for  forty-eight  hours,  usually,  after  which  percolation  is 
allowed  to  proceed,  the  menstruum  being  added  gradually.  The 
strength  of  such  a  fluid  extract  is  in  the  proportion  of  minim  to  grain. 

Abstracta,  which  were  recognized  for  the  first  time  in  the  Pharma- 
copoeia of  1880,  were  removed  from  the  list  of  1890. 

Infusions  are  such  solutions  of  active  and  soluble  principles  as  can 
be  extracted  by  digesting  the  crude  drug  in  water,  cold  or  at  a  tem- 
perature short  of  boiling.  When  water  at  the  boiling  temperature  is 
used,  the  resulting  solution  is  termed  a  decoction.  Cold  infusions  are, 
when  practicable,  to  be  preferred  to  decoctions,  for,  at  the  temperature 
of  boiling  water,  many  active  principles  are  decomposed  or  volatilized. 

Infusa  are  prepared  by  taking  50  grm.  of  the  drug  coarsely  com- 
minuted, and  1,000  c.  c.  of  boiling  water,  which  is  poured  on,  allowed 
to  stand  for  two  hours  in  a  suitable  covered  vessel,  and  is  then  strained, 
and  sufficient  cold  water  is  added  to  make  1,000  c.  c. 

Decocta  are  prepared  of  the  same  strength  as  infusions — 50  grm. 
to  1,000  c.  c. — but  the  medicament,  coarsely  powdered,  is  put  into 
1,000  c.  c.  of  cold  water  and  boiled  for  fifteen  minutes.  It  is  then 
allowed  to  cool  to  104°  Fahr.,  when  sufficient  cold  water  is  added  to 
make  1,000  c.  c. 

Aceta  consist  of  100  grm.  of  drug  to  1,000  c.  c.  of  diluted  acetic 
acid.  Acidum  aceticum  dilutum  consists  of  100  grm.  of  acid  and  500 
grm.  of  distilled  water,  and  therefore  contains  six  per  cent  of  abso- 
lute acetic  acid. 


BY   THE   GASTRO-INTESTINAL  MUCOUS  MEMBRANE.  13 

Vina  are  preparations  made  with  vinum  album,  but  differ  in 
strength.  "  When  white  wine  is  prescribed  without  further  specifica- 
tion, it  is  recommended  that  a  dry  white  wine  of  domestic  production 
be  employed."  TJ.  S.  Pharm.  of  1890. 

Capsules  are  hollow  cylinders  or  cones  of  gelatin,  to  contain  offen- 
sively-tasting substances,  as  copaiba,  oil  of  sandal-wood,  etc.  In  the 
stomach  the  gelatin  is  dissolved  and  the  medicament  liberated. 

Lozenges  or  Troches,  button-shaped  masses,  are  sometimes  intro- 
duced into  the  stomach,  but  usually  these  bodies  are  intended  to 
be  dissolved  slowly  in  the  mouth,  to  exert  a  local  action  on  the 
fauces. 

Wafers  are  circular  disks  with  a  central  cavity  for  holding  the 
medicine.  They  are  made  of  isinglass  or  of  gelatin. 

A  Suppository  is  a  conical  mass  of  cacao-butter,  or  wax  and  cacao- 
butter,  with  which  is  incorporated  a  medicament,  and  should  not  weigh 
more  than  fifteen  grains.  They  are  applied  to  the  rectum,  vagina, 
urethra,  nares,  ear,  and  other  parts. 

Clyster,  Enema,  Lavement,  are  medicated  solutions  to  be  thrown 
into  the  rectum. 

Although  the  rectum  as  an  absorbing  surface  is  inferior  to  the 
stomach,  medicines  are  frequently  introduced  by  this  organ  with  great 
advantage.  Some  medicines  enter  the  blood  more  quickly  by  the  rec- 
tum than  by  the  stomach,  but,  as  a  general  rule,  absorption  is  slower 
by  the  former  organ.  If  the  mucous  membrane  of  the  rectum  be 
irritable,  or  if  the  substances  introduced  be  irritating  or  bulky,  they 
will  not  be  retained.  As  the  contents  of  the  rectum  are  alkaline,  solids 
requiring  an  acid  for  their  solution  will  be  slowly  or  not  at  all  taken 
up.  Acid  solutions  of  medicinal  agents,  on  the  other  hand,  are  readily 
enough  absorbed,  provided  the  quantity  of  acid  present  be  sufficient  to 
maintain  solution.  As  a  general  rule  the  mineral  salts  act  chiefly 
locally  on  the  mucous  membrane  of  the  rectum,  and  enter  the  blood  in 
small  quantity.  The  salts  of  the  alkaloids,  on  the  other  hand,  are  ab- 
sorbed with  facility.  Alkaloids  insoluble  unless  in  the  presence  of  an 
acid  are  not  absorbed  with  the  same  rapidity  and  completeness  by  the 
rectum  as  by  the  stomach,  unless  they  are  administered  in  acid  solu- 
tion. The  salts  of  morphine,  atropine,  and  strychnine,  in  solution,  are 
absorbed  as  quickly,  and  the  last  named  more  quickly,  by  the  rectum 
than  by  the  stomach. 

Remedies  administered  by  the  rectum  may  be  in  solution  suspended 
in  some  menstruum,  or  incorporated  with  a  soap  or  fat  in  the  form  of 
suppository.  The  solution  used  should  have  the  temperature  of  the 
rectum  (about  100°  Fahr.).  The  quantity  administered  should  not 
exceed  two  fluid-ounces  of  solution.  Before  introducing  a  medicated 
solution  or  clyster  into  the  rectum,  this  organ  should  be  emptied  of 
fecal  matter  by  an  ordinary  enema. 


14  HOW   MEDICINES   ARE   INTRODUCED. 

Administration  of  remedies  by  the  rectum  is  an  important  resource 
to  the  therapeutist  in  cases  of  inability  to  swallow,  irritable  stomach, 
and  in  children's  maladies.  Unfortunately,  this  organ  soon  becomes 
intolerant,  the  mucous  membrane  irritable,  and  the  medicament  is 
cither  at  once  rejected  or  absorption  delayed. 

Enteroclysis  is  the  name  given  to  a  procedure  for  irrigation  of  the 
bowel,  lately  proposed  by  Cantani.  It  was  employed  during  the  late 
epidemic  of  cholera  (1892),  but  is  a  method  applicable  to  various  dis- 
orders, and  hence  should  be  mentioned  here.  The  fountain  syringe, 
with  its  flexible  tube,  and  a  rectal  tube  which  can  be  attached,  is  the 
simple  apparatus  employed.  The  solution  which  Cantani  proposed 
for  the  treatment  of  cholera  is  as  follows  :  Tannic  acid,  5  to  20  grm. ; 
laudanum,  20  to  30  drops  ;  gum  arable,  30  to  50  grm.  ;  infusion  of 
chamomile,  2  litres  (=  2  quarts).  The  solution  of  tannin  is  supposed 
to  inhibit  the  bacillus,  to  precipitate  the  albumen,  and  to  act  mechan- 
ically by  washing  out  the  intestinal  contents.  The  mode  of  perform- 
ing enteroclysis  is  as  follows :  The  patient  lies  on  his  back,  with  the 
knees  drawn  up,  or  on  the  right  side,  the  thighs  flexed  on  the  pelvis 
and  the  body  inclined  forward,  resting  on  the  chest.  The  rectal  tube 
is  inserted  up  to  or  is  passed  beyond  the  sigmoid  flexure,  and  the  res- 
ervoir is  placed  at  such  an  elevation  that  the  pressure  is  sufficient  to 
carry  the  fluid  to  the  ileo-caecal  valve  and  beyond.  Massage  of  the, 
abdomen  is  practiced,  to  help  the  dispersion  of  the  fluid  through  the 
small  intestine  from  the  large,  and  with  this  object  in  view  is  so  con- 
ducted as  to  aid  gravity  and  the  hydrostatic  pressure  in  filling  the 
small  intestine.  Do  fluids  inserted  in  this  way  pass  the  ileo-csecal 
valve  ?  The  evidence  is  contradictory.  In  experiments  on  the  cadaver 
it  was  shown  several  years  ago  that,  in  many  subjects  at  least,  the 
bowel  gave  way  to  the  pressure  before  the  orifice  yielded.  In  some 
instances  the  valve  was  found  permeable,  but  this  was  explained  by 
the  supposition  that  a  pathological  state  of  the  bowel  had  occurred, 
or  some  peculiarity  of  formation  had  existed.  In  the  present  epi- 
demic of  cholera  some  cases  have  been  reported  in  which,  subsequent 
to  enteroclysis,  vomiting  of  the  tannin  solution  had  occurred,  whence 
it  follows  that  the  fluid  did  pass  the  ileo-csecal  valve.  Salt  solution — 
1  to  5  per  cent — suitably  sterilized,  is  used  by  the  method  of  entero- 
clysis in  various  cases,  both  for  irrigation  of  the  bowel  and  for  the  sys- 
temic effects.  It  has  been  found  that  salt  solution  used  in  this  way 
will  have  an  action  somewhat  slower,  but  similar  in  kind  to  the  sub- 
cutaneous infusion  of  salines,  and  hence  has  been  employed  with  suc- 
cess after  haemorrhage  or  wasting  discharges,  or  in  the  condition  of 
collapse  from  any  cause. 

The  same  expedient  can  be  advantageously  used  in  the  treatment  of 
chronic  diarrhoea  and  dysentery,  in  haemorrhages,  etc.  It  has  also  been 
employed  in  the  treatment  of  certain  hepatic  diseases.  For  tannin 


BY   THE   GASTRO-INTESTINAL   MUCOUS   MEMBRANE.  15 

may  be  substituted  nitrate  of  silver,  corrosive  chloride,  bismuth,  and 
other  remedies. 

When  should  Medicines  be  administered? — The  curative  effects  of 
remedies  may  be  retarded,  changed  in  form,  or  prevented,  by  untimely 
administration. 

Remedies  that  are  intended  to  act  on  the  mucous  membrane  of 
the  stomach  only  should  be  given  when  the  organ  is  empty.  If  distant 
parts  are  to  be  affected  in  the  most  prompt  and  efficient  manner,  and 
the  remedy  is  free  from  any  distinctly  irritating  quality,  it  should 
also  be  taken  on  an  empty  stomach.  As,  when  digestion  is  going  on, 
the  contents  of  the  stomach  are  acid  in  reaction,  if  alkalies  are  admin- 
istered, combinations  take  place,  and  salts  are  formed.  Various  or- 
ganic substances  are  decomposed  and,  it  often  happens,  rendered  inert 
by  the  action  of  the  stomach  acid.  If  alkalies  are  introduced  before 
digestion  begins,  diffusion  of  the  acid-forming  constituents  of  the 
blood  no  doubt  takes  place,  and  in  this  way  the  acidity  of  the  gastric 
juice  is  promoted.  The  law  of  diffusion  just  given  is  equally  applica- 
ble to  acids  ;  given  before  meals,  they  increase  the  diffusion  of  alkaline 
constituents  of  the  blood  toward  the  stomach. 

The  mineral  acids,  especially  hydrochloric  and  phosphoric,  increase 
the  activity  of  pepsin  when  administered  during  the  process  of  diges- 
tion, and  alkalies  given  before  digestion  begins  have  the  same  effect  to 
some  extent,  but,  if  taken  during  this  process,  retard  or  suspend  it. 
Alcohol  in  considerable  quantity  lessens  the  activity  of  pepsin,  but  a 
small  amount  increases  it.  Five  per  cent,  is  probably  the  limit,  and  the 
larger  the  quantity  beyond  that  the  greater  the  injury  to  digestion 
(Klikowiz).  The  germicides  or  antiseptics  interfere  with  the  process 
of  digestion  in  proportion  to  their  power  ;  hence  the  bichloride,  the 
biniodide,  and  permanganates  are  the  most  injurious  to  pepsin.  It  fol- 
lows that  such  agents  should  be  given  when  the  stomach  is  nearly  or 
quite  empty,  free  dilution  serving  to  prevent  injury  to  the  mucous 
membrane.  The  sulphates,  especially  of  the  metals,  nitrates,  chlo- 
rates, bromides,  salicylates,  in  the  order  named,  decidedly  lessen  the 
ferment  power  of  pepsin,  and  consequently  retard  digestion.  None  of 
these  should  be  given  during  the  period  of  digestion,  but  as  long  be- 
fore or  after  as  the  circumstances  will  permit. 

Remedial  agents  intended  to  enter  the  blood  with  the  food  must 
needs  be  given  during  the  time  when  the  conversion  of  foods  is  going 
on.  Iron,  the  hypophosphites  and  phosphates,  and  certain  lime-salts 
are  of  this  character,  but  these  remedies  should  be  selected  with  refer- 
ence to  their  action  on  the  digestive  fluids.  Thus,  according  to  the 
observations  of  Eccles,  the  hypophosphite  of  potassium,  phosphate  of 
iron,  lactophosphate  of  calcium,  citrate  of  iron,  are  among  those  exert- 
ing comparatively  little  effect  on  the  process  of  digestion,  while 
others,  heretofore  supposed  to  be  free  from  injurious  action,  are 


1G  HOW   MEDICINES  ARE   INTRODUCED. 

especially  hurtful.  While  the  stomach  contents  are  decidedly  acid, 
those  of  the  small  intestine  are  alkaline,  and  sufficiently  so  to  neu- 
tralize the  stomach  acid,  and  to  maintain  the  alkalinity  of  the  in- 
testinal juices.  When,  therefore,  it  is  required  to  have  the  medica- 
ment act  on  the  small  intestine,  the  best  time  to  secure  that  object 
is  when  the  flow  of  materials  is  in  that  direction,  and,  other  things 
being  equal,  by  combination  with  alkalies  if  the  nature  of  the  sub- 
stance will  permit. 

Medicines  intended  to  affect  the  hepatic  and  pancreatic  secretions 
need  to  have  ample  time,  and  should  be  so  administered  as  to  begin 
their  action  when  the  periods  of  physiological  activity  arrive. 

APPLICATIONS  TO  THE  GENITO-URINARY  Mucous  MEMBEANE. — 
Brown-Sequard  has  proposed  to  utilize  the  bladder  for  securing  ab- 
sorption of  remedial  agents  in  cases  of  great  intestinal  disorder,  as  in 
cholera.  Experiment  has  shown  that  morphine,  for  example,  is  taken 
up  with  considerable  rapidity  by  this  viscus. 

Topical  applications  to  the  urethra  and  vagina  are  very  frequently 
made,  usually  in  the  form  of  astringent  injections.  Suppositories, 
variously  medicated,  are  also  occasionally  used  in  the  treatment  of 
affections  of  these  parts. 


m. 

BY    THE    SUBCUTANEOUS    AREOLAR    TISSUE— THE    HYPODERMATIC    OR 
HYPODERMIC    METHOD. 

The  term  hypodermic  is  used  in  conformity  with  the  nomencla- 
ture already  existing — as  "  epidermic,"  "  endermic,"  etc. — but  the  ter- 
mination of  the  word  is  now  altered  in  deference  to  the  opinions  of 
the  best  philologists.  The  term  hypodermic,  which  has  been  univer- 
sally adopted,  is  known  to  be  formed  on  wrong  principles,  and  hence, 
in  accordance  with  the  rules  of  construction,  the  word  hypodermatic 
is  substituted.  As  the  term  indicates,  by  this  method  the  medicine  is 
applied  to  the  subcutaneous  areolar  tissue.  This  does  not  include  the 
method  of  "  inoculation,"  introduced  by  Laf  argue,  nor  that  proposed 
by  Luton  and  Bertin,  which  consists  in  the  injection  of  irritants  into 
diseased  tissues.  It  is  obvious  that  by  the  hypodermatic  method 
medicines  can  be  introduced  only  in  the  state  of  solution.  To  intro- 
duce the  solution  under  the  skin,  a  special  instrument  is  necessary. 
This  is  the  now  well-known  hypodermatic  syringe — a  small  syringe 
having  a  capacity  not  to  exceed  a  drachm — the  nozzle  being  a  hollow 
needle  having  a  lancet-shaped  extremity  for  easily  transfixing  the  skin. 
These  instruments  are  various  in  form  and  construction,  and  are  made 
of  gold,  silver,  glass,  or  hard  rubber.  The  most  efficient  instrument 
for  ordinary  use  is  the  silver  hypodermatic  syringe  described  by  the 


BY  THE  SUBCUTANEOUS  AREOLAR  TISSUE.  17 

author.  The  piston-rod  of  this  instrument  should  be  semi-cylindrical, 
and  should  be  graduated  for  minims  on  its  flat  side,  to  indicate  the 
quantity  of  solution  contained  in  the  barrel.  To  avoid  the  ill  results 
which  may  follow  the  use  of  instruments  not  properly  constructed,  they 
are  now  so  made  as  to  be  easily  rendered  aseptic.  With  an  asbestos 
packing  of  the  piston,  and  needles  that  can  be  sterilized  by  heat,  the 
danger  of  local  inflammation  from  the  deposit  of  septic  germs  is  re- 
duced to  the  minimum.  In  the  instrument  devised  by  Koch,  the  pis- 
ton-rod with  its  packing  is  dispensed  with,  and  the  air  for  forcing  the 
fluid  out  is  furnished  by  a  rubber  air-bag  which  is  attached  to  the 
barrel  of  the  instrument.  Allen  and  Hanbury,  of  London,  have  lately 
brought  forward  an  aseptic  instrument  in  which  the  piston-rod  is 
made  to  fit  accurately  the  barrel  of  the  instrument,  and  thus  any  kind 
of  packing  is  dispensed  with.  Numerous  models  of  the  hypodermic 
instrument  have  been  brought  forward  within  the  past  few  years, 
from  which  a  suitable  selection  can  always  be  made.  Before  using 
any  instrument  it  should  be  well  washed  out  with  boiling  water,  and, 
after  using,  the  needle  should  be  dried  and  the  wire  inserted.  In 
doubtful  cases,  the  skin  at  the  point  where  the  injection  is  to  be  made 
should  be  washed  well  with  soap  and  water,  and  then  bathed  in  hydro- 
gen-peroxide solution,  or  some  other  antiseptic. 

A  medicine  employed  for  hypodermatic  use  should  be  capable  of 
perfect  solution  in  the  menstruum,  which  is  usually  distilled  or  pure 
water.  Particles  of  medicine  undissolved  are  not  only  not  in  a  condi- 
tion for  ready  absorption,  but  are  irritant  to  the  tissues,  producing  in- 
flammation and  abscess.  The  solution  for  hypodermatic  use  should  be 
free  from  foreign  matter  of  every  description  and  should  be  neutral  in 
reaction,  or,  at  least,  without  decided  acid  or  alkaline  property.  Any 
substance  which  will  coagulate  the  blood  or  produce  violent  local  irri- 
tation is  unfit  for  hypodermatic  use.  A  solution  of  even  a  neutral  sub- 
stance should  not  be  too  concentrated.  Clean  water,  free  from  visible 
impurities,  is  entirely  harmless,  and  the  quantity  of  fluid  injected  is, 
within  certain  limits,  a  matter  of  indifference,  provided  suitable  care  be 
used  in  selecting  the  site  and  injecting.  On  the  other  hand,  concen- 
trated solutions  are  more  apt  to  produce  local  irritation  than  dilute 
solutions.  Moreover,  a  drop  too  much  of  a  concentrated  solution  of  a 
powerful  alkaloid  may  produce  an  alarming,  if  not  dangerous  state. 
In  ordinary  syringes  a  few  drops  remain  at  the  bottom  of  the  barrel 
and  in  the  needle — whence  it  follows,  in  'using  strong  solutions,  it  is 
difficult  to  inject  the  precise  amount  desired. 

Solutions  of  alkaloids,  too  long  kept,  become  unfit  for  use  hypoder- 
matically,  by  reason  of  the  development  in  them  of  a  penicittium,  a 
minute  organism  which  grows  at  the  expense  of  the  alkaloid.  Fresh 
solutions  should  be  made  when  needed.  When  hypodermatic  injec- 
tions are  used  infrequently,  it  is  preferable  to  prepare  an  extempore 


18  HOW   MEDICINES   ARE   INTRODUCED. 

solution,  using  powders  of  a  definite  strength.  Filtered  river,  melted 
ice,  or  rain  water,  may  be  used  for  dissolving  the  powders.  Solutions 
prepared  extemporaneously  from  ordinary  spring  or  rain  water  are 
found  to  produce  less  inflammation,  and  are  less  likely  to  be  followed 
by  abscess,  than  solutions  prepared  with  pure  distilled  water  which 
have  been  kept  for  several  days.  The  author,  therefore,  advises  the 
use  of  extemporaneous  solutions  made  with  powders  of  suitable  strength 
or  the  compressed  tablets  now  prepared  by  the  manufacturing  phar- 
macists. 

In  practicing  the  hypodermatic  injection  it  is  important  to  avoid 
puncturing  a  vein.  Serious  depression  of  the  powers  of  life  and  sud- 
den and  profound  narcotism  have  been  produced  by  injecting  a 
solution  of  morphine  directly  into  a  vein.  Fatal  collapse  may  en- 
sue from  injecting  air  into  a  vein  along  with  the  narcotic  solution. 
Bony  prominences  ought  to  be  avoided,  and  also  inflamed  parts.  It 
is  not  necessary  to  follow  Wood,  the  discoverer  of  the  hypoder- 
matic method,  who  advised  that  the  solution  be  inserted  at  those 
points  where  pain  can  be  awakened  by  pressure  (the  painful  points 
of  Valleix).  Some  exceptions  to  this  rule  undoubtedly  exist.  The 
arms,  the  abdomen,  the  thighs,  the  calves  of  the  legs,  and  the  back, 
are  suitable  places.  Eulenburg  makes  the  assertion  that  the  effect  is 
slower  when  the  injection  is  made  in  the  back,  but  I  have  not  ob- 
served this  difference. 

SOLUTIONS. — When  the  quantity  of  the  medicament  to  be  used 
hypodermatically  is  sufficient  in  bulk,  the  most  convenient  mode  of 
procedure  is  to  prepare  extemporaneous  solutions  from  powders  or 
compressed  tablets  of  definite  weight.  Experience  has  abundantly 
proved  that  clean  river,  cistern,  spring,  or  well  water,  is  better  than 
distilled  water  for  preparing  solutions.  If  not  very  recently  distilled, 
the  water  soon  becomes  turbid  from  the  development  in  it  of  a 
minute  vegetable  organism — a  penicillium — which  grows  at  the  ex- 
pense of  the  alkaloid,  and  thus  as  it  increases  in  impurity  also  les- 
sens in  strength.  The  antiseptics — such  as  carbolic  acid,  chloroform, 
salicylic  acid,  cherry  laurel,  etc. — do  not  succeed  in  preventing  the 
development  of  the  parasite  for  any  considerable  period  unless 
added  to  the  solution  in  such  quantity  as  to  render  it  very  irritat- 
ing. The  least  objectionable,  and  at  the  same  time  the  most  effect- 
ive comparatively,  is  chloroform-water  (aqua  chloroformi),  which  is 
made  by  saturating  freshly-distilled  water  with  chloroform,  about 
two  minims  being  required  for  the  ounce.  Oil  of  vaseline  is  also 
an  efficient  solvent  for  many  active  principles,  and  is  free  from  irri- 
tating qualities.  Heating  the  water  to  the  boiling  point  is  also  a 
highly  useful  expedient,  for  this  temperature  is  sufficient  to  kill  the 
organism  referred  to,  and  to  render  innocuous  any  organic  matter 
present. 


BY  THE   SUBCUTANEOUS  AREOLAR  TISSUE.  19 

"Hypodermic  tablets,"  as  they  are  designated,  are  now  made  by 
the  manufacturing  pharmacists  on  an  extensive  scale.  They  have  the 
advantage  of  permanence  of  form,  solubility,  and  accuracy  of  dose. 
When  very  minute  doses  are  required,  a  vehicle  becomes  necessary. 
Some  manufacturers  use  beet-root  sugar  for  the  purpose  ;  others,  sul- 
phate of  soda  ;  but  the  latter  is  the  more  commendable  because  it  is 
soluble,  and  undergoes  no  change.  Sugar,  although  soluble,  has  the 
serious  disadvantage  that  it  is  liable  to  decomposition,  and  thus  to 
produce  local  troubles. 

FORMULA. 

MOBPHIHA — Morphine.  3  Morphinaa  sulphat.,  gr.  xvj ;  aquae,  vel  aquaa 
chloroformi,  §  j.  M.  Sig. :  Two  (2)  minims  are  equal  to  one-fifteenth  of  a  grain. 

An  antiseptic  solution  of  morphine,  intended  to  be  kept  for  several  weeks, 
may  be  prepared  according  to  the  following  formula : 

IJ  Morphinaa  sulph.,  gr.  xvj;  acid,  carbolic.,  gtt.  v;  aquae,  f  j.  M.  Sig.: 
Two  minims  contain  ^  of  a  grain  of  sulphate  of  morphine. 

Solutions  of  morphine  may  be  readily  prepared  extemporaneously  from  pow- 
ders or  pellets  of  a  definite  strength,  as  follows : 

3  Morphinee  sulphat.,  3j;  atropinae  sulphat.,  gr.  ss.  M.  ft.  pulv.  no.  cxx 
(120).  Sig. :  Each  powder  contains  £  of  a  grain  of  morphine  and  ^^  grain  of 
atropine. 

ATROPINA — Atropine.  3  Atropinaa  sulphat.,  gr.  ij  ;  aqute,  ^  j.  M.  Sig. : 
One  minim  contains  -^-^  of  a  grain.  Three  (3)  minims  contain  fa  of  a  grain, 
which  is  a  maximum  dose  for  many  persons. 

MORPHINA  AND  ATROPHY. — IJ  Morphinae  sulphat.,  gr.  xvj ;  atropinae  sul- 
phat., gr.  ss. ;  aquaa,  vel  aquae  chloroformi,  f  j.  M.  Sig. :  Six  (6)  minims  con- 
tain £  grain  of  morphine  and  T|7  grain  of  atropine. 

COOAINA. — Cocaine.  $  Cocainae  hydrochlor.,  gr.  xxiv;  aquae,  vel  aquae 
chloroformi,  §  j.  M.  Sig. :  One  grain  to  20  minims. 

URETHAN. — 3  Urethan,  3j;  aquae,  §j.  M.  Sig.:  Each  drachm  contains 
7£  grains. 

DTTBOISINA — Duboisine.  3  Duboisinaa  sulphat.,  gr.  j  ;  aquae,  ^j.  M.  Sig.: 
Four  (4)  minims  contain  T^  of  a  grain.  Eight  minims  is  the  usual  maximum 
dose  for  an  adult. 

HYOSOYAMINA — Hyoscyamine.  3  Hyoscyaminse  sulph.  vel  hydrobromat., 
gr.  j  ;  aquae  §  j.  M.  Sig. :  Five  (5)  minims  contain  -^  grain. 

Hyoscine,  the  other  alkaloid  of  hyoscyamus,  is  the  better  hypnotic.  The 
following  solution  may  be  used : 

3  Hyoscinae  hydrobromat.,  gr.  j  ;  aquae  destil.,  |  ss.  M.  Four  minims  con- 
tain fa  grain. 

STRYOHNINA — Strychnine.  5  Strychninae  sulphat.,  gr.  j;  aquaa,  §j.  M. 
Sig. :  Ten  (10)  minims  contain  ^  of  a  grain. 

CosriifA — Conine.  5  Coninae  hydrobromat.,  gr.  j;  aqua?,  |j.  M.  Sig.: 
Ten  (10)  minims  contain  j1^  of  a  grain. 

OURARA — or  Woorara.  5  Curaras,  gr.  j;  acid,  acetic.,  TH,v;  aquae,  ad  TH  c 
(to  100  minims).  M.  Filter.  Sig. :  Ten  (10)  minims  contain  ^  of  a  grain. 

As  the  active  constituents  of  curnra  are  soluble  in  water,  an  aqueous  solution 
will  contain  them — the  residue  being  woody  fiber,  starch-granules,  etc.  As, 


20  HOW   MEDICINES   ARE   INTRODUCED. 

however,  the  specimens  vary  greatly  in  strength,  the  character  of  any  new 
specimen  should  be  ascertained  by  trial  on  animals  before  giving  it  to  man. 

Any  salt  of  the  alkaloid,  curarine,  will,  however,  be  more  exact  in  its  effects. 

3  Curarinao  sulphat.,  gr.  j ;  aquas,  |  ss.  M.  Sig. :  Four  (4)  minims  con- 
tain -fa  of  a  grain. 

NICOTIANA — Nicotine.  3  Nicotian®  hydrobromat.,  Til  j ;  aquae,  3  iv.  M. 
Sig. :  Four  (4)  minims  contain  -fa  of  a  grain. 

LOBELLNA — Lobeline.  3  Lobelinae  hydrobromat.,  gr.  j  ;  aquae,  3  ij-  M.  Sig.  : 
Four  minims  contain  -fa  grain. 

ACIDUM  HYDROCYANICUM  DILTJTUM. —  3  Acid,  hydrocyanic,  dil.,  q.  s.  Sig.: 
Four  minims  is  the  maximum  single  dose. 

ESERIXA — Eserine.  The  extract  of  Calabar-bean  dissolved  in  sufficient  water, 
and  filtered,  is  used  hypodermatically,  sometimes ;  but  the  alkaloid  eserine  is  to 
be  preferred. 

3  Eserinas  sulph.  vel  salicylat.,  gr.  j;  aquaa,  3iv.  M.  Sig.:  Four  (4) 
minims  contain  -fa  of  a  grain. 

PILOCARPIXA — Pilocarpine.  3  Pilocarpinae  hydrochlorat.,  gr.  xvj ;  aquae, 
§  j.  M.  Sig. :  Five  (5)  minims  contain  (£)  one  sixth  of  a  grain. 

AMYLI  NITRITUM — Nitrite  of  Amyl.  From  three  (3)  to  five  (5)  minims  of 
amyl  nitrite  can  be  injected  subcutaneously  at  a  time.  The  repetition  of  the 
dose  will  depend  on  the  effect,  but  the  injection  may  be  practiced  every  half 
hour  for  a  time. 

CHLOROFORMUM  PURIFICATUM — Purified  Chloroform.  From  five  (5)  to  fifteen 
(15)  minims  can  be  used  at  one  injection.  This  agent  is  employed  by  the  "  deep 
method  " — i.  e.,  the  chloroform  is  thrown  by  the  syringe  deeply  and  in  the  neigh- 
borhood of  the  nerve-trunk,  the  seat  of  pain. 

The  official  spiritus  chloroformi  has  also  been  used  successfully  in  the  same 
group  of  cases. 

ALCOHOL  and  ETHER  are  also  injected  subcutaneously — alcohol  in  the  diluted 
form,  as  whisky  or  brandy,  and  pure  ether. 

CHLORAL  HYDRATE.  3  Chloral,  hydrat.,  |  ss. ;  aquae,  §  j.  M.  Sig. :  Thirty 
(30)  minims  contain  fifteen  (15)  grains  of  chloral. 

Sometimes  it  is  advantageous  to  give  chloral  and  morphine  together. 

CAFFEINA — Caffeine.  3  Caffeinae,  gr.  xxiv;  glycerines,  aquae,  aa  |  ss.  M. 
Sig. :  Twenty  minims  contain  one  grain. 

APOMORPHIXA — Apomorphine.  3  Apomorphinae,  gr.  j.  Ft.  pulv.  no.  xvj. 
Sig. :  One  or  more  may  be  dissolved  in  sufficient  water  as  required. 

Apomorphine  undergoes  a  change  in  the  presence  of  moisture,  especially 
when  kept  in  solution  for  some  time ;  hence  the  solution  for  hypodermatic  in- 
jection should  be  prepared  when  required.  The  dose  ranges  from  -fa  of  a  grain 
to  |  of  a  grain. 

EROOTA— Ergot.  3  Ext.  ergotae,  3j;  aquae,  fj.  M.  Sig.:  Twenty  min- 
ims contain  two  (2)  grains. 

QUININA — Quinine.  "  3  Quminae  disulphat.,  gr.  1  (50) ;  acid,  sulphuric, 
dil.,  ill  c  (100);  aquae  font.,  §j  ;  acid,  carbolic,  liq.,  V],  v  (5).  Solve. 

"Place  the  quinine  and  water  in  a  porcelain  dish  over  a  spirit-lamp;  heat 
to  the  boiling-point,  and  add  the  sulphuric  acid,  stirring  with  a  wooden  spatula. 
Filter  at  once  into  a  bottle,  and  add  the  carbolic  acid.  This  gives  six  grains  to 
the  drachm."  [Lente's  formula.] 

Quinina  limuriatica  carbamidata,  a  combination  of  quinine  and  urea,  is 


BY  THE  SUBCUTANEOUS  TISSUE.  21 

freely  soluble — in  equal  parts  of  water,  in  fact— and  therefore  a  most  useful 
preparation  for  hypodermatic  use. 

5  Quinine  hydrobromat.,  gr.  xlviij ;  aquse  destil.,  3  iv.  M.  Dissolve,  and 
by  heat  if  necessary.  Sig. :  Twenty  (20)  minims  contain  4  grains. 

The  new  antipyretics,  antipyrine,  acetanilid,  exalgine,  and  some  others,  hav- 
ing been  found  to  possess  analgesic  power,  are  now  used  hypodermatically  for 
the  relief  of  certain  kinds  of  spasmodic  and  painful  diseases. 

ACIDTTM  CARBOLIOUM — Carbolic  Acid.  IJ  Acid,  carbolic,  purif.,  gr.  x  ;  aquae, 
§j.  M.  Sig.:  Eight  minims  contain  ^  of  a  grain. 

The  quantity  administered  will  range  from  one  sixth  of  a  grain  to  two  or 
three  grains. 

HYDRARGYRUM — Mercury.  The  solutions  of  mercury  now  chiefly  used  are 
those  of  the  corrosive  chloride,  the  albuminate,  and  the  formamide,  as  prepared 
by  Liebreich. 

5  Hydrarg.  chlor.  cor.,  gr.  j ;  aqua?,  f  j.  M.  Sig. :  Ten  (10)  minims  con- 
tain 3*5  of  a  grain. 

Various  albuminous  solutions  of  mercury  have  been  proposed :  the  chlorides 
of  mercury,  ammonium,  and  sodium,  mixed  with  albumen. 

ARSENICUM — Arsenic.  The  preparations  of  arsenic  used  hypodermatically  are 
the  official  solutions  and  the  cacodylates,  chiefly  cacodylate  of  sodium,  of  which 
one  grain  is  given  in  sterilized  solution. 

AQTJAPUNCTURE. — By  aquapunctiire  is  meant  the  injection  of  pure  water 
beneath  the  skin.  A  special  instrument  has  been  invented  to  effect  this ;  but 
ordinarily  a  hypodermatic  syringe  will  suffice  for  this  purpose.  From  a  half- 
drachm  to  a  drachm  is  thrown  under  the  skin  over  the  organ  or  part  on  which 
it  is  intended  to  act. 

IRRITANT  INJECTIONS. — Injections  intended  to  excite  local  inflammation  are 
also  employed  in  various  morbid  states.  The  materials  so  used,  and  the  condi- 
tions requiring  them,  will  be  set  forth  hereafter. 

INJECTIONS  OF  ORGANIC  LIQUIDS. — When  the  experiments  made  by 
Brown-Sequard  with  testicular  juice  were  published,  an  extraordinary 
degree  of  attention  was  attracted  to  the  subject,  and  presently  there 
were  brought  forward  trials  made  with  extracts  from  various  organs 
besides  the  testes — with  the  thyroid  gland,  the  pancreas,  the  brain 
and  spinal  cord,  etc.  Not  a  little  ridicule  attended  the  subject  of 
testicular  juice  on  its  first  announcement,  but  subsequent  experience 
has  fully  confirmed  the  statement  originally  made  by  Brown-Sequard, 
and  now  the  remarkable  restorative  power  of  this  fluid  injected  subcu- 
taneously  is  admitted  by  all  scientific  authority  concerned  with  this 
subject.  According  to  Poehl,  of  St.  Petersburg,  the  effect  of  testicu- 
lar juice  is  due  to  the  presence  in  it  of  spermine,  a  principle  which 
accelerates  oxidation  by  contact.  But  by  Brown-Sequard  and  his 
assistant,  D'Arsonval,  the  effects  are  ascribed  to  a  ferment  action,  a 
diastasic  power  which  acts  as  a  succedaneum,  or  replaces  the  natural 
ferment  produced  by  the  testes  and  other  organs.  In  that  disease 
caused  by  atrophy  of  the  thyroid  gland  and  known  as  myxoedema, 
the  injection  of  thyroid  juice  brings  about  a  marvellous  change  in  the 


22  HOW   MEDICINES  ARE  INTRODUCED. 

condition  of  the  patient,  and  is  rapidly  curative.  When  the  testicu- 
lar  juice  is  injected  the  vital  resources  are  remarkably  re-enforced, 
and  the  individual  declining  into  decrepitude  of  old  age,  the  invalid 
exhausted  by  illness  or  wasting  disease,  etc.,  receives  a  new  instal- 
ment of  life  as  it  were,  for  all  the  functions  are  performed  with  in- 
creased vigor.  Spermine  does  not  possess  such  powerful  reconstituent 
qualities,  and  cannot  therefore  be  substituted  for  the  testicular  juice. 

The  mode  of  preparing  the  extract  or  juice,  as  described  by  D'Ar- 
sonval,  is  as  follows  :  The  testicle  of  the  bull,  which  is  preferred,  is 
brought  to  the  laboratory,  enveloped  in  its  membranes,  which  are 
removed  and  the  organ  washed  in  a  10-per-cent  solution  of  corro- 
sive sublimate,  followed  by  douching  with  sterilized  water.  The 
testicle  is  then  divided  into  five  or  six  parts  and  placed  in  aseptic 
glycerin,  and  allowed  to  mature  for  twenty-four  hours — one  litre 
(=  32  oz.)  of  glycerin  being  used  for  every  kilogramme  (=  2'2  Ibs.)  of 
testicle.  A  solution  of  common  salt,  25  grm.  (=  6£  drs.)  in  500  c.  c. 
of  boiled  water,  is  added  to  the  glycerin  solution.  It  is  then  filtered 
through  sirup  paper  (Laurent's  gray  filter  No.  8).  If  the  tempera- 
ture of  the  fluid  is  raised  to  104°  Fahr.,  the  filtration  goes  on  rapid- 
ly ;  if  cold,  but  slowly.  According  to  D'Arsonval,  this  solution  should 
be  sterilized  by  subjecting  it  to  a  pressure  of  30  atmospheres  of  car- 
bonic acid,  and  he  has  invented  an  ingenious  apparatus  for  effecting 
this.  (Bui.  G'en.  de  Therap.,  February  28,  1893,  p.  151.) 

Constantin  Paul's  extract  of  the  gray  matter  of  the  brain  is  pre- 
pared in  a  similar  manner.  He  makes  use  of  the  gray  matter  of  the 
sheep's  brain.  Of  this,  15  grm.  (=  35),  finely  minced,  is  digested  for 
twenty-four  hours  in  five  times  its  weight,  or  75  grm.  (=  3  25,  or  three 
ounces),  of  pure  glycerin.  To  this  is  added  the  same  quantity,  or 
3  25,  of  a  solution  of  common  salt,  12  per  cent  in  strength.  The 
dose  of  this  is  one  c.  c.  (=  16  minims)  once  a  day  or  once  in  two  days. 
Of  D'Arsonval's  testicular  fluid  the  dose  ranges  from  10  to  20  minims. 
It  need  hardly  be  observed  that  in  using  the  testicular  solution  or 
the  cerebral,  the  utmost  care  is  necessary  to  keep  the  instruments 
aseptic,  and  it  is  useful  also  to  wash  the  parts  where  the  injection  is 
to  be  made  with  1  :  1,000  solution  of  corrosive  sublimate,  or  2 : 100 
of  carbolic  acid. 

Besides  the  organic  extracts  above  mentioned,  there  have  been  in- 
troduced into  practice  various  preparations  of  the  same  character,  ob- 
tained, however,  from  other  organs.  The  thyroid  body,  the  supra- 
renal bodies,  the  kidney,  spleen,  bone-marrow,  and  other  parts,  furnish 
extracts  for  subcutaneous  injection.  It  need  hardly  be  stated  that 
such  solutions  must  be  prepared  under  the  strictest  antiseptic  precau- 
tions, to  avoid  serious  accidents.  Of  those  that  have  been  used,  it  is 
certain  that  the  extract  of  the  thyroid  body  has  been  the  most  suc- 
cessful ;  but  the  internal  use  of  the  gland  itself  has  almost  taken 


BY   THE   SUBCUTANEOUS   AREOLAR   PROCESS.  23 

the  place  of  the  subcutaneous  method,  as  being  painless  and  also  far 
safer.  Among  the  other  animal  extracts,  that  of  the  red-marrow 
of  bones  in  anaemia,  of  the  suprarenal  bodies  in  Addison's  disease, 
and  of  the  kidney  in  chronic  interstitial  nephritis,  have  been  most  use- 
ful. In  another  section  fuller  information  will  be  given  on  the  sub- 
ject of  the  antitoxins  and  their  applications  to  the  treatment  of  septic 
states. 

We  have  to  note  that  sodium  phosphate  has  been  proposed  by 
Crocq,  and  by  Luton,  of  Rheims,  as  a  substitute  for  the  organic  mat- 
ters. Crocq  proposes  a  solution  as  follows :  Sodium  phosphate,  1  grm. 
(=  15'5  grs.)  ;  glycerin,  20  grm.  (=  310  grs.)  ;  distilled  water,  25  grm. 
(=  387  grs.)  ;  alcohol,  5  grm.  (=  75  grs.).  The  dose  is  3  c.  c.  (nearly 
50  minims)  every  day  or  on  alternate  days  by  subcutaneous  injection. 
The  usual  antiseptic  precautions  are  to  be  observed  throughout.  Lu- 
ton makes  use  of  a  solution  of  crystallized  phosphate  of  sodium  and 
sulphate  of  sodium.  The  advocates  of  this  remedy  maintain  its  equal- 
ity in  curative  power  with  the  organic  solutions. 

HYPODEBMATOCLTSIS. — By  this  name  Cantani,  of  Naples,  has  in- 
troduced a  method  of  treating  cholera,  which,  as  the  title  imports,  is 
an  extension  of  the  ordinary  hypodermatic  injection.  The  syringe- 
ful  is  the  maximum  as  a  rule  by  subcutaneous  injection,  but  a  much 
larger  amount  is  made  use  of  by  hypodermatoclysis.  Hence,  while 
a  perforated  needle  is  necessary  to  penetrate  the  skin,  a  reservoir 
much  larger  than  the  syringe  is  required  for  containing  a  solution 
that  is  from  one  to  two  litres  (quarts)  in  amount.  Nothing  is  bet- 
ter for  this  purpose  than  the  fountain  syringe  with  its  flexible  tube 
terminating  in  the  perforated  needle.  The  force  with  which  the 
fluid  is  made  to  pass  under  the  skin  is  regulated  by  the  elevation  at 
which  the  fountain  is  placed.  It  should  not  be  forced  at  such  a  rate 
as  to  cause  painful  distention  of  the  skin.  The  lump  which  forms  by 
the  inflow  of  the  liquid  may  be  dissipated  by  careful  massage  ;  but  if 
a  site  where  the  areolar  tissue  is  abundant  has  been  selected,  the 
ordinary  rate  of  absorption  will  suffice  to  dispose  of  the  solution  as  it 
is  introduced.  The  apparatus  must  be  sterilized  in  boiling  water  ; 
the  solution  must  be  allowed  to  flow  enough  to  displace  the  air,  and 
care  should  be  used  to  prevent  the  introduction  of  foreign  matters. 
The  solution  employed  contains  common  salt,  about  4  grammes  =  3  j; 
sodium  carbonate,  3  grammes  =  45  grains,  dissolved  in  one  litre  =  one 
quart,  of  sterilized  water.  This  amount  of  fluid  is  inserted  at  one 
time,  and  is  subsequently  repeated  as  required.  That  is  known  as 
"  Samuel's  continuous  method  "  in  which  the  fluid  is  made  to  flow 
continuously  until  several  litres  are  injected.  The  temperature  of  the 
fluid  should  be  104°  to  105°  Fahr.,  or  higher  if  it  can  be  borne — that 
is,  when  cholera  is  the  disease  being  treated — and  it  should  not  be 
lower  than  100°  Fahr.  in  any  case.  The  introduction  of  so  large  an 


24  HOW   MEDICINES  ARE   INTRODUCED. 

amount  of  fluid  must  necessarily  cause  some  local  irritation,  swelling, 
and  tenderness,  but  it  is  rare  that  an  abscess  results. 

It  is  not  only  in  cholera  that  the  method  of  hypodermatoclysis  is 
resorted  to.  It  has  been  proposed  as  a  substitute  for  transfusion  of 
blood  in  some  of  the  cases  requiring  filling  of  the  blood-vessels  ;  as  in 
haemorrhage,  where  the  loss  of  blood  threatens  heart-failure  ;  in  ace- 
tonsemia,  or  diabetic  coma  ;  and  in  cases  where  rapid  decline  is  the 
result  of  an  acute  septic  inflammation,  as  in  peritonitis. 

Infiltration  Anaesthesia. — Schleich's  method.  Closely  allied  to  the 
method  of  subcutaneous  medication  is  the  plan  of  inducing  anaes- 
thesia by  injection  into  the  skin  itself,  so  as  to  obtain  the  pressure 
of  the  fluid  on  the  nerve  endings  and  the  local  action  of  the  ano- 
dynes simultaneously.  The  agents  employed  for  this  purpose  are 
cocaine,  morphine,  and  common  salt — the  last  method  being  used  be- 
cause of  its  physical  properties.  Some  of  the  newer  anodynes,  espe- 
cially eucaine  "  a  "  and  "  b,"  have  lately  been  proposed  as  substitutes 
for  cocaine,  but  the  most  recent  researches  have  shown  that  cocaine 
is  in  all  respects  the  most  desirable  for  the  production  of  local  anaes- 
thesia. Of  course,  the  principle  of  this  method  is  to  procure  the  most 
effect  with  the  least  expenditure  of  material.  Various  formulae  are  to 
be  found  on  page  611.  To  avoid  untoward  results,  the  solution  must 
be  weak,  for  such  a  number  of  punctures  is  made  as  the  seat  of  pain 
or  the  length  of  the  incision  may  require.  The  fluid  injected  must  be 
sufficient  in  amount  to  cause  a  wheal  to  arise  at  that  point,  and  they 
must  be  numerous  enough  to  render  the  whole  surface  to  be  operated 
on  entirely  anaesthetic.  It  must  not  be  forgotten  that  the  point  of  the 
needle  is  passed  into,  and  not  through,  the  true  skin,  if  the  operative  pro- 
cedure is  to  be  confined  to  this  tissue.  When  the  desired  area  of  skin 
is  rendered  anaesthetic  the  fluid  can  then  be  injected  into  the  subcuta- 
neous areolar  tissue,  and  into  the  deeper  parts  exposed  in  the  course  of  a 
surgical  operation.  When  thus  inserted  into  the  skin  an  incision  can 
be  made  without  pain,  a  small  tumor  removed,  an  abscess  opened,  or  a 
small  amputation  practiced.  The  same  method  is  applicable  to  the  treat- 
ment of  neuralgia,  or  to  allay  the  pain  of  a  local  inflammation.  When 
the  skin  which  it  is  intended  to  incise  is  the  seat  of  an  acute  hyperaemia 
or  inflammation,  the  infiltration  anaesthesia  is  practiced  around  or  about 
the  part,  and  this  is  not  acted  on  until  the  sensibility  is  so  far  reduced 
that  the  injection  into  the  true  skin  can  be  practiced  without  suffering. 

Instead  of  solutions  prepared  for  use,  it  is  preferable  to  make  use  of 
powders  containing  right  proportions  of  the  several  ingredients.  They 
can  be  dissolved  in  rain,  filtered,  or  distilled  water,  made  sterile  by  boil- 
ing at  the  time  required.  A  conspicuous  advantage  of  the  method  is  the 
small  quantity  of  the  anodyne  required.  Cocaine  anaesthesia  practiced 
in  the  ordinary  way  is  not  without  danger  ;  but  by  this  method  the 
result  is  more  perfectly  accomplished,  and  the  danger  is  not  appreciable. 


TRANSFUSION.  25 

IV. 

BY   THE  VEINS. 

THE  injection  into  the  veins  of  medicinal  agents  is  dangerous  of 
not,  according  to  the  character  of  the  material  so  used.  Numerous 
experiences  have  demonstrated  the  safety  of  ammonia  injections,  and 
Prof.  Ore,  of  Bordeaux,  has  practiced  the  intra-venous  injection  of 
chloral  to  induce  anaesthesia.  Formerly,  before  the  introduction  of 
the  hypodermatic  method,  the  injection  of  medicines  directly  into 
the  blood  was  suggested  and  occasionally  practiced  in  cases  of  as- 
phyxia, in  the  collapse  of  cholera,  in  the  insensibility  due  to  nar- 
cotic poisons,  etc.  At  present  this  method  is  restricted  within  nar- 
rower limits.  Some  remarkable  results  have  been  obtained  by  the 
injection  of  a  saline  solution  into  the  veins  in  cases  of  the  collapse 
of  cholera.  The  first  trials  with  the  intra-venous  injection  of  salines 
were  made  in  1832  with  little  success,  but  in  succeeding  epidemics 
greater  confidence  was  felt  in  the  remedy,  and  in  1866  it  came  to  be 
used  quite  freely.  For  example,  in  1867,  Little,  reporting  on  his  ex- 
periences, gave  an  account  of  five  recoveries  out  of  twenty  cases  in 
an  apparently  hopeless  state.  During  the  epidemic  of  1892  at  Ham- 
burg, Havre,  Paris,  Berlin,  and  elsewhere  intra-venous  injections  were 
practiced  on  a  large  scale  and  with  a  greatly  increased  measure  of  suc- 
cess, so  that  it  has  now  become  a  practice  of  the  first  importance  in  the 
treatment  of  the  algid  stage  of  cholera.  The  same  method  is  also  em- 
ployed in  the  treatment  of  haemorrhage  instead  of  transfusion  of  blood 
in  cases  of  sudden  heart-failure,  in  diabetic  coma,  and  other  states. 

The  injection  of  salines  into  the  veins  is  also  entitled  intravenous 
infusion.  By  means  of  a  suitable  apparatus  the  fluid  is  poured  into 
the  veins.  The  simplest  arrangement  for  this  purpose  consists  of  a 
reservoir  for  containing  the  requisite  amount  of  solution,  a  flexible 
tube  for  conveying  the  solution,  and  a  suitable  perforated  needle  for 
transfixing  the  vein.  There  are  various  patterns  of  instruments  for 
effecting  the  intravenous  injection,  but  if  the  right  conditions  are  com- 
plied with  the  least  complicated  may  be  used  with  complete  success. 
The  fluid  must  be  a  saline  solution,  so  as  not  to  coagulate  the  blood 
or  to  dissolve  the  blood  globules  ;  it  must  be  sterilized,  so  as  not  to 
convey  germs  ;  it  must  be  at  the  right  temperature  ;  and  it  must  be 
passed  into  the  blood  without  at  the  same  time  carrying  globules  of 
air.  The  amount  to  be  inserted  need  not  exceed  a  few  ounces.  Even 
when  the  loss  of  blood  has  been  enormous,  or  when  the  serous  dis- 
charges have  brought  on  collapse,  a  few  ounces  of  saline  fluid  suffices 
to  restore  the  circulation.  Recent  experiences  have  apparently  shown 
that  even  in  great  loss  of  blood  it  is  not  so  much  the  blood  itself  that 
is  needed,  but  a  small  quantity  of  serous  fluid  apparently  suffices. 


2fi  HOW   MEDICINES   ARE   INTRODUCED. 

Hayem  recommends  the  following  formula  as  a  close  approximation 
to  the  composition  of  blood-serum  : 

Water 8    oz. 

Hydrate  of  sodium 15£  grains. 

Chloride  of  sodium 80    grains. 

Sulphate  of  sodium 6£  drachms. 

The  temperature  of  the  fluid  injected  should  not  be  greater  than 
100°  Fahr.,  and  the  amount  which  experience  has  shown  to  be  well  sup- 
ported is  not  greater  than  two  litres,  and  usually  one  litre  (a  quart)  is 
sufficient  for  one  operation.  The  fluid  should  be  injected  slowly,  ac-. 
cording  to  Potain,  at  such  a  rate  that  not  more  than  20  cubic  centi- 
metres pass  into  the  blood  in  a  second.  Dr.  Histon  Fagge  has  recently 
reported  a  case  of  diabetic  coma,  in  which  the  injection  of  twenty-six 
ounces  of  a  warm  solution  of  salines  (phosphate  and  chloride  of  soda) 
produced  an  astonishing  improvement  in  the  condition  of  the  patient. 
A  suitable  saline  solution  for  intra-venous  injection  may  be  made  of 
phosphate,  carbonate,  and  choloride  of  sodium,  dissolved  in  water  at 
the  temperature  of  100°  Fahr.  until  the  specific  gravity  of  1020  is  at- 
tained. The  instruments  employed  for  transfusion  of  blood  may  be 
used  for  the  intra-venous  injection  of  salines. 

Halford,  of  Australia,  has  successfully  practiced  the  injection  of  am- 
monia into  the  veins,  in  the  treatment  of  the  bite  of  venomous  snakes. 
He  employs  one  part  of  the  stronger  aqua  ammonice  to  two  parts  of  * 
distilled  water,  the  injection  being  made  with  an  ordinary  hypodermat- 
ic syringe.  A  vein  in  a  convenient  situation  is  selected,  the  needle  is 
inserted  into  it,  and  the  solution  of  ammonia  is  thrown  in  gradually. 
The  operation  may  be  repeated,  as  necessary,  the  guide  to  the  repetition 
of  the  injection  being  the  state  of  the  circulation.  Fayrer  shows  that 
this  practice  is  not  successful  in  the  systemic  condition  caused  by  the 
bite  of  the  venomous  snakes  of  India,  and  the  special  committee  of  the 
Medical  Society  of  Victoria,  appointed  to  investigate  the  subject  of 
the  intra-venous  injection  of  ammonia,  report  adversely  to  the  claims 
of  Halford.  The  proposer  of  this  expedient  has,  at  least,  demonstrated 
the  safety  of  the  intra-venous  injection  of  ammonia  ;  and,  although 
his  first  claim  has  been  shown  to  be  incorrect,  the  method  itself  has 
been  utilized  in  other  maladies  :  for  example,  in  chloroform  asphyxia, 
opium  narcosis,  hydrocyanic-acid  poisoning,  etc.  Failure  of  the 
heart's  action  and  thrombosis  of  the  pulmonary  artery,  post  partum, 
are  also  indications  for  the  intra-venous  injection  of  ammonia. 

Attention  has  been  called  elsewhere  to  an  instance  reported  by  Dr. 
Eskridge,  which  is  remarkable  both  as  to  the  injection  and  as  to  the 
results  obtained.  By  an  error,  undiluted  aqua  ammonia  was  injected 
directly  into  the  blood-current,  but  no  untoward  effects  accompanied 
or  followed,  and  the  curative  action  exerted  in  the  malady  was  most 
successful.  Although,  at  one  time,  the  escape  of  ammonia  was  sup- 


TRANSFUSION.  27 

posed  to  be  the  cause  of  the  coagulation  of  the  blood,  and  although 
this  is  no  longer  held  as  a  theory,  it  has  served  to  demonstrate  the 
fact  that  such  intra- venous  injections  can  be  practiced  without  ill 
effects,  immediate  or  remote. 

TRANSFUSION. — This  consists  in  an  operation  for  substituting  healthy 
blood  for  the  abnormal  fluid  occurring  in  certain  diseases,  and  for  sup- 
plying blood  in  cases  in  which  a  deficiency  exists  by  reason  of  haemor- 
rhage. Ordinarily  the  blood  of  a  healthy  adult  is  used  in  transfusion, 
because  ever  since  the  time  of  Blundell  it  was  supposed  the  blood  of 
an  animal  would  not  functionate  properly  in  the  arterial  system.  This 
notion  is  now,  however,  fully  exploded,  and  Gesellius  has  especially 
shown,  in  his  elaborate  monograph  on  transfusion,  that  lamb's  blood 
will  answer  the  same  purpose  in  the  human  system  as  human  blood. 

As  the  red  globule  is  the  vivifying  constituent  of  the  blood,  and  as 
the  fibrin  is  non-essential  to  the  most  important  office,  at  least  of  the 
circulating  fluid,  it  is  obvious  that  defibrinated  blood  may  be  used  for 
transfusion.  According  to  the  statistics  collected  by  Gesellius,  of  one 
hundred  and  forty-six  cases  of  transfusion  with  blood  without  defibri- 
nation,  seventy-nine,  or  54'11  per  cent,  were  successful,  and,  of  one 
hundred  and  fifteen  cases  in  which  defibrinated  blood  was  used,  sev- 
enty-nine, or  68'70  per  cent,  proved  fatal.  Mr.  Higginson,  of  Liver- 
pool, reports  thirteen  cases  occurring  under  his  own  observation,  in 
which  mediate  transfusion  with  pure  blood  was  employed,  with  the 
result  of  six  successful.  The  injection  of  defibrinated  blood  is  free 
from  one  source  of  danger — the  introduction  of  clots  into  the  circula- 
tion— which,  as  Panum  has  shown,  will  be  followed  by  the  disastrous 
result  of  multiple  embolisms,  or  thrombus  of  the  pulmonary  artery. 
Separating  the  fibrin,  however,  renders  the  blood  much  less  capable  of 
performing  its  office.  The  necessary  agitation  in  order  to  coagulate 
the  fibrin  injures  the  blood-globules,  and  the  fibrin  itself  is  necessary 
to  prevent  transudations  and  the  recurrence  of  haemorrhage.  With 
the  improved  instruments  now  used  for  the  operation,  and  with  the 
exercise  of  the  necessary  care,  there  need  be  no  formation  of  clots,  the 
chief  danger  in  the  use  of  blood  containing  its  fibrin. 

Transfusion  may  be  mediate  or  immediate.  Mediate  transfusion 
consists  in  the  reception  of  the  blood  in  a  suitable  vessel,  and  its  trans- 
ference by  means  of  an  injecting  apparatus  into  the  veins  of  the  pa- 
tient. Immediate  transfusion  consists  in  an  apparatus  for  making  di- 
rect communication,  from  the  vein  of  the  person  or  animal  furnishing 
the  blood,  with  the  vein  of  the  patient  receiving  it.  A  number  of  ap- 
pliances have  been  invented  for  mediate  transfusion.  Martin,  of  Ber- 
lin, has,  used  in  his  operations  a  glass  syringe  provided  with  a  suitable 
canula  for  insertion  into  the  vein.  Belina  invented  an  apparatus  con- 
sisting of  a  receiver  for  the  blood,  a  hand-ball  like  that  of  the  spray- 
douche,  and  a  flexible  tube  provided  with  a  stop-cock  and  canula.  Beli' 
4 


28  HOW   MEDICINES  ARE   INTRODUCED. 

na,  who  has  treated  at  great  length  of  the  operative  procedure,  decides 
that  all  forms  of  syringes  are  objectionable.  Higginson  proposed  and 
has  used  successfully  an  instrument  similar  to  the  enema-syringe  in- 
vented by  him.  This  apparatus  can,  however,  only  be  used  for  mediate 
transfusion.  As  immediate  transfusion  is  to  be  preferred,  as  a  rule,  it 
were  better  to  be  provided  with  a  suitable  instrument  for  this  opera- 
tion. The  instrument  invented  by  Dr.  Aveling,  and  presented  to  the 
Obstetrical  Society  of  London  in  1864,  is  at  the  same  time  the  simplest 
and  most  effective.  This  consists  of  a  hand-ball  and  flexible  tubes 
like  a  Davidson  syringe,  but  without  valves.  There  are  two  canulae 
attached  to  either  extremity  of  the  flexible  tubes — one  for  insertion 
into  the  vein  furnishing  the  blood,  and  the  other  for  insertion  into  the 
vein  receiving  it.  The  small-sized  Davidson  syringe  will  answer  per- 
fectly well  by  removing  the  valves,  the  action  of  which  tends  to  sepa- 
rate the  fibrin,  and  fitting  to  the  flexible  tubes  suitable  perforated  nee- 
dles or  canulae.  In  using  Aveling's  instrument  it  must  be  first  put  into 
water  at  the  temperature  of  100°  Fahr.,  and  it  must  be  filled  with  warm 
water,  or  better,  a  warm  solution  of  phosphate  and  chloride  of  sodium 
of  a  specific  gravity  of  1020.  The  object  of  this  is  to  exclude  the  air 
from  the  apparatus.  The  next  step  consists  in  inserting  the  canula  in  a 
vein — usually  of  the  forearm — of  the  person  or  animal  furnishing  the 
blood,  and  in  a  position  so  that  the  blood-current  will  be  in  the  direc- 
tion of  the  current  in  the  patient  receiving  it.  Should  the  veins  of  the 
patient  be  collapsed,  the  skin  overlying  those  at  the  elbow  may  be 
transfixed  and  raised,  which  will  bring  into  view  a  vein  into  which  the 
canula  may  be  inserted — care  being  used  here  that  the  direction  of  the 
current  shall  be  toward  the  heart.  The  canulse  can  be  held  in  position 
by  the  fingers  of  assistants.  The  operator  compresses  the  bulb  gently, 
pressing  at  the  same  time  the  supply-tube  between  the  thumb  and  fin- 
ger of  the  other  hand,  in  order  to  prevent  a  reflux  of  the  fluid.  When 
the  bulb  is  emptied,  the  delivery-tube  is  pressed  between  the  thumb 
and  finger  shifted  from  the  supply-tube,  and  the  bulb  is  allowed  to  fill 
with  blood  from  the  source  of  supply.  In  this  way,  successive  charges 
of  fresh  blood  can  be  delivered  without  difficulty  into  the  patient's 
vein.  The  aspirateur  may  be  used  in  the  same  way  for  immediate 
transfusion,  as  has  been  suggested  by  Dr.  J.  W.  Howe,  of  New  York, 
who  has  used  it  successfully.  He  advises  the  substitution  of  smaller 
tubes  than  those  which  accompany  this  instrument,  and  he  has  devised 
suitable  canula?  for  the  veins. 

The  quantity  of  blood  which  it  is  advisable  to  introduce  varies 
from  four  to  eight  ounces.  The  smaller  amount  is  generally  more  suc- 
cessful. Too  large  an  amount  will  seriously  embarrass  the  heart.  A 
further  precaution  is  necessary  as  to  the  manner  of  injection  ;  force 
is  never  necessary,  and  may  be  very  injurious  ;  the  blood  should  be  de- 
livered into  the  vein  slowly  and  gently. 


TRANSFUSION.  29 

Besides  the  danger  arising  from  coagulation  of  the  blood  and  the 
formation  of  thrombi,  immediate  bad  symptoms  or  fatal  syncope  may 
come  on  from  the  introduction  of  air  into  the  veins.  The  utmost  care 
is  necessary  to  exclude  air  from  the  apparatus.  Phlebitis  may  also 
ensue  from  the  injury  done  to  the  vein,  and  the  patient's  life  be  put  in 
jeopardy  from  this  cause,  but  this  is  a  danger  much  more  remote  than 
the  introduction  of  air  and  clots  into  the  circulation. 

As  a  number  of  successful  cases  of  transfusion  (Gesellius,  Hasse, 
and  others)  have  been  reported  in  which  lamb's  blood  was  used,  the 
practitioner  is  now  justified  in  its  employment,  notwithstanding  Landois 
has  shown  by  experiment  that  transfusion  of  mixed  blood  does  injury 
to  the  red  blood -globules.  If  lamb's  blood  is  to  be  used,  the  animal 
should  be  sufficiently  anaesthetized  to  keep  it  quiet,  and  it  should  be 
securely  tied.  A  vein  may  be  selected,  and  immediate  transfusion 
performed  with  Aveling's  instrument  or  with  the  aspirateur  in  the 
mode  already  described. 

Transfusion  is  especially  indicated  in  cases  in  which  life  is  put  in 
imminent  jeopardy  by  haemorrhage.  According  to  Belina,  it  is  in 
haemorrhage  from  abortion,  and  during  the  first  months  of  pregnancy, 
that  transfusion  is  most  successful.  Of  thirteen  cases  of  haemorrhage 
from  abortion  thus  treated,  according  to  this  author,  eleven  had  a 
fortunate  issue.  Of  the  cases  of  post-partum  haemorrhage — eighty-five 
in  number — in  which  this  expedient  was  adopted,  fifty-six  resulted 
favorably.  Routh,  Soden,  Hicks,  McDonnell,  Mudge,  Howe,  and 
others,  have  reported  successful  cases,  not  included  in  the  statistics  of 
Belina.  In  other  forms  of  haemorrhage,  hcematemesis,  intestinal  hcem- 
orrhage,  epistaxis,  etc.,  in  which  death  by  exhaustion  is  imminent,  the 
operation  of  transfusion  is  proper.  Belina  has  collected  twenty-six 
cases  of  traumatic  haemorrhage,  of  which  twelve  resulted  favorably, 
in  two  the  result  was  doubtful,  and  twelve  terminated  fatally. 

Transfusion  has  also  been  employed  in  certain  morbid  states  of  the 
blood,  but  not  with  encouraging  results.  Thus,  Belina  has  collected 
a  number  of  cases  belonging  to  this  category,  of  which  nineteen  termi- 
nated favorably,  in  two  the  result  was  equivocal,  in  three  temporarily 
beneficial,  and  thirty-nine  died.  Two  very  interesting  cases  of  the 
hoBmorrhagic  diathesis  successfully  treated  by  transfusion  have  been 
reported  by  Dr.  Joseph  Buchser,  of  New  York.  This  form  of  consti- 
tutional cachexia  is  especially  an  indication  for  transfusion.  In  the 
treatment  of  ancemia  this  operation  has  not  been  successful.  Thus, 
three  cases  treated  by  Stohr,  of  Wilrzburg,  terminated  fatally.  Cases 
have  also  been  reported  by  Concato,  Cavaleri,  and  others.  Transfusion 
has  been  used  very  successfully  in  cases  of  carbonic-oxide  poisoning 
(Uterhart,  Prof.  Konig,  Prof.  Martin),  and  in  phosphorus-poisoning 
(Prof.  Jurgensen). 

Eulenburg  and  Landois  advise  transfusion  in  cases  of  danger  to  life 


30  HOW  MEDICINES  ARE  INTRODUCED. 

from  poisons  for  which  there  are  no  antidotes.  It  has  been  recom- 
mended, in  such  cases,  to  abstract  blood  and  to  supply  fresh  blood  to 
the  suffering  organism.  Nussbaum  has  employed  transfusion  with 
complete  success  in  epilepsy,  and  it  has  also  been  used  with  favorable 
results  in  eclampsia  due  to  urcemic  poisoning. 

Arterial  Transfusion. — Prof.  Albanese  has  proposed  injection  of 
defibrinated  blood  into  an  artery,  either  the  radial  or  posterior  tibi- 
al,  as  a  substitute  for  the  intra-venous  injection.  The  artery  is  ex% 
posed,  punctured,  and  the  blood  thrown  into  it,  in  the  same  way  as 
in  the  operation  on  the  vein.  It  is  claimed  for  this  method  that 
thrombosis  is  less  apt  to  occur,  and  that  the  danger  arising  from  the 
introduction  of  air  is  obviated.  When  a  large  amount  of  blood  is 
necessary,  it  is  more  safely  introduced  by  the  arterial  system,  because, 
having  to  traverse  the  capillaries  before  reaching  the  right  side  of 
the  heart,  sudden  distention  of  this  organ  is  avoided.  Prof.  Huter, 
who  has  especially  advocated  this  method,  reports  a  number  of  cases 
successfully  performed  in  this  way,  and  Asche  has  collected  a  number 
of  others. 

Transfusion  of  Milk. — The  experiments  of  Donne  on  animals 
demonstrated  the  harmlessness  of  the  intra-venous  injection  of  milk. 
Hodder,  of  Canada,  was  the  first  to  employ  this  expedient  on  man  ; 
and,  of  three  cases  of  cholera  collapse  which  he  thus  treated,  two  re-» 
covered.  Thomas,  of  New  York,  has  also  transfused  milk  with  success 
in  postpartum  haemorrhage  ;  and  Wagstaff  has  failed  twice  with  the 
same  method  in  traumatic  haemorrhage.  Within  the  present  year 
(1880)  Mr.  Arthur  Meldon  has  published  an  account  of  three  cases  in 
which  the  transfusion  of  milk  was  performed  with  success. 

When  milk  is  used  for  transfusion,  it  should  be  fresh  and  directly 
from  the  cow  if  practicable,  and  its  temperature  should  be  that  of  the 
blood  itself — 100°  Fahr.  Not  more  than  four  to  six  ounces  should  be 
injected  at  one  time,  lest  the  heart  be  paralyzed  by  over-distention. 
The  effects  which  follow  the  intra-venous  injection  of  milk  are  very 
much  the  same  as  those  produced  by  blood,  except  that  they  are  prob- 
ably less  permanent,  and  that  albuminuria  is  a  frequent  result.  That 
this  expedient  is  as  useful  as  blood  transfusion  by  the  immediate 
method  has  been  strongly  maintained,  but  the  most  recent  experience 
does  not  justify  this  opinion.  Indeed,  it  is  probable  that  the  chief 
value  of  blood  transfusion,  in  functional  diseases,  is  to  gain  time  for 
the  operation  of  other  and  more  permanent  measures  (Pepper).  We 
also  agree  in  the  estimate  of  Dr.  Pepper  that  transfusion  in  any  of  its 
forms  is  without  utility  in  important  organic  diseases. 

In  an  experimental  inquiry  into  the  methods  of  transfusion,  Schafer 
has  examined  anew  the  question  of  the  substitution  of  some  other  fluid 
for  blood,  deciding  with  Landois,  of  Germany,  and  Howe  and  Dupuy, 
of  America,  that  the  introduction  of  any  other  fluid  does  injury  to  the 


TRANSFUSION.  31 

corpuscles,  and  that  a  fluid  without  haemoglobin  can  not  functionate 
as  blood.  As  respects  the  substitution  of  the  blood  of  some  other 
animal — lamb's  blood,  for  example — the  conclusion  of  Schafer  is  in 
accord  with  the  previously  expressed  judgment  of  Landois,  that  only 
human  blood  should  be  used  in  transfusion  on  man.  Schafer  has  also 
made  some  important  observations  on  the  best  mode  of  performing 
the  operation.  He  finds  that  the  best  results  are  obtained  on  animals 
by  arterial  transfusion,  and  recommends  that  the  dorsal  artery  of  the 
foot  be  used  for  receiving  and  furnishing  the  blood  in  the  operation 
on  man.  When  the  artery  is  used  the  blood  is  received  into  that  part 
of  the  vascular  system  where  it  is  most  needed,  and  only  an  elastic 
rubber  tube  and  glass  canula  are  required,  the  force  of  the  donor's  cir- 
culation being  sufficient  to  propel  the  blood.  There  is  no  danger  of 
the  supply  from  the  donor  becoming  excessive,  as  the  pressure  in  the 
arterial  systems  of  the  donor  and  of  the  recipient  soon  acquires  the 
same  force.  Usually,  and  indeed  unless  the  circulation  in  the  donor 
is  feeble,  no  other  medium  of  communication  is  necessary  besides  the 
flexible  tube  and  glass  canula,  as  the  elastic  pump  of  Aveling's  instru- 
ment does  not  contribute  to  the  force  of  the  flow.  The  tube  and 
canulse  should  be  filled  with  carbonate-of-soda  solution,  both  to  exclude 
air  and  to  prevent  clots  forming.  It  is  not  necessary  to  measure  the 
quantity  of  blood,  as  the  condition  of  the  recipient  furnishes  the  true 
indications  to  be  followed. 

Peritoneal  Transfusion. — To  the  various  kinds  of  transfusion  must 
now  be  added  this  form,  originally  proposed  by  Ponfick.  With  anti- 
septic precautions,  a  trocar  with  canula  is  passed  through  the  abdomi- 
,nal  walls  in  the  linea  alba.  A  flexible  tube,  with  a  glass  funnel  at- 
tached, is  then  connected  with  the  canula — the  trocar  being  withdrawn 
— and  defibrinated  blood  is  poured  into  the  cavity.  Excellent  results 
follow  this  practice,  which  the  researches  of  Bizzozero  and  Golgi  have 
shown  to  be  based  on  sound  physiology.  This  method  has  been  used 
successfully  by  Von  Kaczorowski  and  others  in  the  various  maladies 
in  which  the  other  modes  of  transfusion  have  been  employed.  Some 
adverse  reports  have,  however,  been  made.  Peritonitis  has  been 
caused  by  the  procedure,  but  in  these  cases  the  subjects  operated  on 
may  have  been  unsuitable  ones.  On  the  whole,  peritoneal  transfusion, 
which  at  one  time  promised  to  be  a  valuable  measure,  must  be  regarded 
as  still  subjudice — if,  indeed,  its  utility  is  not  questionable. 

Dr.  Joseph  W.  Howe,  of  New  York,  who  has  made  many  valuable 
observations  on  transfusion,  in  a  recent  issue  of  the  "New  York 
Medical  Journal "  (February  3,  1883),  announces  that  no  other  expedi- 
ent can  be  properly  substituted  for  the  intra-venous  injection  of  blood. 
When  life  is  endangered  by  haemorrhage,  Dr.  Howe  holds  that  it  is 
not  advisable  to  wait  for  intestinal  or  peritoneal  absorption,  but  that 
mtra-venous  transfusion  should  be  practiced  without  delay. 


32  HOW   MEDICINES  ARE   INTRODUCED. 

Infusion  of  Salt  Solution. — The  solution  of  common  salt — from  1 
to  5  per  cent — in  distilled  and  sterilized  water,  is  employed  for  this 
purpose.  A  fountain  syringe  with  a  suitable  needle  for  transfixing  the 
skin  is  the  simple  instrumental  means  required.  The  hypodermatic 
needle  is  suitable  for  most  of  the  cases,  but  longer  and  larger  needles 
may  be  necessary  in  special  cases.  The  best  places  for  practicing  the 
infusion  are  those  where  the  skin  is  loose  and  the  space  most  abun- 
dant, as  in  the  armpits,  in  the  lumbar  and  inguinal,  and  in  the  pop- 
liteal regions.  The  pressure  obtained  by  elevating  the  reservoir  deter- 
mines the  rapidity  with  which  the  solution  enters  the  subcutaneous 
connective  tissue.  The  effect  of  the  infusion  on  the  powers  of  life  is 
remarkable.  In  fact,  it  has  been  found  that  the  method  of  infusion 
of  salt  solution  is  nearly  equal  to  the  intravenous  injection  of  the 
same,  or  to  transfusion  of  blood.  This  procedure  has  greatly  devel- 
oped in  the  last  few  years,  and  is  freely  used  in  conditions  of  depres- 
sion of  the  powers  of  life,  the  result  of  haemorrhage  or  exhausting  dis- 
charges, in  uraemic  convulsions,  in  diabetic  coma,  and  in  many  cases 
in  which  heart  failure  is  threatened  by  sudden  losses  of  fluid,  or  by 
unexpected  weakness  of  the  centers  presiding  over  important  functions. 


THE  TROY  SYSTEM.  33* 

V. 
PRESCRIPTION  WRITING. 

THE  TROT  SYSTEM. — Until  the  Pharmacopoeia  of  1890  appeared, 
the  weights  used  in  compounding  drugs  were  from  the  Troy  pound, 
and  the  measures  from  the  wine  gallon.  These  are  still  largely,  indeed, 
chiefly  used.  The  edition  of  the  Pharmacopoeia  of  1890  adopted  the 
metric  system,  and  hence  it  is  necessary  for  the  prescriber  to  be  famil- 
iar with  both. 

Certain  symbols  are  employed  in  representing  weights  : 

The  pound  is  represented  by "  libra  "  (g>). 

The  ounce "  uncia  "          (  §  ). 

The  drachm "  drachma  "     ( 3  ). 

The  scruple " scrupulum "  (3). 

The  grain "  granum  "      (gr.). 

The  measures  of  quantity  from  the  wine  gallon  are  also  represented 
by  certain  symbols,  as  follows  : 

The  gallon  is  represented  by "  congius  "  (C). 

The  pint "  octarius  "  (O). 

The  fluid  ounce "  fluiduncia  "     (f  §  ). 

The  fluid  drachm "  fluidrachma  "  (f  3  ). 

The  minim "  minimum  "        (m,). 

The  letter  "f  "  is  placed  before  the  symbols  for  ounce  and  drachm 
respectively. 

The  domestic  measures  are  nearly  as  given  below  : 

A  teaspoon  contains  about 1  drachm. 

A  dessertspoon  "  "     2  drachms. 

A  tablespoon      "  "     4        " 

A  wineglass        "  "     2  fluid  ounces. 

Usually  the  measures  of  weight  are  used  to  represent  quantity  as 
well.  In  that  case  the  same  symbols  may  represent  both.  In  pre- 
scribing liquids  the  letter  "  f "  is  generally  made  to  precede  the  sym- 
bol, for  the  reason  that  some  liquids  weigh  more,  others  less,  than  the 
indicated  quantity. 

Terms  Used  in  Prescription  Writing. — A  medical  prescription  is 
a  formal  expression  of  the  physician's  instructions  addressed  to  the 
authorized  compounder  of  medicines — the  apothecary.  The  word 
"  prescription  "  is  derived  from  the  Latin  "  prae,"  before,  and  "  scribo," 
I  write,  or  "  scriptum,"  written.  Prescriptions  are  written  in  Latin,  as 
are  also  the  formulae  of  the  present  Pharmacopoeia.  The  reasons  for 
the  continued  use  of  Latin  are  long  custom,  and  because  Latin,  a  dead 
language,  is  not  subject  to  the  variations  of  form  and  meaning — the 
fluctuations — of  a  living  language,  which  is  frequently  adopting  new 
words  and  terms,  and  changing  the  meaning  of  the  old. 


34*  PRESCRIPTION  WRITING. 

Long  usage  has  given  a  special  form  to  medical  prescription.  It 
is  made  up  of  the  basis,  or  chief  ingredient ;  the  adjuvant,  or  modify- 
ing material ;  the  corrigent,  or  correcting  substance  ;  the  excipient, 
for  the  proper  combination  of  the  whole  into  a  uniform  body  ;  and 
the  vehicle,  for  containing  all  in  a  uniform  solution,  mass,  or  mixture. 
In  actual  practice  this  is  much  simplified. 

In  writing  a  prescription  it  is  usual  to  begin  with  the  letter  R 
crossed  thus,  $,  and  this  signifies  "  recipe,"  "  take,"  and  is  an  imitation 
of  the  invocation  to  Jupiter,  with  which  the  ancient  physicians  began 
their  prescriptions.  In  constructing  a  prescription  the  proper  Latin 
form,  so  far  as  necessary,  should  be  adhered  to.  The  word  "  recipe  " 
governs  the  object  in  the  accusative,  and  here  the  object  is  the  quan- 
tity of  the  several  ingredients  composing  the  prescription.  The 
quantity  in  grains,  drachms,  or  ounces  governs  the  medicament  in  the 
genitive,  represented  by  the  English  preposition  "of."  Thus,  $, 
"  recipe,"  take,  for  example,  one  scruple,  "  scrupulum  unum,"  of  sulphate 
of  iron,  ferri  sulphatis,  "ferri"  and  "sulphatis"  being  the  genitives  of 
"ferrum  "  and  "  sulphas."  The  same  construction  obtains  for  the  adju- 
vant, the  corrigent,  and  for  the  vehicle.  In  prescriptions  as  usually 
written,  the  excipient  is  rarely  given,  the  addition  of  this  being  left  to 
the  judgment  of  the  compounder.  When  the  several  parts  or  ingre- 
dients have  been  written,  then  follows  the  instructions  as  to  form.  If 
all  ingredients  are  liquid,  the  prescriber  may  content  himself  with  sim- 
ply writing  under  their  names  and  proportions  the  first  letter  of  the 
word  mix,  Latin  "  misce."  If  pills  or  powders  are  intended,  then,  in 
addition  to  M.,  should  be  written  M.  div.  in.  pil.  no.  xii,  or  M.  ft.  pil. 
or  pulv.  no.  x,  etc.  When  the  form  and  number  of  the  pills  or  pow- 
ders are  determined  on,  then  follows  the  instructions  directed  by  the 
word  "  signa  "  or  the  letter  S.,  which  signifies  "  write."  There  are  a  few 
rules  for  determining  case,  which  the  prescriber  should  be  familiar 
with,  as  follows  : 

Rule  1. — The  quantity  is  put  in  the  accusative  case,  governed  by 
the  word  "recipe." 

Rule  2. — If  no  quantity  is  expressed,  the  substance  ordered  is  put 
in  the  accusative. 

Rule  3. — Adjectives  agree  with  nouns  in  gender,  number,  and 
case. 

The  substance  in  the  genitive  case  is  governed  by  the  word  for 
quantity,  as  already  mentioned. 

The  terminations  of  nouns  and  adjectives  vary  with  the  declen- 
sion. Thus : 

Nouns  ending  in  "a"  are  of  the  first  declension,  and  have  their 
genitive  in  "  se  "  ;  as  aqua,  aquae. 

Nouns  ending  in  "  us,"  "  um,"  "  os,"  "  on  "  have  their  genitive  in 
"  i "  ;  as  hydrargyrum,  hydrargyri,  etc. 


THE  TROY  SYSTEM.  35* 

All  other  nouns  make  their  genitive  in  "  s  "  or  "  is,"  as  chloral, 
chloralis  ;  but  in  some  the  termination  is  lengthened.     Thus  : 
"  as,"  genitive  "  atis,"  as  acetas  acetatis. 
"  is,"  genitive  "  idis,"  as  anthemis,  anthemidis. 
"  o,"  genitive  "  onis,"  as  pepo,  peponis. 
"x,"  genitive  "cis,"  as  cortex,  corticis. 

A  few  prepositions  are  used  in  the  construction  of  prescriptions. 
They  are  the  following  : 

"  Ad,"  to  ;  "  ana,"  of  each  ;  "  in,"  into  ;  "  cum,"  with. 
Of  these,  "  ad  "  and  "  in  "  govern  the  accusative,  "  cum  "  the  abla- 
tive, and  "  ana  "  the  genitive. 

Other  phrases  with  their  abbreviations  follow  : 

Quantum  sufficiat q.  s.,    a  sufficient  quantity. 

Granum gr.,      a  grain. 

Gutta gtt.,     a  drop. 

Semissis ss.,       a  half. 

Pilula  pil.,      a  pill. 

Chartula chart.,  a  powder. 

Mistura mist.,  a  mixture. 

Liquor liq.,      a  solution. 

Pulvis pulv.,  a  powder. 

Tinctura tinct.,  a  tincture. 

Syrupus syr.,     a  syrup. 

Aqua aq.,      water. 

Fluidus,  adjective fl.,        fluid. 

Dilutus,  adjective dil.,      diluted. 

Ana aa.,      of  each. 

In  writing  the  directions  for  a  prescription,  many  of  the  verbs  em- 
ployed are  abbreviated. 

Thus,  "fiant"  and  "fiat,"  make,  "ft."  ;  "misce,"  mix,  M. 
"Divide,"  Div.,  "Signa,"  write,  S. 

Prescriptions  are  extemporaneous  or  official.  The  latter  are  con- 
tained in  the  United  States  Pharmacopoeia.  For  example,  the  com- 
pound cathartic  pill.  In  directing  an  official  combination  of  this  kind, 
we  proceed  as  follows  : 

I£  Pil.  cathartic,  comp.  (U.  S.  P.)  no.  xii. 

S.  One  or  two  pills  at  night. 

These  abbreviations  are  sufficiently  clear  to  permit  no  mistake.  If 
written  out  they  would  be  : 

1^   Pil.  catharticse  composite  no.  xii. 

There  are  but  fifteen  formulae  of  official  pills  in  the  Pharmacopoeia, 
and  nine  of  these  are  purgative  combinations.  In  prescribing  them, 
the  official  title  should  be  made  use  of.  For  example,  Pilulse  ferri 


3G*  PRESCRIPTION   WRITING. 

iodidi.  To  avoid  the  necessity  of  changing  the  termination,  the  word 
pilulse  is  abbreviated  into  pil. 

Among  the  products  of  the  manufacturing  pharmacist's  art  are 
compressed  pills  or  "pellets,"  "tablets,"  or  "tabloids,"  in  which  the 
pill  mass  is  formed  by  the  compressing  machines.  Although  these 
preparations  are  not  "  official,"  rightly  speaking,  the  official  forms  may 
be  thus  prepared. 

In  prescribing  pills  extemporaneously  certain  considerations  must 
have  due  weight.  The  pill  mass  must  not  be  too  large.  By  common 
consent,  the  pill  should  not  exceed  five  grains  in  weight.  Deliques- 
cent substances,  those  too  great  in  bulk,  oils,  emetics,  and  stimulants 
are  not  suitable  for  this  mode  of  administration.  When  the  pill  mass 
is  bulky  and  the  taste  disagreeable,  capsules  are  substituted,  as  in  the 
examples  given  below.  A  few  formulae  will  suffice  to  show  the  mode 
in  which  extemporaneous  prescriptions  are  constructed. 

]J  Ext.  colocynth.  comp 3  j ; 

Ext.  rhei gr.  xij ; 

Ext.  belladonnas gr.  iij. 

Misce  et  ft.  pil.  no.  xii. 
S.  :  One  pill  at  night. 

Or,  instead  of  pills,  the  mass  may  be  put  into  gelatine  capsules, 
as  follows  : 

IJ   Quininse  sulphatis 3  j  ; 

Ferri  sulphatis gr.  xij  ; 

Extract!  nucis  vomicae gr.  iij. 

M.  Ft.  capsulae  no.  xii. 

S.  :  A  capsule  morning  and  night. 

In  these  prescriptions  the  material  used  for  forming  the  pill  mass 
is  left  to  the  discretion  of  the  pharmacist,  whether  he  employs  for  this 
purpose  syrup,  gum,  or  acid. 

A  powder  (chartula)  is  made  use  of  when  the  medicament  is  bulky, 
not  deliquescent,  and  not  disagreeable  to  the  taste.  They  are  of 
various  sizes,  according  to  number  and  weight  of  the  ingredients. 
When  the  taste  is  bad,  or  for  the  sake  of  convenience,  the  contents 
are  put  in  a  wafer  instead  of  in  a  paper.  The  following  is  the  mode 
in  which  a  prescription  for  powders  is  written  : 

3  Hydrarg.  chlor.  mitis gr.  j  ; 

Sodii  bicarb gr.  xij  ; 

Pulv.  aromatic gr.  vj. 

M.  div.  in  pulv.  vel  chartulas  no.  xii. 

Sig.  :  One  powder  or  wafer  three  times  a  day. 

Mixtures  (misturae)  are  made  by  mixing  fluid  preparations,  salts 
that  can  be  dissolved  in  a  suitable  menstruum  or  held  in  suspension 


THE   TROY  SYSTEM.  37* 

by  agitation,  or  substances  that  may  be  diffused  and  held  by  the  use 
of  suitable  excipients.  Mixtures  to  be  of  proper  consistency  should 
hold  certain  proportions.  For  example,  one  fluid  ounce  should  con- 
tain about  one  drachm  of  a  vegetable  powder  and  one  scruple  of  a 
vegetable  extract. 

Emulsions  are  mixtures  made  by  suspending  an  oil  or  resin — an  oil 
by  means  of  gum,  or  yolk  of  egg,  or  tragacanth  ;  a  resin  by  means  of 
an  alkali ;  and  if  a  gum  resin,  the  proportion  of  gum  present  suffices 
to  suspend  the  resin.  The  U.  S.  Pharmacopeia  recognizes  four  mix- 
tures and  four  emulsions.  Of  the  latter,  two  are  made  merely  by 
triturating  thoroughly  with  water,  as  emulsum  asafetidae  and  emul- 
sum  ammoniaci.  The  emulsion  of  chloroform  is  made  by  triturating 
chloroform  with  oil  of  almond  and  gum  tragacanth. 

The  following  forms  will  show  the  manner  of  prescribing  a  mix- 
ture and  an  emulsion  : 

$   Misturae  f erri  composite f  iv. 

S.  :  A  dessertspoonful  three  times  a  day. 

$   Emulsi  ammoniaci §  viij. 

S.  :  A  tablespoon  ful  as  required. 

3   Bismuthi  subnitratis 3  iij  ; 

Pulvis  aromatic! 3  j ; 

Mucilaginis  acacise q.  s.  ; 

Aquae  menthae  pip ad  f  §  iv. 

S.  :  Two  teaspoonfuls  every  four  hours. 

Suppositories  (suppositoria).  The  Pharmacopeia  recognizes  but 
a  single  formula — suppositoria  glycerini — beside  the  model.  But  it 
prescribes  the  size  and  form  of  the  several  kinds.  Thus,  "  rectal  sup- 
positories" should  be  cone  shaped  and  of  a  weight  of  about  one 
gramme  (15-4)  ;  "  urethral  suppositories  "  should  be  pencil  shaped 
and  of  a  weight  of  about  one  gramme  (15'4)  ;  "vaginal  suppositories" 
should  be  globular  (or  ovoid),  and  of  a  weight  of  about  three  grammes 
(46  grains). 

The  following  prescription  may  serve  as  a  model : 

IJ  Acidi  tannici 3  j  ; 

Olei  theobromae q.  s. 

M.  et  ft.  suppositoria  vaginale  no.  vi. 

Linimenta  (liniments)  are  preparations  for  topical  application,  to 
be  rubbed  in  with  friction,  and  sufficiently  active  to  cause  some  rube- 
faction,  or  they  may  have  anodyne  and  vesicating  properties.  The 
United  States  Pharmacopeia  recognizes  nine  liniments  as  official,  and 
they  are  so  various  in  composition  and  quality  that  it  is  rarely  neces- 
sary to  write  an  extemporaneous  prescription  calling  for  some  other 


38*  PRESCRIPTION   WRITING. 

combination.     In  directing  an  official  liniment,  the  nomenclature  of 
the  Pharmacopoeia  should  be  adhered  to.     For  example  : 

3   Linimenti  ammoniae q.  s. 

S.  :  Ammonia  liniment — for  external  use. 

Plasters  (emplastra).  There  are  thirteen  official  combinations  con- 
tained in  the  United  States  Pharmacopoeia  (1890).  The  materials  are 
of  such  consistency  and  firmness  as  to  be  spread  on  lead  or  resin 
plaster.  When  a  plaster  is  ordered  by  prescription,  the  following 
procedure  should  be  made  use  of  : 

$   Emplastri  picis  cantharidati quantum  sufficiat 

fiat  emplastrum  ii. 
S.  :  Warming  plaster. 

When  a  blistering  plaster  is  desired,  the  following  method  is  used: 

IJ   Cerati  cantharidis q.  s. 

ft.  emplastrum  11  X  11. 
S.  :  Apply  to  seat  of  pain. 

Besides  the  foregoing  there  are  other  forms  for  the  prescription  of 
medicinal  agents,  but  as  they  are  seldom  used,  and  the  principles  gov- 
erning them  are  the  same  as  those  above  given,  it  is  the  less  necessary 
to  enter  into  further  details. 

THE  METRIC  SYSTEM. — Since  the  introduction  of  the  metric  sys- 
tem, its  use  has  become  almost  universal  among  scientific  men  as  the 
standard  of  weights  and  measures.  It  was  not,  however,  until  1890 
that  the  United  States  Pharmacopoeia  adopted  it  for  use  in  that  work, 
and  as  it  is  likely  to  continue  as  the  standard,  it  were  well  that  all 
practitioners  who  have  occasion  to  write  prescriptions  based  on  the 
official  list  of  remedial  agents  should  be  familiar  with  it. 

The  metric  system  is  based  on  the  meter,  which  is  the  unit  of  linear 
measurements  and  is  equivalent  to  39*37  inches.  The  meter  is  subdi- 
vided into 

Decimeter,  or  one  tenth  of  the  meter  ; 
Centimeter,  or  one  hundredth  of  the  meter  ; 
Millimeter,  or  one  thousandth  of  the  meter. 

In  writing  prescriptions  the  decimeter  is  rarely  employed.    , 

The  unit  of  weight  is  the  gramme,  which  is  the  weight  of  one 

cubic  centimeter  of  water  at  4°  C.,  the  point  of  maximum  density  ; 

1  gramme  is  equivalent  to   15*432  Troy  grains,  and  is  written    1  ; 

1  decigramme  is  equivalent  to  -fa  of  a  gramme,  and  is  written  *1  ; 

1  centigramme  is  equivalent  to  y^  of  a  gramme,  and  is  written  '01  ; 

1  milligramme  is  equivalent  to  y-gVff  of   a  gramme,  and  is  written 

•001. 

The  abbreviation  for  the  gramme  is  gm.    Quantities  by  weight  are 


THE  METRIC  SYSTEM.  39* 

employed  both  for  fluids  and  solids,  but  in  a  few  instances  it  is  neces- 
sary to  allow  for  differences  in  specific  gravity  of  some  liquids. 

Instead  of  Roman  numerals,  quantities  are  expressed  in  Arabic 
figures.  Thus,  for  x  is  written  10. 

The  following  rules  for  quantity  should  be  remembered  : 

One  Troy  grain  or  minim  is  the  equivalent  of  0*06  gramme. 

One  drachm,  or  fluid  drachm,  is  the  equivalent  of  4  grammes. 

One  ounce,  or  fluid  ounce,  is  the  equivalent  of  30  grammes. 

One  gramme,  or  fluid  gramme,  is  the  equivalent  of  15  grains  or 
minims. 

Four  grammes,  or  fluid  grammes,  is  the  equivalent  of  1  drachm. 

Thirty  grammes,  or  fluid  grammes,  is  the  equivalent  of  1  ounce. 

In  writing  a  prescription  by  the  metric  method,  it  is  usual  to  draw 
a  vertical  line  to  separate  the  grammes  from  the  centigrammes  and 
milligrammes — thus  : 

$  Quininse  sulphatis 4 

Ferri  sulphatis 1 

Extract!  nucis  vomicae 5 

M.  Ft.  pil.  no.  30. 

S.  :  One  pill  three  times  a  day. 

Or  the  same  might  be  written  without  the  line,  but  by  decimal 
points,  thus  : 

3  Quininae  sulphatis 4' 

Ferri  sulphatis 1* 

Extract!  nucis  vomicae ...  '5 

M.  Ft.  pil.  no.  30  ;  or,  M.  ut  fiant  pilulae  no.  30. 

S.  One  pill  three  times  a  day. 

One  of  the  great  merits  of  the  metric  system  is  its  simplicity. 
Our  French  colleagues  rarely  use  other  weights  than  the  gramme 
and  centigramme,  and  although  designating  the  article  required  in  the 
terms  of  the  French  Codex  in  Latin,  write  the  instructions  and  direc- 
tions in  their  own  tongue.  It  is  best  to  conform  to  the  French  method 
in  these  respects. 

As  already  remarked,  in  prescribing  fluids  by  this  system,  parts  by 
weight  and  volume  are  made  to  be  mutually  convertible.  Some  fluids, 
however,  weigh  considerably  more  than  they  measure  ;  others  less. 
Thus,  while  one  drachm  or  one  teaspoonful  of  water  weighs  3'75 
grammes,  the  same  quantity  of  chloroform  weighs  about  5*50  grammes, 
and  the  same  quantity  of  ether  only  2-80  grammes.  Allowance  must 
be  made  for  these  articles,  but,  generally  speaking,  parts  by  weight  and 
volume  are  written  in  the  same  way. 

In  the  following  table  the  equivalents  are  sufficiently  accurate  to 
be  employed  in  prescribing  by  the  metric  system  : 


40*  PRESCRIPTION  WRITING. 

Measures  of  Length. 

1  meter  is  equivalent  to  1-0936  yards. 

1     "      "          "  "  3-280    feet. 

1      "       "          "  "  39-370    inches. 

1  centimeter  is  equivalent  to     0*393    inch. 
1  millimeter  "          "  "      0-0393    " 

Fluid  Measures. 

1  liter  is  equivalent  to  1-0567  quarts. 

1     "     "          "  "  2-113    pints. 

1     "     "          "          "  33-814    fluid  ounces. 

1     "     "          "  "  270-519    fluid  drachms. 

1  cubic  centimeter  is  equivalent  to  16-231  minims. 

The  following  are  the  equivalents  of  metric  weights  in  grains 


Milligrammes. 

Approximate. 

Exact  equivalent 

•001          = 

irV  grain 

=          -0154 

•002          = 

A  grain 

=          -0308 

Centigrammes. 

•01            = 

i  grain 

=          '1542 

•02            = 

i  grain 

•3086 

Grammes. 

1-00            = 

15-  gr. 

=        15-434 

2-00            = 

3  ss 

=        30-868 

3-00            = 

3ij 

=        46-302 

4-00            = 

3j 

=        61-736 

PART  II. 
THE  ACTIONS  AND    USES   OF  REMEDIAL  AGENTS. 


THOSE  USED  TO  PROMOTE  CONSTRUCTIVE 
METAMORPHOSIS. 

ALIMENTS. 

THIS  extensive  subject  can,  in  this  work,  be  considered  briefly  only, 
and  from  the  point  of  view  of  therapeutics.  The  various  aliments  are 
of  the  first  importance  as  remedial  agents.  No  satisfactory  repair  of 
diseased  or  wasting  tissues  can  take  place  without  a  suitable  supply 
of  healthy  blood,  and  healthy  blood  is  the  product  of  proper  food  and 
normal  digestion  and  assimilation. 

THE  PHYSIOLOGICAL  RELATIONS  OF  FOOD. — The  food  of  man  is 
derived  from  the  three  great  kingdoms  of  nature  :  mineral,  vegetable, 
animal.  It'maybe  conveniently  classified  into  three  principal  groups  : 
1.  Mineral  constituents — incombustible  or  unoxidizable  :  water,  phos- 
phate of  lime,  chloride  of  sodium,  etc.  ;  2.  Oxidizable — heat-produc- 
ing and  force-forming — carbon  compounds  :  fat,  sugar,  starch,  gum, 
etc.  Nitrogenous  —  flesh-forming  :  albumen,  fibrin,  casein,  etc.  ;  3. 
Food  adjuncts — alcohol,  acids  (citric,  tartaric,  etc.),  alkaloids  (caffeine, 
theine,  etc.). 

The  members  of  the  first  group  will  be  discussed  hereafter,  under 
the  head  of  "  agents  promoting  constructive  metamorphosis  "  ;  the  sec- 
ond group,  the  most  important,  will  be  considered  in  this  relation,  with 
the  foods  ;  and  the  third  will  have  separate  treatment  under  appro- 
priate heads. 

The  classification  of  foods,  originally  formulated  by  Liebig,  if  not 
too  strictly  adhered  to,  is  of  much  utility,  as  indicating  the  general 
purposes  of  these  substances  in  the  economy — viz.:  carbonaceous  or 
force-producers  ;  nitrogenous  or  flesh-formers.  Under  the  first  divis- 
ion are  comprehended  fat,  starch,  sugar,  etc.  ;  under  the  second,  sub- 
stances containing  nitrogen,  as  albumen,  casein,  etc.  There  is  not, 
however,  a  rigid  line  of  separation  between  these  two  classes,  for  both 


34  RESTORATIVE   AGENTS. 

are  more  or  less  concerned  in  the  functions  attributed  to  each,  but 
their  most  important  position  and  office  are  as  assigned  by  the  classifi- 
cation. 

The  ultimate  uses  of  food  are  two  :  to  construct  tissues  or  repair 
them  when  destroyed  by  wear  ;  to  supply  force — muscular,  nervous, 
secretory,  etc.  The  reception,  digestion,  and  absorption  of  food  is 
known  as  the  primary  assimilation  ;  the  utilization  of  the  material 
for  the  growth  and  repair  of  the  tissues,  and  by  the  organs,  as  force, 
constitutes  the  secondary  assimilation. 

The  first  step  in  the  primary  assimilation  is  the  mechanical  subdi- 
vision of  the  food  by  mastication.  The  admixture  of  the  saliva  with 
the  food  facilitates  the  process  of  mastication,  and,  as  it  contains  a 
ferment,  ptyalin,  which  has  the  property  of  converting  starch  into 
sugar,  a  portion  of  this  constituent  undergoes  conversion  ;  but,  prob- 
ably, the  chief  use  of  the  saliva  is  to  give  a  slight  alkaline  reaction  to 
the  mass  of  food.  According  to  the  laws  of  osmosis,  the  entrance  of 
an  alkaline  fluid  into  the  stomach  hastens  the  formation  of  the  acid 
gastric  juice.  In  the  stomach,  under  the  influence  of  the  ferment, 
pepsin,  and  the  acid  (hydrochloric)  of  the  gastric  juice,  the  nitrogenous 
materials — the  albuminous  constituents  of  the  food,  the  proteids — are 
transformed  into  peptones.  Although  fat  is  necessary  to  the  stomach 
digestion,  it  does  not  undergo  conversion  in  the  stomach,  and  escapes 
in  a  coarse  emulsion,  with  the  chyme,  into  the  duodenum.  Starch, ' 
sugar,  and  gum,  also  pass  into  the  chyme  unchanged,  although  sepa- 
rated from  their  proteid  envelopes,  by  the  action  of  the  gastric  juice, 
except  such  portions  as  may  diffuse  directly  into  the  stomach- veins. 
The  peptones,  to  a  large  extent,  diffuse  into  the  blood  from  the  ston> 
ach,  and  doubtless,  also,  such  crystalloidal  substances  as  sugar,  to 
some  extent.  The  chyme  contains  parapeptones,  starch,  fat,  sugar, 
and  refuse  matter  remaining  undissolved.  In  the  duodenum  the  acid 
chyme  mixes  with  the  alkaline  intestinal  and  pancreatic  juices  and 
the  bile,  which  are  poured  out  freely  as  the  materials  from  the  stom- 
ach distend  the  canal.  Here  the  conversion  of  starch  into  sugar  takes 
place  actively,  and  the  fats  are  emulsionized  and  to  some  extent,  also, 
saponified.  The  pancreatic  juice  not  only  emulsionizes  the  fats,  but 
separates  them  into  their  component  fat  acids  and  glycerin,  and  the 
acids  meeting  alkaline  bases  form  soaps,  which  are  readily  diffusible. 
The  action  of  the  bile  is  also  very  important.  It  renders  the  soaps 
formed  soluble,  and  promotes  the  em  unionizing  of  the  fats.  Its  agen- 
cy in  the  digestion  of  the  fats  is  well  shown  in  the  results  of  the  ex- 
periment  for  forming  a  biliary  fistula.  When  the  bile  is  conveyed 
externally,  the  amount  of  fat  entering  the  lacteals  is  much  below  nor- 
mal, and  instead,  the  fat  appears  in  the  stools.  In  the  small  intestine 
the  proteids  which  escape  conversion  in  the  stomach  are  transformed, 
under  the  agency  of  the  bile,  pancreatic  fluid,  and  intestinal  juice,  into 


ALIMENTS— ANIMAL.  35 

peptones  and  other  substances,  the  starch  is  converted  into  suger,  and 
the  fats  are  emulsionized,  and  in  part,  also,  saponified.  These  nutri- 
tion materials  diffuse  into  the  portal  veins  and  into  the  lacteals,  so 
that,  by  the  time  the  intestinal  contents  reach  the  ileo-caecal  valve, 
they  are  composed,  for  the  most  part,  of  excrementitious  matters  and 
the  refuse  of  the  foods  taken. 

When  the  nutrition  of  the  body  goes  on  in  the  normal  manner, 
there  exists  a  certain  ratio  between  the  income  and  the  outgo.  The 
income  consists  of  the  proteids,  fats,  carbohydrates,  salts  and  water 
of  the  food,  together  with  the  oxygen  absorbed  from  the  atmosphere. 
The  outgo  is  made  up  of  the  excreta  of  the  respiratory  act,  consist- 
ing of  carbonic  acid  and  water  with  a  little  hydrogen  ;  of  the  perspira- 
tion, composed  of  water  and  salts  ;  of  the  urine,  which  contains  the 
nitrogen  excreted  from  the  body  and  a  large  quantity  of  saline  matter  ; 
and  of  the  faeces,  composed  of  excreta  from  the  immense  glandular 
apparatus  of  the  ileum  and  colon,  and  from  the  liver.  In  a  perfectly 
healthy  condition  of  the  body,  after  it  has  attained  its  full  growth, 
there  should  be  an  exact  ratio  between  the  income  and  outcome  ;  the 
income  should  suffice  to  furnish  the  force  necessary  for  the  perform- 
ance of  the  various  functions  and  to  repair  the  waste  of  the  outcome. 
In  an  ideal  dietary,  the  amount  of  the  food  should  be  sufficient  to 
maintain  this  ratio  at  the  normal  standard. 

As  respects  classification  of  foods,  for  the  purposes  of  this  work, 
they  may  be  considered  under  the  natural  divisions  of  Animal  and 
Vegetable. 

Animal. — One  of  the  most  important  articles  of  diet  for  the  sick 
is  Beef,  which  should  be  of  good  quality.  The  bone  should  not  ex- 
ceed 20  per  cent ;  the  fat  should  be  firm,  not  yellow,  and  free  from 
blood,  and  should  not  be  in  too  great  proportion  relatively ;  the  mus- 
cle should  be  firm  without  being  tough,  not  too  pale,  nor  dark-colored, 
and  should  not  present  any  marbling  or  lividity  on  cross-section.  The 
most  esteemed  parts  of  the  beef  are  the  thigh  and  hip  (round,  sir- 
loin, fillet),  the  loin,  and  certain  parts  of  the  shoulder  (rib-roast, 
porter-house  steak,  etc.). 

Beef  varies  much  in  composition,  according  to  the  age  of  the  ani- 
mal, the  state  of  its  nutrition,  the  kind  of  food-stuffs  employed  to  fat- 
ten the  beast,  and  the  hygienic  character  of  the  animal's  environments. 
The  age  should  be  four  to  five  years,  and  the  amount  of  fat  appropriate 
to  a  well-kept  and  well-fed  animal.  The  best  proportions,  taking  the 
mean  of  various  analyses,  Continental  and  English,  are  about  as  follows  : 

Water 72*5 

Nitrogenous  matters,  or  albuminates 2T3 

Fat 5.2 

Extractives  and  salts 2'5 

5 


36  RESTORATIVE   AGENTS. 

The  composition  of  cooked  meat,  according  to  Moleschott  (Parkes), 
is  as  follows : 

Water 54'0 

Albuminates 27'6 

Fats 15-45 

Salts 2-95 

It  will  be  perceived  from  the  foregoing  analyses  that  beef  contains  ali- 
mentary principles  the  most  important  for  the  nutrition  of  the  body. 
When  of  good  quality,  neither  too  old  nor  too  young,  the  fat  and  mus- 
cle suitably  proportioned,  and  not  altered  by  disease,  and  properly 
cooked,  it  is  the  best  of  the  animal  foods.  The  loss  of  lean  beef  in  the 
process  of  cooking  is  about  one  third  of  the  total  weight ;  of  fat  beef, 
about  one  half.  The  time  required  for  the  complete  digestion  of  beef, 
as  ascertained  by  Dr.  Beaumont,  is  two  and  three  fourths  to  three 
hours. 

Veal  is  less  digestible  and  less  nutritious  than  beef,  and  has  a  laxa- 
tive action,  which  may,  however,  be  utilized  in  states  of  disease.  It 
has  the  following  composition  : 

Parts. 

Water 63'0 

Nitrogenous 16'5 

Fat 15-8 

Salts 4-Y 

As  compared  with  beef,  it  is  rather  slow  of  digestion,  requiring  five 
hours  or  more.     It  is  more  albuminous  than  fibrinous,  and  abounds  in 
gelatin  (Fonssagrives).     The  thymus  gland  of  the  veal  (sweetbread)* 
is,  when  "  plainly   cooked  (by  boiling)  and  moderately  seasoned,  a 
very  agreeable  and  suitable  dish  for  the  convalescent." — (Pereira.) 

Mutton,  although  possessing  a  lower  degree  of  nutritive  value  than 
beef,  is  one  of  the  most  useful  of  the  animal  foods,  as  it  is  easily  di- 
gested. Many  patients,  however,  experience  a  marked  degree  of  re- 
pugnance to  mutton  and  can  not  be  induced  to  make  use  of  any  article 
of  diet  containing  it.  An  evident  idiosyncrasy  exists  in  some  consti- 
tutions against  it,  so  that  taken  disguised  in  any  way  it  disagrees  with 
the  stomach.  It  does  not  continue  long  in  favor  as  the  exclusive  arti- 
cle of  the  meat  portion  of  the  diet,  even  with  those  who  relish  it  for 
occasional  use.  According  to  Church,  the  following  is  the  composition 
of  mutton  : 

In  100  parts. 

Water 444 

Albumen \'1 

Fibrin  (true  muscle) 6'9 

Ossein-like  substances 1'2 

Fat 42-0 

Organic  extractives 1-8 

Mineral  matters I'O 

Other  substances. .  ...  2-3 


ALIMENTS— ANIMAL.  37 

Pork  contains  more  fatty  matter  and  more  often  disagrees  than  the 
meats  above  described.  Many  dyspeptics  can  not  make  use  of  it  in 
any  form  :  on  the  other  hand,  breakfast  bacon  may  be  much  relished 
and  be  easily  borne.  Pork  is  rarely  prescribed  as  a  diet  for  the  sick, 
but,  for  convalescents,  roasted  sucking-pig,  which  is  easily  digested, 
may  be  ordered  to  vary  the  food  and  to  stimulate  a  languid  appetite. 
Pork  differs  from  beef  and  mutton  in  the  relatively  greater  quantity 
of  fat.  The  loss  on  cooking  pork  is  50  per  cent.  Pork,  also,  yields 
up  to  water  less  solid  matter,  for,  while  the  solids  contained  in  broth  of 
beef  and  mutton  were  27  and  33  per  cent  respectively,  that  from  pork 
contained  only  19  per  cent.  Beaumont  found  that  roasted  pork  re- 
quired five  and  one  fourth  hours  for  its  solution  and  digestion  in  the 
stomach. 

Bacon  has  the  following  composition,  according  to  Church  : 

In  100  parts.  In  1  Ib. 

oz.  gr. 

Water 22'3  3  248 

Nitrogenous  matter 8-1  1  130 

Fat 65-2  10  189 

Salt 3'8  0  256 

Phosphates,  etc 0'6  0  42 

Venison  has  the  following  composition  (Von  Bibra) :  Water,  74'63 ; 
albuminates,  19*24;  fat,  1'3.  When  young  and  tender,  it  is  palatable 
and  easily  digested,  and,  although  inferior  to  beef  in  nutritive  value, 
may  be  a  useful  addition  to  the  diet  of  the  sick  and  convalescent. 

The  domestic  Chicken  is  a  most  important  article  of  food  for  sick 
and  convalescents.  The  taste  is  agreeable,  the  tissues  soft  and  easy  of 
mastication  and  digestion.  "  Spring  chickens  "  are  more  tender  and 
delicate  than  the  fully-developed  fowl  of  four  or  six  months.  Next  to 
the  chicken  in  point  of  digestibility  is  the  domestic  turkey,  and  after 
this  the  domestic  goose  and  duck.  Certain  "  game-birds,"  e.  g.,  the 
prairie-chicken,  wild-ducks,  woodcock,  snipe,  are  frequently  prescribed 
for  convalescents,  and  possess  a  high  degree  of  nutritive  value,  but 
are  not,  of  course,  adapted  for  habitual  use. 

The  viscera  of  certain  animals  are  sometimes  employed  as  food. 
Allusion  has  already  been  made  to  "  sweetbreads,"  the  thymus  of  the 
calf.  The  pancreas  is  very  often  substituted  for  the  true  sweetbread, 
and  may,  when  in  proper  condition,  be  used  instead  of  the  thymus, 
but  it  is  apt  to  be  stringy  and  fibrous.  The  brain,  tongue,  heart,  liver, 
kidneys,  and  alimentary  canal,  are  occasionally  eaten,  but  are  not  fre» 
quently  prescribed  for  the  sick.  Brain  is  easily  digested,  and,  as  it 
contains  fats  in  combination  with  phosphorus,  may  be  usefully  pre- 
scribed in  conditions  of  disease  in  which  these  constituents  are  pre- 
sumed to  be  deficient  in  amount.  Liver,  as  ordinarily  prepared  by 
frying,  is  very  trying  to  weak  stomachs,  but  this  food  contains  mat- 


38 


RESTORATIVE   AGENTS. 


ters  which  may  be  utilized  in  certain  diseased  states.     According  to 
Braconnot  (Pereira),  the  composition  of  liver  is  as  follows  : 

Brown  oil,  containing  phosphorus 3'89 

Nitrogenous  matter. .  „ 6'07 

Albumen 20'19 

Salts 1-21 

Water 68'64 

Kidneys,  especially  as  ordinarily  prepared,  are  very  difficult  of 
digestion,  and  are  unsuited  for  the  sick.  As  they  contain  a  notable 
quantity  of  urea  and  other  excrementitious  matters,  they  are  for  this 
reason  objectionable  articles  of  diet.  Tripe,  the  stomach  of  ruminants, 
is  very  easily  digested  and  very  nutritious,  when  prepared  in  the  sim- 
ple way,  only,  which  is  advisable  for  invalids.  It  consists  largely  of 
albumen. 

In  order  to  test  the  relative  value  of  the  animal  foods  considered 
in  the  foregoing  pages,  Marchal  de  Calvi  (Fonssagrives)  made  a  series 
of  elaborate  examinations  to  determine  the  proportion  of  water  and 
fat  to  the  solid.  The  results  were  as  follow  : 


ANIMAL  FOODS. 

FIBST  ANALYSIS. 

SECOND  ANALYSIS. 

Solid  matters. 

Water. 

Solid  matteri. 

Wmter. 

Pork  

294-60 
277-00 
265-50 
263-50 
260-00 

705-50 
723-00 
734-50 
736-50 
740-00 

302-50 
275-00 
263-50 
263-00 
255-50 

697-50 
725-00 
736-50 
737-00 
744-60 

Beef  .           

Mutton  

Chicken  

Veal  

These  analyses  assign  to  pork  the  first  position.  In  another  series 
of  experiments  M.  Marchal  used  ether  to  dissolve  the  fat  contained  in 
the  fibers  of  these  meats.  His  results  are  expressed  in  the  following 
figures  : 


ANIMAL  FOODS. 

Matten  soluble  in  ether. 

Matter*  insoluble  hi  ether. 

Beef  

25-437 

249-663 

Chicken  

14-070 

248-930 

Pork  

59-743 

242-757 

Mutton  

29-643 

233-857 

Veal                   

28-743 

226-757 

The  following  is  the  most  recent  contribution  to  our  knowledge  of 
the  composition  of  these  animal  foods  (Church)  : 

The  composition  of  1  Ib.  of 


Beef. 

Mutton. 

Pork. 

Veal. 

Lamb. 

Water  .   .. 

Ox.      Gr. 

8        0 

Or.       Gr. 
7          16 

Ot.      Or. 
6          69 

Oi.      Gr. 

10         0 

Ox.      Gr. 
8         44 

Albuminoids  

1     122 

0       385 

0     315 

1     199 

0     360 

Ossein-like  substances  .... 
Fat  

1       62 
4     340 

1       52 
6     176 

0     385 
8         0 

1       82 
2     281 

0     400 
5     263 

Mineral  matter  

0     350 

0     245 

0     105 

0     312 

0     244 

ALIMENTS— ANIMAL.  39 

According  to  these  experiments,  from  the  chemical  point  of  view, 
beef  has  the  highest  nutritive  value  ;  chicken  ranks  second,  and  is  but 
little  inferior  to  beef  ;  while  veal  is  the  lowest. 

There  are  solid  and  fluid  preparations  of  beef  to  which  some  refer- 
ence should  be  made.  Scraped  beef  is  prepared  by  scraping  with  a 
case  knife  a  strip  of  lean  beef  and  separating  the  muscle  pulp  from 
the  connective  tissue.  This  may  be  thrown  on  to  a  hot  skillet  and 
quickly  cooked  on  one  side,  when  it  is  turned  over  to  be  acted  on  the 
reverse  side.  It  is  preferable  to  keep  it  teased  apart  rather  than  made 
into  solid  balls.  The  meat  may  be  first  broiled  and  then  scraped. 

The  beef  meal  known  as  Mosquera's  is  made  by  digesting  lean  beef 
with  pineapple  juice,  which  converts  the  muscular  tissue  into  peptones. 
After  this  conversion  is  complete,  the  preparation  is  dried  at  a  proper 
temperature.  It  is  found  to  contain  about  90  per  cent  of  nutritious 
matter,  of  which  77  per  cent  is  proteid  and  13  per  cent  is  fat.  It  has 
no  taste  or  odor,  and  can  be  mixed  with  equal  parts  of  sugar  and 
cocoa,  and  taken  in  hot  milk. 

Powdered  JSeef. — One  of  the  most  efficient  alimentary  preparations 
is  beefj  desiccated  and  reduced  to  a  state  of  powder.  This  is  largely 
employed  by  French  physicians  as  a  restorative  means  in  phthisis  and 
other  wasting  diseases.  The  manner  of  its  preparation  is  as  follows  : 
Lean  beef  (the  round  answers  well)  is  chopped  into  small  particles,  and 
is  then  carefully  dried.  The  mode  of  drying  is  an  important  element 
in  the  process.  It  should  be  dried  on  a  water-bath  or  in  an  oven,  the 
heat  of  which  can  be  kept  within  the  proper  range.  It  is  important 
not  to  carry  the  desiccation  too  far.  When  sufficiently  dried,  the  beef 
is  then  ground  in  as  fine  a  powder  as  an  ordinary  coffee-mill  will  make. 
The  time  usually  occupied  in  the  drying  depends  on  the  degree  of  heat 
and  the  size  of  the  pieces,  and  ranges  from  ten  to  twenty  hours.  If 
carefully  done,  the  beef  loses  nothing  of  its  constituents  but  its  water, 
and  preserves  its  real  nutritive  qualities.  The  powder  for  adminis- 
tration can  be  mixed  with  broth,  milk,  soup,  eggnog,  and  other  pre- 
pared liquid  foods,  into  which  it  may  be  stirred  quickly  and  tossed  off. 
Debove,  the  author  of  this  forced  alimentation,  finds  that  in  this  way 
two  to  four  pounds  of  beef  may  be  given  daily,  added  to  other  useful 
foods.  It  has  been  shown  that  the  stomach  not  only  receives  this  large 
quantity  of  food  materials,  but  digests  them  satisfactorily.  The  au- 
thor, who  has  had  considerable  experience  with  this  method  of  forced 
alimentation,  is  able  to  speak  with  confidence  as  to  its  nutritive  value. 

Blood. — The  blood  of  beef  carefully  desiccated  is  now  furnished  in 
great  quantity,  and  is  used  internally  and  by  rectal  injection  as  a  means 
of  improving  nutrition.  It  is  almost  the  equivalent  of  dried  beef. 

Fluid  beef  preparations  are  numerous.  Beef  juice  is  prepared  ex- 
temporaneously by  broiling  quickly  over  a  hot  fire  and  then  subject- 
ing small  pieces  to  strong  ppessure  in  a  lemon-squeezer.  Valentine's 


40  RESTORATIVE   AGENTS. 

meat  juice  is  prepared  by  subjecting  partly  cooked  beef  to  powerful 
compression  in  suitable  presses.  One  of  the  most  recent  preparations 
is  the  beef  juice  of  Wyeth  &  Brother,  and  it  is  said  to  contain  the 
largest  proportion  of  albumoses.  Johnson's  fluid  beef  and  Bovinine 
are  two  good  representatives  of  this  class. 

Eggs. — The  following  observations  refer  to  the  eggs  of  the  domes- 
tic chicken.  The  egg  is  composed  of  four  distinct  parts  :  the  shell ; 
the  membranous  envelope  of  the  albumen  ;  the  white  ;  the  mtellus,  or 
the  yellow.  The  envelope  of  the  albumen  contains  nitrogen  and  sul- 
phur, and  phosphate  of  lime  remains  after  incineration.  The  white  or 
the  albumen  contains  in  100  parts  : 

Albumen 12  to  15 

Matter  not  coagulable 5 

Water 80 

The  residue  after  incineration  of  the  albumen  is  composed  of  phos- 
phates and  sulphates  of  lime  and  magnesia,  and  alkaline  carbonates. 
The  yellow  is  a  phosphorated  fatty  matter  suspended  in  water  by 
means  of  an  albuminous  substance  known  as  mtellin.  The  yellow 
contains  53'78  parts  of  water,  17*47  of  albumen,  and  28'75  of  fatty 
matter.  According  to  Gobley  (Fonssagrives,  from  whom  most  of 
these  details  have  been  obtained),  the  yellow  has  the  following  chemi- 
cal constitution  : 

Water 51'486 

Vitellin 15'760 

Margarin  and  olein 21-304 

Cholesterin 0'438 

Margaric  and  oleic  acids 7*226 

Phospho-glyceric  acids 1-200 

Sal-ammoniac 0'034 

Salts 7-299 

Extracts 0-400 

Ammonia,  nitrogenized  matters,  coloring  matter,  lactic  acid 0'833 

Eggs  consumed  by  the  sick  should  be  fresh  and  sound.  The  aver- 
age weight  is  about  two  ounces  avoirdupois.  According  to  Parkes, 
the  following  are  tests  of  the  freshness  and  soundness  of  eggs  : 

"  Fresh  eggs  are  more  transparent  in  the  center  ;  old  ones  at  the 
top.  Dissolve  one  ounce  of  salt  in  ten  ounces  of  water  :  good  eggs 
sink,  indifferent  swim.  Bad  eggs  will  float  even  in  pure  water." 
Fonssagrives  recommends  the  same  tests.  Eggs  coated  with  beeswax 
dissolved  in  warm  olive-oil  (one  third  beeswax,  two  thirds  olive-oil)  it 
is  said  may  be  preserved  for  two  years. 

Eggs  raw,  or  better,  whipped,  are  the  most  digestible  of  alimentary 
substances,  and,  as  their  composition  indicates,  possess  a  very  high  de- 
gree of  nutritive  value. 

Milk  is  one  of  the  most  important  articles  of  food  for  the  sick,  and 


ALIMENTS— ANIMAL.  41 

enters  largely  into  the  composition  of  various  diets.  It  is  constituted 
essentially  of  four  elements — albuminoid,  fatty,  saccharine,  and  saline 
— and  therefore  contains  all  the  materials  necessary  for  the  growth 
and  nutrition  of  tissues.  The  nitrogenous  constituent  is  casein,  an 
albuminoid  substance,  but  which  differs  from  ordinary  albumen  in  that 
it  is  combined  with  a  larger  proportion  of  alkali,  and  is  not  coagulable 
by  heat.  The  fatty  element  is  butter,  which  contains  several  neutral 
fats.  The  composition  of  butter  is  not  exactly  the  same  in  all  kinds 
of  milk,  the  difference  being  due  chiefly  to  a  volatile  principle  upon 
which  the  special  taste  of  each  variety  depends.  The  saccharine  ele- 
ment is  a  crystallizable  sugar,  known  as  lactin  or  lactose,  a  substance 
which  easily  decomposes  into  lactic  acid  by  a  process  of  fermentation 
in  which  the  casein  plays  the  part  of  a  ferment.  The  mineral  con- 
stituents of  milk  are,  chlorides  of  sodium  and  potassium,  phosphates 
of  lime,  soda,  magnesia,  and  iron.  The  most  important  of  these  is 
the  phosphate  of  lime.  The  amount  of  these  salts  varies  from  *5  to 
•8,  and  rarely  exceeds  one  per  cent  (Parkes).  The  French  commis- 
sion, appointed  by  the  Prefect  of  Police  of  Paris,  reported  upon  the 
analysis  of  milk  made  in  various  countries,  and  concluded  that  the 
following  figures  represent  the  composition  of  this  fluid  when  of  good 
quality  (Tardieu)  : 

Water 87 

Total  solids 13 

Caiein,  extractive 

matters,  and  salts.  Butur.  Lactin. 

Solids 4-00  4-00  5 

The  commission  fixed  the  minimum  standard  of  good  milk  at — 

Water 88'50 

C  Casein,  extractives,  and  salts 4'00 

Solids 11-50  <  Butter 2'70  to  3'00 

(  Lactin 4'50 

When  perfectly  fresh,  milk  is  usually  neutral  in  reaction,  or  it  may 
6e  a  little  alkaline.  After  a  short  time — especially  in  summer — it  be- 
comes acid  by  a  process  of  fermentation  in  which  the  lactin  is  con- 
verted into  lactic  acid,  and  the  casein  coagulates.  The  fluid  portion 
is  called  whey,  and  the  semi-solid  casein  curds.  By  the  fermentation  of 
mare's-milk  an  alcoholic  liquor,  named  koumiss,  is  prepared  in  Tartary, 
and  has  been  introduced  into  medical  practice  as  a  remedy  for  phthisis. 

The  proportion  of  cream  in  good  milk  ranges  from  10  to  15  per 
cent  by  volume.  By  churning,  the  fat  of  the  cream  is  collected  and 
is  then  known  as  butter.  This  important  article  of  food  has  the  fol- 
lowing composition  (Fonssagrives)  : 

Margarin 68 

Butyrolin 30 

Butyrin,  caprin,  and  caproin 2 


42  RESTORATIVE   AGENTS. 

Butter  readily  undergoes  decomposition — becomes  rancid — capric 
and  butyric  acids  separating  from  the  base  glycerin.  This  process  is 
one  of  fermentation  (butyric],  and  is  due  to  the  action  of  a  special 
organism,  the  growth  of  which  is  favored  by  air,  light,  and  imperfect 
separation  of  milk  in  the  process  of  churning. 

After  the  process  of  churning,  which  separates  the  butter,  the  re- 
sultant liquid,  known  as  buttermilk,  contains  the  casein,  lactin,  and 
the  salts,  and  is  therefore  a  nutritious  article  of  food. 

As  the  milk  of  other  animals  than  the  cow  is  sometimes  prescribed 
in  medical  practice,  the  comparative  chemical  constitution  of  this  fluid 
should  be  studied.  The  following  table  (Pereira)  shows  at  a  glance 
the  difference  in  composition  of  the  milk  from  several  animals  : 


CONSTITUENTS. 

Cow. 

AM. 

Goat. 

Woman. 

Casein            

4-48 

1-82 

4-02 

1-52 

Butter   

3-13 

0-11 

3-32 

3-55 

Lactin  

4-77 

6-08 

5-28 

6-50 

Salts  

0-60 

0-34 

0-58 

0-45 

\Vater                          

87-02 

91-65 

86-80 

87-98 

"Whenever  fresh  and  pure  milk  can  be  procured,  this  only  should 
be  prescribed  for  the  sick,  but  in  large  cities  it  is  not  always  practica- 
ble to  obtain  it.  Under  these  circumstances  "  condensed  milk  "  must 
be  used.  This  preparation  is  made  by  evaporation  of  the  water  of 
the  milk  and  the  addition  of  some  sugar.  It  is  found  in  two  forms, 
dependent  on  the  extent  to  which  the  abstraction  of  water  is  carried  : 
as  a  granular  solid  and  as  a  soft  semi-solid.  The  addition  of  warm 
water  to  the  condensed  milk  furnishes  a  palatable  fluid,  of  the  appear- 
ance and  composition  of  fresh  warm  milk. 

Fresh  milk,  boiled  and  corked  up  in  bottles  to  exclude  the  air,  will 
keep  for  a  considerable  length  of  time.  To  prevent  fermentation,  some 
sulphite  of  lime  may  be  added  to  it.  For  temporary  preservation  of 
milk  in  the  summer-time,  especially  when  intended  for  food  for  infants, 
a  little  bicarbonate  of  soda  and  sugar  may  be  used. 

Cheese  contains  all  the  constituents  of  milk,  except  the  water  and 
some  salts  and  lactin  removed  by  expression.  In  the  preparation  of 
cheese  the  casein  of  the  milk  is  coagulated  by  rennet,  the  butter  and 
a  portion  of  the  lactin  and  salts  are  entangled  in  the  meshes  of  the 
casein,  and  the  mass  is  subjected  to  powerful  compression.  The  pe- 
culiar flavor  and  quality  of  the  cheese  depend  upon  the  nature  and 
richness  of  the  milk,  and  upon  certain  fermentative  changes  which  take 
place,  developing  volatile,  odorous,  and  sapid  constituents.  The  follow- 
ing table  of  the  composition  of  cheese  illustrates  its  nutritive  qualities : 

Water 36-8 

Albuininates 33-5 

Fats 24-3 

Salts...                     ,  5-4 


ALIMENTS— ANIMAL.  43 

It  is  evidently  a  concentrated  food.  The  digestibility  of  cheese  de- 
pends in  part  on  its  freshness,  in  part  on  its  composition.  When  fresh 
and  of  good  quality,  it  does  not  ordinarily  disagree  with  the  stomach. 
A  small  quantity  of  cheese  taken  after  dessert  in  some  cases  assists 
digestion  ;  but  many  dyspeptics  and  persons  of  weak  digestion  can 
not  make  use  of  it  under  any  circumstances. 

JJToumiss. — This  is  a  fluid  obtained  from  mare's-milk  by  fermenta- 
tion, and  constitutes  the  principal  part  of  the  food  of  the  people  inhab- 
iting a  portion  of  Tartary.  It  contains  alcohol,  lactic  acid,  sugar, 
casein,  fat,  salts,  carbonic  acid,  and  water.  In  addition  to  these  con- 
stituents, ascertainable  by  chemical  analysis,  koumiss  possesses  fragrant 
compounds,  volatile,  the  product,  probably,  of  the  decomposition  of 
the  fat  and  the  reaction  of  the  acids  on  the  alcohol,  forming  ethers. 
Koumiss  of  good  quality  may  also  be  prepared  from  cow's-milk  by  the 
process  of  fermentation,  but,  as  mare's-milk  is  more  nearly  allied  to 
human  milk  in  composition,  it  is  to  be  preferred  in  the  preparation  of 
this  aliment.  By  variations  in  the  method  of  preparation,  different 
kinds  of  koumiss  are  produced,  as,  for  example,  thick  koumiss,  whey- 
koumiss,  skimmed-koumiss.  According  to  the  different  stages  to 
which  the  process  of  fermentation  is  carried,  there  result  three  degrees 
of  quality,  No.  1,  No.  2,  and  No.  3.  No.  2  differs  from  No.  1  in  con- 
taining more  alcohol  and  carbonic  acid,  and  less  sugar  and  casein. 
These  constituents,  especially  the  carbonic  acid,  impart  a  liveliness  to 
the  fluid,  so  that  it  effervesces  like  champagne.  In  No.  3,  the  fermen- 
tation having  proceeded  further,  butyric,  succinic,  and  acetic  acids  are 
produced,  and  the  sparkling  quality  is  enhanced. 

Koumiss  is  prepared  from  milk,  by  the  addition  of  a  ferment — 
some  koumiss  obtained  from  a  previous  fermentation  or  dried  kou- 
miss. It  is  allowed  to  ferment  three  days  at  a  temperature  of  from 
70°  to  80°  Fahr.  It  is  then  a  bluish-white  liquid,  having  a  sharp, 
acidulous  taste,  and  none  of  the  characteristics  of  ordinary  milk.  If 
heated  to  100°  Fahr.,  fermentation  is  definitely  arrested.  If  before 
being  heated  it  is  bottled,  products  corresponding  to  1,  2,  and  3, 
named  above,  are  the  result.  Allowed  to  stand  after  three  days'  fer- 
mentation, it  separates  into  three  layers  :  the  inferior,  caseous  ;  the 
middle,  an  acid  water ;  and  the  uppermost,  a  whitish  fluid,  the  best 
koumiss.  The  alcoholic  strength  is  of  course  determined  by  the  stage 
of  fermentation.  The  koumiss  of  two  days'  fermentation  is  feeble  in 
strength,  and  hence  the  product  of  three  days'  fermentation  is  prefer- 
able for  medicinal  use. 

The  quantity  of  koumiss  administered  depends  on  the  condition  of 
the  patient.  In  cases  of  feeble  digestion,  this  being  the  only  article 
of  food,  an  ounce  every  hour  will  be  a  sufficient  quantity.  With 
increased  facility  in  its  digestion  and  assimilation,  from  a  quart  to 
a  gallon  a  day  may  be  taken.  When  it  is  used  in  connection  with 


44  RESTORATIVE   AGENTS. 

other  food,  a  tumblerful  may  be  administered  after  each  meal.  It 
is  estimated  that  each  quart  of  koumiss  contains  four  ounces  of  solid 
food. 

The  tolerance  of  the  stomach  to  koumiss  is  remarkable,  even  in 
<;ases  of  gastralgia.  It  improves  the  appetite,  and  excites  the  action 
of  the  kidneys.  The  patients  experience  a  pleasing  exhilaration,  due 
probably  to  the  combined  action  of  the  carbonic  acid  and  the  alcohol. 
Decided  intoxication  undoubtedly  may  result  from  the  use  of  a  large 
quantity  by  any  one  unaccustomed  to  it.  It  also  causes  somnolence 
during  the  day,  and  favors  sleep  at  night  without  leaving  any  after- 
headache.  Its  most  important  action  is  the  increase  of  the  body 
nutrition  ;  and  hence  its  utility  in  the  treatment  of  phthisis,  indiges- 
tion, and  the  various  cachexiae.  Jagielsky  says  that  he  has  had  pa- 
tients gain  as  much  as  ten  pounds  a  month  when  no  other  food  was 
taken. 

Galazyme  and  Kefyr. — As  the  milk  of  mares  and  asses  can  not 
be  procured  in  quantity  in  this  country,  it  is  necessary,  if  prepara- 
tions like  koumiss  are  to  be  made,  to  employ  for  this  purpose  the 
milk  of  cows.  Under  the  name  of  galazyme,  a  fermented  liquor 
analogous  to  koumiss  was  first  proposed  by  Schneep.  This  is  made 
by  the  addition  to  milk  of  sugar  and  a  ferment,  the  carbonic  acid 
and  alcohol  being  produced  by  the  fermentation  of  the  cane-sugar, 
the  lactose  of  the  milk  remaining  unchanged.  The  formula  he  gives 
js  as  follows : 

To  every  litre  (quart)  of  milk  he  adds  three  parts  of  cane-  and  five 
parts  of  milk-sugar  and  some  brewer's  yeast.  The  mixture  is  put 
aside  in  a  suitable  temperature  until  the  fermentation  has  reached  the 
proper  point,  care  being  taken  to  stop  the  process  before  reaching 
the  acetic  and  lactic-acid  stage.  Deschiens  has  proposed  another 
formula  which  has  some  advantages.  He  employs  the  yeast  now 
made  for  the  manufacture  of  high-grade  alcohols,  and  mixes  one 
drachm  of  this  with  two  and  a  half  drachms  of  sugar  in  some  water ; 
this  solution  is  placed  in  a  quart  of  milk,  and  the  whole  is  then 
allowed  to  proceed  to  the  alcoholic  fermentation  in  the  ordinary  way. 
When  the  process  has  reached  the  proper  stage,  the  galazyme  is  put 
into  strong  bottles,  the  corks  fastened  in  the  way  the  sparkling  wines 
are  now  inclosed. 

A  fermented  milk  analogous  to  koumiss  is  prepared  in  the  Cau- 
casus under  the  name  of  Jcefyr.  The  fermentation  is  set  up  in  the 
milk  by  the  addition  to  it  of  a  ferment  known  as  kefyr,  which  is  a 
microbe  having  peculiar  qualities.  The  microbe  ferment  of  milk — the 
oidium  lactis — under  appropriate  conditions,  transforms  the  lactose  or 
sugar  of  milk  into  lactic  acid  ;  but  kefyr — the  dispora  caucasica — 
.changes  it  into  alcohol  and  carbonic  acid.  The  difference  in  composi- 
tion of  milk  and  kefyr  has  been  shown  by  chemical  analysis  to  consist 


ALIMENTS— ANIMAL.  45 

in  a  diminution  in  the  kefyr  of  the  albumen,  fat,  and  sugar,  and  the 
addition  of  lactic  alcohol  and  carbonic  acid. 

The  quantity  of  alcohol  in  kefyr  and  galazyme  varies  from  one 
half  of  one  per  cent  to  three  per  cent,  and  is  determined  by  the  extent 
to  which  the  fermentation  has  been  carried.  The  amount  of  car- 
bonic acid,  on  the  presence  of  which  the  sparkling  character  depends, 
is  governed  by  the  stage  to  which  the  fermentation  has  gone  at  the 
time  of  bottling.  When  completed  and  bottled,  it  presents  a  milky 
appearance,  and  on  pouring  it  out  from  the  bottle  containing  it,  effer- 
vesces finely,  and  is  covered  with  an  abundant  foam.  The  taste  is 
fresh,  slightly  acid,  and  a  little  pungent,  like  the  ordinary  carbonated 
waters.  There  is  probably  no  difference  between  koumiss,  galazyme, 
and  kefyr,  in  respect  to  their  action  on  digestion  and  assimilation,  and 
hence  the  domestic  preparation,  if  properly  made,  may  be  substituted 
for  the  more  expensive  imported  koumiss. 

Preparations  of  Milk. — Milk  is  prepared  by  predigestion  with  pep- 
sin (peptonizing),  or  with  pancreatin  (pancreatinizing}.  Milk  is  pep- 
tonized  by  adding  some  powdered  pepsin,  or  solution  of  pepsin,  to 
fresh  milk  slightly  acidulated  (hydrochloric  acid) ;  or  it  is  pancreatin- 
ized  by  adding  pancreatic  extract  or  solution  of  pancreatin  to  the  fresh 
milk,  with  sodium  bicarbonate  (fifteen  grains  of  the  sodium  bicarbonate 
to  the  pint). 

Milk  is  preserved  by  the  method  of  sterilization,  or  Pasteurization. 
Milk,  heated  up  to  the  boiling  point — to  212°  Fahr. — becomes  sterile 
because  all  ferments  or  organisms  are  inhibited  or  destroyed  at  that 
temperature.  To  accomplish  this  result,  the  milk  in  bottles  or  jars  is 
placed  in  steam  chambers,  the  temperature  of  which  is,  of  course,  at 
212°  Fahr.  Such  milk  has,  however,  the  taste  of  boiled  milk,  and 
various  changes  occur  in  it  in  consequence  of  which  the  casein  is  less 
digestible  in  the  juices  of  the  stomach  and  intestines,  the  emulsioniz- 
ing  and  absorption  of  the  fat  is  rendered  slower,  and,  according  to 
Leeds,  the  amylolytic  ferment  is  destroyed.  If  the  milk  is  allowed  to 
remain  too  long  at  212°  Fahr.  the  lactose  is  converted  in  part  into 
caramel,  whence  the  milk  assumes  a  brownish  hue. 

Pasteurized  milk  is  prepared  by  raising  the  temperature  of  the 
milk  for  fifteen  to  twenty  minutes  to  160°  or  170°  Fahr.  The  bottles 
containing  the  milk  are  immersed  for  the  required  period  in  water  at 
the  temperature  named.  The  milk  so  prepared  is  but  little  changed, 
but  it  will  keep  for  a  day  or  two  only. 

Condensed  milk  has  been  briefly  referred  to,  but  some  further 
details  are  necessary,  since  this  has  become  an  important  food  for 
infants  and  various  invalids.  Milk  is  condensed  by  depriving  it  of  its 
water  by  means  of  slow  and  moderate  heat  in  vacuo.  The  varieties 
of  condensed  milk  are  due  to  differences  in  the  mode  of  preparation. 
All  the  water  evaporated,  and  the  residue  mixed  with  a  large  (60  to  75) 


46  RESTORATIVE   AGENTS. 

percentage  of  sugar,  a  dry  granular  mixture  results.  The  usual  form 
is  a  soft  solid  about  the  consistence  of  honey,  and  containing  30  to  45 
per  cent  of  sugar.  Swiss  condensed  milk  is  a  mixture  of  cow's  and 
goat's  milk.  One  form  is  evaporated  by  sufficient  heat  to  render  it 
aseptic,  and  no  sugar  is  required.  Put  while  hot  in  cans  and  hermet- 
ically sealed  it  remains  fresh  for  months — even  years. 

Condensed  cream  is  a  product  like  condensed  milk,  and  is  a  mix- 
ture of  milk  and  cream. 

Humanized  milk  is  a  preparation  of  cow's  milk  made  in  imitation 
of  human.  The  preparation  of  Meigs  is  a  good  one  ;  it  is  as  follows  : 

Cream 2  tablespoonfuls. 

Milk 1  tablespoonful. 

Lime-water 2  tablespoonfuls. 

Water 3  tablespoonfuls. 

Milk  sugar '. $  teaspoonful. 

Fish. — A  great  many  varieties  of  fish  are  used  as  foods  to  which 
it  is  necessary  to  allude  in  general  terms  only.  Salted  fish  is  not  a 
suitable  article  of  food  for  the  sick  :  it  is  difficult  of  digestion,  and 
possesses  but  slight  nutritive  value.  Fresh  fish,  however,  properly 
cooked,  is,  as  a  rule,  easy  of  digestion,  and  furnishes  a  pabulum  of  a 
valuable  kind  in  diseases  of  certain  textures.  The  following  is  the 
composition  of  fish  as  compared  with  beef,  according  to  the  analysis 
of  Fr.  Schulze  : 


CONSTITUENTS. 

Beef. 

Fish. 

Fibrin,  cellular  tissue,  nerves,  and  vessels  

15'0 

12'0 

4'3 

5'2 

Alcoholic  extract  and  salts  

1-3 

ro 

Aqueous  extract  and  salts  

1'6 

1-7 

Phosphates  

traces. 

traces. 

I'O 

it 

Water  

11-& 

80'  1 

The  commonly-received  opinion,  that  fish  is  a  more  highly-phospho- 
rated food  than  beef,  does  not  receive  support  in  this  analysis.  White- 
fish,  shad,  bass,  and  fresh  mackerel,  are  more  suitable  for  the  sick  than 
cod,  salmon,  or  eels.  They  should  be  prepared  and  eaten  as  soon  as 
possible  after  being  taken  from  the  water,  and  should  be  either  broiled 
or  boiled.  Only  at  the  time  of  the  ripening  of  the  milt  and  roe  are 
fish  in  a  suitable  condition  for  the  dietary  of  invalids.  At  the  time 
of  spawning,  and  immediately  after,  the  flesh  of  fish  is  watery  and 
semi-gelatinous. 

Oysters  rank  among  the  most  digestible  of  foods,  and  are  usually 
easily  borne  by  the  most  delicate  stomach.  According  to  Fonssagrives 
the  French  oyster  contains  about  12 '6  parts  of  solid  matters,  consist- 
ing of  osmazome,  chlorides  of  sodium  and  magnesium,  sulphates  of 
lime  and  magnesia,  fibrin,  albumen,  and  gelatin.  They  are  more  easily 


ALIMENTS— VEGETABLE.  47 

and  quickly  digested  when  eaten  raw,  or  broiled,  but  stewed  is  the 
most  common  form  for  use  in  disease.  In  cases  of  great  irritability 
of  the  stomach,  the  most  easily  borne  oyster-soup  is  prepared  by  the 
addition  of  the  liquor  to  boiling  milk. 

Vegetable. — The  most  important  members  of  this  class  of  foods 
are  the  cereal  grains — wheat,  rye,  corn,  rice,  buckwheat,  oats,  and  bar- 
ley. The  universality  of  its  consumption  and  its  nutritive  value  place 
wheat-bread  in  the  first  position  as  an  article  of  diet.  The  composi- 
tion of  wheat-flour  is  as  follows  : 

Water 14-0 

Fatty  matters 1-2 

Gluten 12'8 

Albumen , 1*8 

Dextrin,  sugar 7*2 

Starch 59'7 

Cellulose 1-7 

Salts  (potash,  soda,  lime,  magnesia,  phosphoric  acid,  etc.) 1*6 

In  the  preparation  of  wheat-flour,  the  bran  is  separated.  Important 
constituents  of  the  wheat  are  thus  removed,  as  the  following  analysis 
of  the  bran  shows  : 

Water 10'3 

Fatty  matters 2'82 

Gluten .' 10-84 

Albumen 1'64 

Dextrin,  sugar 5*8 

Starch 22-62 

Cellulose 43'98 

Salts 2-52 

The  internal  envelope  of  the  wheat-grain  contains  also  a  ferment, 
know  as  cerealin,  which  has  very  active  properties.  As  the  propor- 
tion of  bran  to  flour  is  as  sixteen  to  eighty,  it  is  obvious  that  consider- 
able loss  accrues  in  the  preparation  of  superfine  flour.  Wheat-bread 
made  from  superfine  flour  is  easy  of  digestion,  owing  to  its  lightness 
and  sponginess  permitting  a  rapid  diffusion  of  the  gastric  juices  through 
every  part  of  it.  Most  of  it  is  also  available  for  nutrition  ;  there  is 
little  residuum  ;  hence  the  constipation  which  attends  its  use  in  large 
proportion  relatively  to  the  other  constituents  of  the  diet.  When 
flour  is  unbolted  (bran  not  separated),  an  increase  of  nutritive  value  is 
obtained,  at  the  expense,  however,  of  digestibility.  A  large  part  of 
the  bran,  probably,  resists  the  action  of  the  gastric  juice,  and  hence, 
irritating  the  mucous  membrane,  increases  by  reflex  action  the  secre- 
tions and  peristaltic  movements. 

Whole  wheat-grains,  under  the  name  of  "  cracked  wheat,"  is  fre- 
quently prescribed  as  an  article  of  diet  for  invalids.  It  is  boiled  until 


48  RESTORATIVE   AGENTS. 

the  envelope  of  the  grain  is  burst  open,  and  is  eaten  with  cream  and 
sugar.  Obviously  such  a  combination  forms  a  food  of  great  excel- 
lence. The  special  advantage  which  it  possesses,  besides  its  nutritive 
value,  is  its  laxative  action. 

Ordinarily,  wheat-bread  made  of  superfine  flour  is  to  be  preferred 
for  the  use  of  invalids.  To  obviate  the  constipating  action  of  such 
bread,  and  to  obtain  a  laxative  effect,  various  expedients  are  adopted. 
Bran,  rye,  and  corn  meal,  and,  in  some  kinds  of  bread,  molasses,  are 
added  to  the  dough,  forming  those  varieties  known  as  Graham  bread,, 
brown  bread,  and  Boston  brown  bread. 

The  important  quality  of  lightness  is  imparted  to  wheat-bread  by 
thorough  incorporation  of  carbonic-acid  gas  with  the  dough.  Two 
processes  are  employed  for  this  purpose  :  By  the  addition  of  yeast, 
fermentation  takes  place  at  the  expense  of  a  portion  of  the  starch,  and 
carbonic  acid  and  alcohol  are  produced.  By  mechanical  means,  car- 
bonic acid  obtained  from  other  sources  is  mixed  with  the  flour.  The 
latter  is  known  as  "  aerated  bread."  Obviously,  the  mechanical  pro- 
cess is  more  economical  because  there  is  no  loss  of  flour.  It  furnishes 
usually  a  lighter  and  drier  bread,  and  is  more  easily  digested.  Bread 
made  by  the  fermentation  process  is  not  unf requently  moist  and  heavy, 
and  sour,  because  the  fermentation  has  proceeded  beyond  the  alcoholic 
stage.  "  French  bread  "  is  lighter,  drier,  and  better  baked,  than  ordi- 
nary baker's  fermented  bread.  Warm,  fresh  bread  is  not  suitable  for 
invalids.  It  can  not  be  so  perfectly  masticated  as  older  bread,  and, 
not  reaching  the  stomach  in  a  state  to  permit  diffusion  through  the 
mass  of  the  gastric  juices,  lies  unchanged  for  hours. 

According  to  Smith,  the  ultimate  composition  of  wheat-bread  is 
as  follows  : 

Water 37'0 

Starch , 47'4 

Sugar 3-6 

Fat 1-6 

Salts 23 

Macaroni  stewed  in  milk  is  sometimes  prescribed  for  the  sick. 
Prepared  with  butter,  cheese,  and  condiments,  it  is  not  an  appropriate 
food  for  invalids.  In  composition  it  consists  chiefly  of  gluten,  and  of 
course  starch — but  in  less  proportion  than  in  bread — and  of  fat.  The 
cylindrical  tubes  in  which  it  occurs  are  formed  by  passing  the  paste 
of  flour  (gluten)  through  perforated  plates. 

Bread  requires  from  three  and  a  half  to  four  hours  for  complete 
digestion.  Brown  bread  digests  somewhat  more  slowly. 

Barley  is  but  rarely  used  as  food  in  this  country.  It  is  occasionally 
prescribed  for  the  sick  in  the  form  of  infusion — a  demulcent  drink — 
and  is  frequently  added  to  soup.  It  has  the  following  composition 
(Smith)  : 


ALIMENTS— VEGETABLE.  49 

Water 15'0 

Starch 69-4 

Sugar ; 4'9 

Fat 24 

Salts 2-0 

Albuminous  substances 63 

Rice  is  one  of  the  most  digestible  of  vegetable  foods,  requiring, 
when  boiled,  about  one  hour.  Its  nutritive  value  is  not  equal  to 
wheat,  because  it  consists  chiefly  of  starch.  The  following  is  its 
proximate  constitution : 

Water 13'0 

Nitrogenous  matter 6'3 

Starch 79-1 

Sugar , 0'4 

Fat 0>(7 

Salts 0-5 

Rice-water,  or  decoction  of  rice,  like  the  corresponding  preparation 
of  barley,  is  used  as  a  demulcent  drink  in  fevers  and  intestinal  disor- 
ders. Boiled  rice  is  frequently  prescribed  as  a  diet  for  invalids  with 
weak  digestion,  and  is  enriched  by  the  addition  of  milk  and  cream, 
and  eggs  (rice-pudding). 

A  comparison  of  its  chemical  composition  with  that  of  wheat  or 
corn  will  show  that  it  is  by  no  means  equal  to  them  in  nutritive  value. 
It  is  obviously  unfitted  to  sustain  life  alone,  and  hence  in  rice-eating 
countries  it  is  mixed  with  fat  or  other  foods  supplying  principles  in 
which  it  is  deficient. 

Corn  has  the  following  composition  (Letheby,  Smith)  : 

Water 14'0 

Nitrogenous  matter  (albumen) ll'O 

Starch. . .    - 64'7 

Sugar 0'4 

Fat 8'1 

Salts 1-7 

It  is  not  so  readily  digested  as  starch,  requiring  about  three  hours. 
Corn,  when  green,  is  prepared  for  the  table  by  boiling,  and  is  eaten 
with  salt  and  butter,  or  milk.  If  young  and  tender,  and  sufficiently 
cooked,  it  is  a  digestible  and  nutritious  food  ;  but,  if  the  grain  is  too 
mature,  it  resists  the  action  of  the  intestinal  juices,  and  passes  un= 
changed. 

The  mature  grain,  deprived  of  the  heart  and  husk,  is  known  as 
hominy.  Thus  prepared  and  thoroughly  boiled  it  is  an  esteemed 
article  of  diet,  ranking  in  nutritive  value  a  little  above  boiled  starch. 
Mush  is  boiled  corn-meal,  which  may  be  eaten  with  milk,  and  is  some- 
times fried,  but  in  that  form  is  highly  objectionable.  Corn-meal  is  also 
eaten  in  the  form  of  bread  and  cakes.  These  various  preparations  of 


50  RESTORATIVE   AGENTS. 

corn  are  liable  to  cause  intestinal  disorders,  and  hence  are  improper 
in  cases  of  irritable  mucous  membrane,  and  in  diarrhceal  diseases. 
For  this  reason  corn-bread  is  sometimes  prescribed  in  cases  of  con- 
stipation dependent  on  diminished  secretion  of  the  intestinal  mucous 
membrane,  and  torpor  of  the  muscular  layer  of  the  bowel.  The 
starch  of  corn  is  not  unfrequently  prepared  for  invalids  in  the  form 
of  blanc-mange. 

Oatmeal  corresponds  in  physical  qualities  and  composition  to 
corn-meal.  Its  proximate  composition,  according  to  Smith,  is  as 
follows  : 

Water 15'0 

Nitrogenous  matter 12'6 

Starch 68'4 

Sugar 5'4 

Fat 5-6 

Salts 3-0 

It  is  not  at  all  generally  used  as  an  article  of  diet  in  this  country. 
It  is  prescribed  in  the  form  of  gruel  as  a  delicate  food.  Boiled  for 
a  long  time,  the  oatmeal  swells  up  and  thickens,  forming  a  blanc- 
mange, which  may  be  eaten  with  milk,  or  butter,  or  cream,  and  sugar 
and  aromatics. 

buckwheat  flour  is  largely  consumed  in  this  country,  chiefly  in 
the  form  of  breakfast-cakes.  As  it  contains  a  relatively  small  propor- 
tion of  starch,  and  considerably  more  fat  and  salts  than  wheat  flour, 
it  can  be  eaten  by  diabetics  in  the  form  of  light  bread,  and  is  said  to 
be  preferable  to  any  gluten  preparation. 

The  Potato,  next  to  wheat,  is  the  most  important  food  derived 
from  the  vegetable  kingdom.  Its  composition  is  affected  by  its 
source  and  variety,  and  by  the  soil  in  which  it  is  grown.  The 
specific  gravity  of  the  potato  affords  an  index  of  its  nutritive 
value,  for,  the  heavier,  the  greater  the  quantity  of  starch  it  contains. 
For  the  sick,  watery  potatoes  are  unsuitable.  "When  cooked,  the 
tuber  should  be  mealy  and  dry.  The  following  is  the  composition 
of  the  potato : 

Water 75'0 

Nitrogenous  matter 2'1 

Starch 18'8 

Sugar 3'2 

Fat '. ...  0-2 

Salts 0-7 

According  to  some  authorities,  the  potato  contains  free  citric  acid. 
The  salts  are  rich  in  potash.  According  to  Letheby,  the  composition 
of  the  sweet-potato  is  nearly  that  of  the  white,  the  chief  difference 
being  the  proportion  of  sugar,  which  is  three  times  greater  than  in 
the  latter. 


DENUTRITION.  51 

Starch,  Sago,  Arrowroot,  and  Tapioca,  differ  from  the  preceding 
vegetable  foods  in  that  they  contain  no  nitrogen.  They  are  digested 
in  from  one  to  two  hours.  They  are  largely  used  in  the  preparation 
of  diets  for  the  sick,  but  are  insufficient  in  themselves  to  maintain  for 
any  considerable  period  the  vital  functions.  Hence  they  are  prepared 
and  eaten  with  sugar,  milk,  cream,  butter,  and  aromatics. 

Turnips,  Parsnips,  Carrots,  Onions,  Asparagus,  Beets,  Cauliflower, 
Cabbages,  and  Celery,  are  but  rarely  prescribed  for  the  sick,  but  enter 
into  certain  special  plans  of  diet.  According  to  Smith,  the  following 
represents  the  composition  of 


Turnips. 

Carrots. 

Pannips. 

Water  

.  91-0 

83-0 

Water  

82'0 

Sugar  

.     2-1 

6-1 

Sugar  

5'8 

Nitrogenous  matter.  . 
Fat  

.      1-2 

Nitrogenous  matter.  . 
Fat  

1-3 

0'2 

Nitrogenous  matter.  .  . 
Fat 

1-1 
0'5 

Starch  

.     5-1 

Starch  

8'4 

Starch  .  .          ... 

9-6 

Salts  

.     0'6 

Salts    

1-0 

Salts  

1-0 

Beets  differ  from  the  above  chiefly  in  the  quantity  of  sugar.  The 
following  is  the  analysis  of  Payen  : 

Water 83'5  Nitrogenous  matter 1*5 

Sugar 10-5  Pectose,  etc 0'8 

Salts  and  pecten 3'7 

All  of  the  members  of  this  group  are  deficient  in  nutritive  value, 
and  are  besides  slow  and  difficult  of  digestion,  requiring  from  three  to 
five  hours  for  complete  solution. 

Ripe  fruits,  as  grapes,  apples,  pears,  peaches,  oranges,  lemons,  etc., 
possess  but  little  nutritive  value,  as  they  contain  only  about  10  to  15 
per  cent  of  solid  matters.  In  composition  they  are  represented  by 
sugar,  free  acid  (tartaric,  citric,  etc.),  nitrogenous  matters,  and  salts. 
They  differ,  of  course,  in  the  peculiar  flavoring  matters  which  give  to 
each  fruit  its  special  taste.  Dried  fruits,  as  dates,  figs,  and  raisins,  are 
relatively  much  more  nutritive,  because  they  contain  a  larger  percent- 
age of  sugar.  Under  the  head  of  dietetic  management  of  diseased 
states,  some  further  remarks  will  be  made  on  the  use  of  the  fresh  and 
dried  fruits. 

SPECIAL  PLANS  OF  DIET. 

The  food-supplies  to  the  organism  may  be  so  managed  as  to  secure 
very  definite  therapeutical  results.  By  increasing  or  diminishing  the 
whole  amount  of  foods  ingested,  by  variations  in  the  quality  and  char- 
acter of  them,  and  by  the  employment  of  some  special  and  restricted 
methods  of  feeding,  cures  are  effected  not  attainable  by  medicinal 
treatment. 

DENUTRITION. — The  amount  of  food  necessary  for  bare  subsistence 

has  been  pretty  accurately  determined.    During  the  siege  of  Paris  the 
6 


52  RESTORATIVE   AGENTS. 

daily  ration  was  at  one  time  reduced  to  less  than  ten  ounces  of  bread 
and  one  ounce  of  meat  daily.  Dr.  Edward  Smith  ascertained  that  the 
daily  amount  of  food  barely  sufficient  to  maintain  life  among  the  fac- 
tory operatives  must  contain  2 '84  ounces  of  nitrogenous  matter,  and 
19 '25  ounces  of  carbonaceous.  Pettenkofer  and  Voit  give,  as  the 
necessary  amount  of  food  required  by  an  adult  when  at  work,  5 '22 
ounces  of  nitrogenous  and  22'38  of  carbonaceous  matter.  Letheby 
furnishes  the  following  table  as  the  result  of  his  investigations  on 
this  point  : 

Nitrogenous,  Carbonaceous, 

Daily  diet  for  OM.  OB. 

Idleness 2'67  19'61 

Ordinary  labor 4'56  29"24 

Activelabor 5'81  34'97 

The  ration  of  the  United  States  soldiers  imprisoned  at  Andersonville 
consisted  of  one  third  pound  of  bacon  and  one  pound  and  a  quarter  of 
unbolted  corn-meal.  This  amount  and  quality  of  food  were  insufficient 
to  maintain  the  bodily  functions  in  a  healthy  state,  and  hence  vast 
numbers  died  of  scorbutus,  diarrhrea  and  dysentery,  and  hospital  gan-> 
grene.  From  these  data  we  are  enabled  to  form  an  estimate  of  the 
amount  and  kind  of  food  necessary  to  maintain  life  in  those  cases  of 
disease  in  which  it  is  desirable  to  apply  the  method  of  denutrition. 

Physiological  Effects  of  Insufficient  Food. — Intestinal  uneasiness, 
more  or  less  pain,  borborygmi,  and  a  feeling  of  hunger,  are  among  the 
first  symptoms  of  an  insufficient  supply  of  food.  The  secretions  of  the 
intestinal  canal  diminish,  digestion  becomes  difficult,  and  constipation 
results.  The  respiratory  movements  are  diminished  in  frequency  and 
volume,  and  the  exhalation  of  carbonic  acid  notably  declines.  Ac- 
cording to  Dr.  Edward  Smith,  while  under  an  ordinary  diet  the  daily 
excretion  of  carbonic  acid  amounts  to  thirty -four  ounces,  under  an 
almost  complete  abstinence  it  falls  in  twenty-four  hours  to  twenty-two 
ounces.  The  blood  suffers  a  notable  diminution  in  its  amount  ;  the 
quantity  of  water  augments,  and  the  number  of  blood-globules  greatly 
diminishes.  Meanwhile  the  blood  loses  its  plasticity,  and  a  tendency 
to  hsemorrhagic  extravasations  is  developed.  The  urinary  secretion 
also  lessens  in  amount ;  the  urea  and  uric  acid  diminish,  but  the  hip- 
puric  acid  rather  increases  ;  the  chlorides  after  some  days  almost  dis- 
appear, but  the  sulphuric  and  the  phosphoric  acids  persist.  As  a  re- 
stilt  of  the  very  obvious  decline  in  the  function  of  assimilation,  the 
temperature  of  the  body  falls  some  degrees  below  the  normal.  The 
functions  of  the  nervous  centers  undergo  a  marked  derangement. 
Giddiness,  vertigo,  hallucinations,  ensue,  and  are  coincident  with  a 
fatty  degeneration  of  the  cells  of  the  gray  matter.  The  subcutaneous 
fat  disappears  ;  the  muscles  lose  a  considerable  part  of  their  substance. 
The  muscular  substance  of  the  heart  diminishes  proportionally.  The 


DENUTRITION.  53 

bones  do  not  suffer  much  loss.  The  extreme  degree  of  loss  attaina'ole 
with  safety  is  from  40  to  50  per  cent  of  the  average  weight. 

Therapy. — Diminution  in  the  gross  amount  of  aliment  and  a  rear- 
rangement of  its  constituents  are  of  the  first  importance  in  the  treat- 
ment of  obesity.  The  tendency  to  obesity  may  be  hereditary  or  ac- 
quired. In  the  former  it  is  cured  with  difficulty  ;  in  the  latter  a  suit- 
able regimen  will  accomplish  much.  The  fat  accumulates  under  the 
skin,  in  the  visceral  cavities,  and  in  the  interstices  of  organs.  Two- 
doctrines  have  been  held  by  physiologists  with  regard  to  the  mode  of 
production  of  fat  in  the  organism  :  one,  that  the  fat  received  in  the 
food  is  simply  stored  up  ;  the  other,  that  it  is  also  produced  by  the 
transformation  of  some  of  the  other  constituents  of  the  food.  If  the 
first  theory  contained  the  whole  truth,  it  would  be  necessary  only  in 
the  treatment  of  obesity  to  withdraw  from  the  patient's  aliment  all 
fatty  substances  ;  but  it  is  found  in  practice  that  this  is  insufficient, 
and  that  fat  is  created  out  of  the  starchy  and  saccharine  elements  of 
the  food.  Hence  it  is  necessary  in  the  treatment  of  corpulence  to  in- 
terdict not  only  fats,  but  the  starches  and  sugar.  This  was  the  method 
of  Hippocrates ;  but  it  has  been  revived  in  our  generation  by  Mr. 
Banting,  and  is  now  usually  called  Bantingism.  As  a  guide  to  this 
method  of  treatment  I  quote  the  rules  of  Mr.  Banting  : 

"  For  breakfast,  at  9  A.  M.,  I  take  five  or  six  ounces  of  beef,  mutton, 
kidneys,  broiled  fish,  or  cold  meat  of  any  kind  except  pork  or  veal ;  a 
large  cup  of  tea  or  coffee,  without  milk  or  sugar  ;  a  little  biscuit  or 
one  ounce  of  dry  toast  ;  making  together  six  ounces  of  solid  and  nine 
of  liquid.  For  dinner,  at  2  p.  M.,  five  or  six  ounces  of  any  fish  except 
salmon,  herring,  or  eels  ;  any  meat  except  pork  or  veal ;  any  vegetable 
except  potato,  parsnip,  beet,  turnip,  or  carrot ;  one  ounce  of  dry  toast ; 
fruit  out  of  a  pudding  not  sweetened  ;  any  kind  of  poultry  or  game,, 
and  two  or  three  glasses  of  good  claret,  sherry,  or  madeira — cham- 
pagne, port,  and  beer,  forbidden  ;  making  together  ten  or  twelve 
ounces  solid  and  ten  liquid.  For  tea,  at  6  P.  M.,  two  or  three  ounces 
of  cooked  fruit,  a  rusk  or  two,  and  a  cup  of  tea  without  milk  or  sugar  ; 
making  together  two  to  four  ounces  solid  and  nine  liquid.  For  sup- 
per, at  9  P.  M.,  three  or  four  ounces  of  meat  or  fish,  similar  to  dinner^ 
with  a  glass  or  two  of  claret  or  sherry  and  water,  making  together 
four  ounces  solid  and  seven  liquid." 

Sugar,  Mr.  Banting  finds,  is  one  of  the  most  active  of  fat-forming 
foods.  His  method  consists  in  the  avoidance  of  sugar,  fat,  and  farina- 
ceous substances — in  fact,  all  roots  or  vegetables  grown  underground. 
Although  this  system  was  pursued  by  Mr.  Banting  with  success,  it 
can  not  always  be  persisted  in  without  danger.  The  dietary  is  want- 
ing in  the  amount  both  of  carbonaceous  and  nitrogenous  constituents 
necessary  to  the  healthy  action  of  the  organism.  Therapeutically  it  is 
adapted  to  the  end  in  view — the  denutrition  of  the  body  ;  but  it  ia 


54  RESTORATIVE  AGENTS. 

physiologically  considered,  unsafe  to  be  long  persisted  in,  "because  in- 
sufficient for  the  work  of  the  body. 

Aneurism. — A  low  diet,  with  absolute  rest,  is  of  great  value  in  the 
treatment  of  internal  aneurisms.  The  diet  should  be  only  sufficient  to 
maintain  life.  The  method  of  Valsalva  consisted  in  such  a  diet  and 
frequent  and  free  bleedings,  with  rest.  Mr.  Tufnell's  plan  of  diet, 
which  has  proved  very  satisfactory  in  this  disease,  consists  in  two 
ounces  of  liquid  and  four  ounces  of  solid  food  morning  and  evening, 
and  four  ounces  of  liquids  and  six  ounces  of  solids  at  noon,  and  with 
this  dietary  is  associated  absolute  repose  in  the  recumbent  posture. 

To  diminish  the  Volume  of  the  Foetus  in  cases  of  Dystocia  has 
been  suggested  by  Merriman,  Baudelocque,  and  Moreau,  and  was  suc- 
cessfully practiced  in  two  cases  by  Depaul.  The  method  consists  in 
free  abstraction  of  blood,  and  the  lowest  diet  consistent  with  the  exist- 
ence of  life.  At  the  present  time  the  methods  of  inducing  premature 
labor  have  been  so  perfected  as  to  quite  take  the  place  of  the  practice 
of  Depaul. 

Syphilis. — It  is  certainly  an  eminently  rational  expedient  to  relieve 
the  organism  of  a  virus  by  a  continuous  and  gradual  molecular  de- 
struction and  a  renewal  of  the  anatomical  elements.  Such  is  the  hun- 
ger-cure of  syphilis,  an  Arabic  method  of  treating  that  disease.  Very 
satisfactory  results  have  been  attained  by  this  means  ;  but  the  self- 
denial  and  even  suffering  which  it  requires  render  it  exceedingly  un- 
popular with  patients. 

DRY  DIET. — This  consists  in  a  decided  diminution  or  a  temporary 
total  suspension  of  liquid  of  all  kinds.  It  is  well  known  that  water 
constitutes  about  two  thirds  of  the  gross  weight  of  the  adult  body. 
The  quantity  of  water  daily  lost  from  the  body  has  been  estimated  at 
about  four  and  a  half  pounds.  Dalton  thinks  that  fifty-two  fluid- 
ounces  is  the  quantity  required  by  a  man  in  full  health  exercising  in 
the  open  air.  The  difference  between  this  and  the  amount  of  loss  is 
made  up  by  the  water  contained  in  food,  especially  in  the  succulent 
vegetables.  Indeed,  it  is  quite  possible  for  the  vegetarian,  whose  diet 
consists  of  fruits  and  vegetables,  to  receive  sufficient  water  in  this  way 
for  the  purposes  of  his  organism. 

Physiological  Effects  of  Dry  Diet. — Besides  the  tormenting  sensa- 
tion of  thirst,  the  food  is  swallowed  with  difficulty  and  the  appetite  is 
lost.  Absorption  of  the  interstitial  fluids  takes  place,  and  the  volume 
of  the  organs  undergoes  diminution.  The  subcutaneous  veins  flatten, 
and  the  pulse  loses  in  tension  and  amplitude  ;  the  saliva  becomes  vis- 
cid ;  the  urine  reddens  and  deposits  a  sediment ;  constipation  ensues, 
and  a  rapid  emaciation  takes  place  (Fonssagrives). 

Therapy. — As  the  withdrawal  or  decided  diminution  of  fluid  causes 
rapid  absorption  of  the  interstitial  water,  this  method  of  treatment 
may  be  resorted  to  with  advantage  in  cases  of  dropsy.  It  has  been 


VEGETABLE   DIET. 


55 


used  with  success  in  dropsical  accumulations  of  the  serous  cavities, 
and  is  adapted  to  the  treatment  of  hydrothorax,  hydrops  pericardii, 
and  ascites. 

Fonssagrives  reports  two  cases  of  diabetes  insipidus  (polyuria)  de- 
cidedly benefited  by  the  dry  diet.  This  method  of  treatment  is  indi- 
cated in  diabetes  mellitus,  in  inflammatory  affections,  and  in  fevers — 
for  it  has  been  shown  that  the  febrile  temperature  is  in  proportion  to 
the  amount  of  water  furnished  the  tissues. 

Dilatation  of  the  Stomach,  besides  other  appropriate  treatment,  is 
benefited  by  water-free  food.  That  form  of  dyspepsia  and  dilatation 
of  the  stomach  produced  by  excessive  beer-drinking  is  much  improved 
by  abstinence  from  drinks  of  all  kinds.  The  ice-water  dyspepsia,  a 
malady  quite  common  during  the  summer  months  of  this  country,  may 
be  entirely  relieved  by  dry  diet. 

VEGETABLE  DIET. — The  special  indications  for  the  use  of  vegeta- 
ble food  are  reserved  for  the  sections  on  diet  in  special  diseases.  It  is 
necessary,  however,  to  say  something  here  of  the  grape-cure,  a  method 
of  treatment  much  in  vogue  in  some  parts  of  France  and  Germany. 

The  grape-cure  consists,  according  to  Carriere,  of  a  diet  exclusively 
of  grapes.  They  are  taken  many  times  a  day  to  repletion.  It  is  usual 
to  commence  with  a  pound,  and  progressively  to  increase  the  amount 
to  two,  three,  six,  and  eight  pounds,  a  limit  which  is  not  exceeded. 
The  first  grape-repast,  which  may  be  the  most  abundant,  is  in  the  early 
morning,  but  not  as  are  the  others,  eaten  in  the  vineyard.  Another  is 
taken  at  the  time  of  the  morning  meal  (corresponding  to  our  break- 
fast) ;  the  next  after  the  morning  walk  at  the  time  of  the  dejeuner 
(noon),  consisting  of  bread  and  water  ;  another  before  the  usual  din- 
ner-hour (evening),  and  finally  before  retiring.  The  treatment  is  con- 
tinued during  the  five  or  six  weeks  of  the  duration  of  the  grape-crop. 

The  grape-cure  is  used  with  success  in  plethora  of  the  portal  circu- 
lation, diarrhoea,  dysentery,  hemorrhoids,  and  engorgement  of  the 
spleen.  It  renders  much  service  in  the  principal  dyscrasiae,  as  scrofula, 
tuberculosis,  and  phthisis,  gout,  and  cutaneous  diseases  (Carriere).  The 
influence  of  change  of  air,  of  new  scenery,  and  of  the  hygienic  rules 
enforced  at  these  resorts,  should  not  be  ignored  in  an  estimate  of  the 
value  of  this  method. 

The  composition  of  the  ripe  grape  is,  according  to  Smith,  as  follows : 


Soluble. 

Grape-sugar 13'8 

Tartaric  acid 1'12 

Nitrogenous  matter *8 

Gum,  fat,  etc , '5 

Salts '36 

Water..                             ...  79'8 


Insoluble. 

Skins,  stones,  etc 2-6 

Pectose '9 

Mineral  water *12 


The  quantity  of  nitrogenous  matter  is  insufficient  for  the  needs  of  the 


56  RESTORATIVE  AGENTS. 

organism,  hence  the  addition  of  bread  and  water  to  the  diet  of  the 
grape-cure. 

ANIMAL  DIET. — The  more  or  less  exclusive  use  of  animal  food  im- 
proves the  quality  of  the  blood  by  increasing  the  number  of  the  red 
corpuscles.  The  urine  rises  in  specific  gravity,  and  the  urea  and  uric 
acid  are  increased  in  amount.  According  to  Liebig,  force  in  excess  is 
developed  from  a  diet  of  animal  food,  whence  a  nation  of  animal  feed- 
ers must  be  a  nation  of  hunters,  possessing  a  savage  disposition. 
Those  who  consume  largely  of  animal  food  are  not  fat,  but  have  a 
high  degree  of  muscular  activity.  They  are  tormented  by  imperious 
venereal  desires,  and  are  irritable  in  temper. 

Therapy. — A  diet  of  animal  food  is  specially  indicated  and  of  great 
utility  in  diabetes.  As  the  vegetables  and  fruits  contain  sugar,  and 
starch  which  is  readily  transformed  into  sugar,  they  are  interdicted  in 
this  disease.  A  method  of  treating  diarrhoea  long  practiced  in  Rus- 
sia, and  popularized  by  Trousseau,  consists  in  the  use  of  a  pulp  of  raw 
meat.  A  bit  of  fillet  of  beef  is  deprived  of  all  fat  and  aponeurotic 
fiber,  minutely  divided,  and  beaten  in  a  mortar  until  all  traces  of  fibers 
have  disappeared.  It  is  then  pressed  through  a  fine  sieve  and  mixed 
with  sugar,  conserve  of  roses,  or  suitable  aromatics,  or  seasoned  with 
salt  and  pepper  to  the  taste.  It  may  be  administered  in  this  form 
with  fruit-jelly,  or  spread  on  thin  pieces  of  bread.  A  beefsteak  has- 
tily broiled  on  a  hot  fire,  so  as  to  retain  its  juices,  may  be  treated  by 
the  same  method,  or  the  raw  beef  scraped  to  a  pulp,  rejecting  the 
fiber,  may  be  thrown  on  to  a  hot  skillet  for  a  few  seconds  to  give  an« 
odor  and  appearance  of  cooked  meat.  This  method,  which  has  been 
used  especially  in  the  treatment  of  diarrhoeal  diseases  of  early  life,  is 
equally  efficacious  in  the  chronic  diarrhoea  of  adults.  The  chief  ob- 
jection to  this  mode  of  alimentation  is  the  great  frequency  with  which 
tape- worm  follows. 

In  states  of  debility  arising  from  any  cause  in  which  it  is  neces- 
sary to  supply  an  easily-digested  nitrogenous  aliment,  raw  beef  may 
be  used  in  this  way. 

Blood  is  so  rich  in  the  elements  of  nutrition  that  its  employment 
as  a  food  in  wasting  diseases  need  not  excite  surprise.  Within  a  few 
years  it  has  been  much  used  in  the  treatment  of  phthisis,  the  patients 
resorting  to  the  butchers'  shambles  to  quaff  the  blood  as  it  flows  away. 
On  the  part  of  the  patients,  it  is  supposed  to  possess  some  special  cura- 
tive power  ;  but  it  is  only  as  a  nutrient  that  its  use  is  justifiable.  Be- 
sides the  unpleasant  associations  which,  must  necessarily  be  connected 
with  blood-drinking,  there  is  danger  of  swallowing  parasites.  That 
it  improves  nutrition,  often  to  a  remarkable  extent,  is  undeniable.  It 
must  therefore  remain  a  question  to  be  decided  by  the  patient  whether 
he  will  incur  the  risk  of  infection  by  parasites,  to  be  benefited  by 
drinking  a  valuable  nutrient. 


MILK-DIET.  57 

As  the  serum  of  the  blood  contains  the  most  important  of  the  nu- 
tritive elements  of  the  blood,  the  use  of  this  has  been  proposed  in  lieu 
of  the  latter,  administering  one  ounce  three  times  a  day.  Blood-serum 
is  said  to  be  an  efficient  vermifuge.  It  must  be  taken  fasting. 

MILK-DIET. — The  numerous  and  important  applications  of  milk= 
diet  in  the  treatment  of  certain  forms  of  disease  render  it  necessary  to 
devote  considerable  space  to  the  consideration  of  this  subject.  Milk 
is  a  food  already  prepared,  and  therefore  needs  no  intervention  of  un- 
skillful cooks  ;  it  can  be  obtained  everywhere ;  few  patients  are  dis- 
inclined to  take  it. 

Physiological  Effects  of  Milk-Diet. — In  the  use  of  a  diet  for  a  long 
time  exclusively  of  milk,  great  difficulty  is  often  experienced  in  over- 
coming the  repugnance  of  the  patient.  Although  as  a  rule  it  is  taken 
with  readiness  at  first,  after  a  time  it  begins  to  pall  upon  the  appetite, 
and  the  greatest  resolution  is  necessary  on  the  part  of  the  patient  in 
order  to  continue  it.  A  distressing  sense  of  emptiness  is  experienced 
at  the  epigastrium.  The  mouth  becomes  pasty,  and  the  tongue  is 
coated  with  a  thick,  whitish  fur.  Constipation,  sometimes  exceedingly 
obstinate,  occurs,  and  the  stools  are  hard  and  of  an  ochre-yellow  color. 
Occasionally  diarrhoea  is  produced,  but  this  is  due  to  the  fact  that  the 
milk  disagrees  and  is  not  digested.  The  urinary  secretion  is  increased 
in  amount,  but  this  is  due  simply  to  an  increased  flow  of  water.  Al- 
though milk  contains  all  the  constituents  necessary  for  the  nutrition 
of  the  body,  when  it  is  used  as  an  exclusive  article  of  diet  in  the  case 
of  those  accustomed  to  a  full  mixed  diet,  a  decided  diminution  in  the 
weight  of  the  body  takes  place.  After  a  time,  however,  the  waste 
ceases,  and  the  weight  continues  at  a  uniform  level.  The  interference 
of  a  milk-diet  with  nutrition  is  more  decided  when  skimmed  milk  is 
used — a  form  in  which  it  is  more  usually  administered  in  intestinal 
disorders.  The  pulse  is  quickened  and  the  arterial  tension  lowered  ; 
but  a  fall  in  the  pulse-rate  takes  place  when  the  body  ceases  to  lose 
weight.  A  marked  degree  of  debility  is  experienced  by  some  persons, 
so  that  they  are  unable  to  take  exercise.  In  two  cases  in  which  I  used 
this  method  with  signal  success — chronic  eczema,  and  chronic  ulcer  of 
the  stomach — the  patients,  both  females,  experienced  vertigo  and  faint- 
ness,  and  Mitchell  mentions  a  case  in  which  from  the  same  cause  he 
was  compelled  to  discontinue  the  milk.  Ordinarily,  however,  nothing 
more  than  weakness  is  experienced. 

Therapy. — Pecholier,  Carel,  Mitchell,  and  all  who  have  treated  of 
the  milk-cure,  insist  upon  the  suspension  of  all  other  food  and  drink. 
The  quantity  to  be  taken  will  vary  with  the  constitutional  peculiarities, 
habits  of  life,  and  probably  the  mental  condition  of  the  patient.  As 
milk  requires  about  three  hours  for  its  complete  digestion,  this  fur- 
nishes a  rule  for  its  administration.  One  gill,  or  four  ounces,  every 
three  hours,  beginning  on  rising  in  the  morning,  is  the  rule  which  I 


58  RESTORATIVE   AGENTS. 

have  followed  with  success.  As  soon  as  the  patient  can  take  a  suffi- 
cient quantity,  one  or  two  tumblerf uls  four  times  a  day  may  be  ordered. 
From  a  quart  to  two  quarts  is  the  daily  amount  which  will  be  taken 
usually  by  the  patient.  It  is  better  administered  slightly  warm. 

In  many  cases  of  stomach  and  intestinal  disorders,  it  is  better  to 
give  skimmed  milk.  The  milk  should  stand  for  twenty-four  hours  in 
a  cool  place,  and  then  all  the  cream  which  has  risen  should  be  care- 
fully removed.  Sometimes,  says  Pecholier,  when  crude  milk  disagrees 
with  or  is  disgusting  to  the  patient,  it  may  be  boiled.  The  digestion 
of  the  milk,  says  the  same  authority,  when  it  is  poorly  borne,  may  be 
aided  by  the  addition  of  lime-water,  bicarbonate  of  soda,  and  other 
alkalies.  Mitchell  has  added  lime-water  for  the  first  few  days  under 
the  same  circumstances,  and,  in  order  to  overcome  the  patient's  repug- 
nance to  the  taste,  has  faintly  flavored  the  milk  with  a  little  coffee 
or  caramel ;  but  he  prefers  to  give  it  alone  as  soon  as  possible.  My 
own  observation  has  been,  that  milk  is  better  borne  when  given  for 
the  first  few  days  with  lime-water,  in  proportion  of  one  fourth  of  the 
latter. 

For  the  nourishment  of  infants  deprived  of  their  natural  food,  no 
substitute  is  better  than  cow's-milk  diluted  with  about  one  third  of 
water  and  sweetened  with  sugar,  in  order  more  closely  to  assimilate  it 
in  composition  to  the  human  milk.  This  should  be  given  at  a  tem- 
perature of  100°  Fahr.,  and  at  intervals  of  three  hours.  No  other 
food  than  milk  is  proper  for  infants  up  to  the  eighth  month  of  life,  for 
their  digestive  organs  are  not  adapted  to  the  digestion  of  the  farina- «, 
ceous  foods  so  commonly  supplied  them.  If  the  milk  be  rejected,  the 
addition  of  lime-water  may  enable  the  infant  to  retain  and  digest  it. 

In  the  treatment  of  disease  in  the  adult  with  skimmed  milk,  the 
time  for  suspension  of  the  diet  depends  on  several  conditions.  Carel 
begins  to  make  additions  after  two  or  three  weeks  ;  Pecholier  when 
the  effects  sought  for  in  the  treatment  are  obtained.  Mitchell  formu- 
lates his  method  as  follows  :  "  My  own  rule,  founded  on  considerable 
experience,  is  this  :  Dating  from  the  time  when  the  patient  begins  to 
take  milk  alone,  I  wish  three  weeks  to  elapse  before  anything  be  used 
save  milk.  After  the  first  week  of  the  period,  I  direct  that  the  milk 
be  taken  in  just  as  large  amount  as  the  person  desires,  but  not  allow- 
ing it  to  fall  below  a  limit  which,  for  me,  is  determined  in  each  case 
by  his  ceasing  to  lose  weight.  Twenty-one  days  of  absolute  milk-diet 
having  passed,  with  such  exception  as  I  shall  presently  mention,  I  now 
give  a  thin  slice  of  stale  white  bread  thrice  a  day.  After  another 
week  I  allow  rice  once  a  day — about  two  tablespoonfuls — or  a  little 
arrow-root,  or  both,  as  circumstances  may  dictate.  At  the  fifth  week 
I  give  a  chop  once  a  day  ;  and,  in  a  day  or  two,  another  at  breakfast ; 
and  after  the  sixth  week  I  expect  to  return  gradually  to  a  diet  which 
should  still  consist  largely  of  milk  for  some  months."  My  own  rule 


WHEY-CURE— KOUMISS-CURE.  59 

has  consisted  in  the  gradual  addition  of  other  diet  after  the  cessation 
of  symptoms  for  which  the  milk-treatment  was  instituted. 

Dr.  Stanley  S.  Cornell,  of  Ontario,  Canada,  has  favored  me  with  an 
account  of  a  case  of  fecal  impaction,  in  which  a  great  quantity  of  curds 
accumulated  behind  the  faeces.  Such  an  accident  illustrates  the  neces- 
sity of  keeping  the  bowels  in  good  condition  during  a  course  of  milk 
diet.  One  of  the  Saratoga  waters,  a  little  Epsom  or  Rochelle  salts  in 
the  early  morning,  or  a  little  aloes  and  belladonna  at  night,  will  usually 
suffice.  A  little  black  coffee  added  to  the  milk  may  answer. 

The  milk-cure  is  especially  adapted  to  the  treatment  of  obstinate 
stomach  affections.  It  has  succeeded  admirably  in  the  treatment  of 
dyspepsia,  gastric  catarrh,  gastralgia,  gastric  ulcer,  and  has  procured 
marked  amelioration  in  cases  of  scirrhus  of  the  stomach.  In  chronic  in- 
testinal indigestion,  obstinate  and  persistent  enteralgia,  chronic  diar- 
rhoea, and  dysentery,  it  has  proved  very  efficacious. 

The  treatment  of  ascites  by  a  milk-diet  appears  to  have  been  of  an- 
cient origin,  for  Hippocrates  distinctly  refers  to  it,  but  the  revival  of  the 
practice  in  modern  times  is  due  to  Chrestian,  of  Montpellier,  who  demon- 
strated the  utility  of  this  practice  in  a  number  of  cases  (Fonssagrives). 
Pecholier  and  Chairon  also  report  cases  of  success  treated  by  this 
method.  In  cases  of  ascites  the  result  appears  to  be  due  to  the  profuse 
alvine  and  urinary  discharges  which  are  caused  by  the  milk-diet  in  this 
disease.  Pecholier  also  reports  cases  of  general  anasarca  due  to  cardiac 
disease,  much  benefited  by  this  treatment.  In  England,  Donkin  has 
issued  a  monograph  on  the  skim-milk  treatment  of  albuminuria,  with 
successful  cases.  This  method  has  also  been  extended  to  diabetes,  and 
reports  of  cures  are  not  wanting. 

Eczema,  connected  with  acid  indigestion,  has  been  successfully 
treated  by  an  exclusive  skim-milk  diet  in  my  hands,  and  Mitchell  reports 
an  analogous  case.  Gout  and  gouty  affections  have  also  been  much 
improved,  and  the  diathesis  apparently  removed,  by  a  persistent  use  of 
the  milk-cure.  Lastly,  aneurism  and  cardiac  disease  (irregular  and 
tumultuous  action  due  to  valvular  lesions)  have  been  benefited  by  a 
milk-regimen. 

"WHEY-CURE. — This  mode  of  treatment  is  conducted  in  the  moun- 
tain health-resorts  of  Switzerland  and  Germany,  and  is  usually  connected 
with  the  grape-cure.  As  whey  contains  so  little  of  the  nutritious  ele- 
ments of  the  milk,  we  may  conclude  with  Lebert  that  the  hygiene  and 
climate  of  these  mountain-resorts  do  everything  for  the  patients,  and  if 
they  improve  they  do  so  in  spite  of  the  whey. 

KOUMISS-CURE. — Koumiss  differs  from  whey  in  containing  the  nutri- 
tive constituents  of  milk,  and  from  milk  itself  in  the  important  respect 
that  it  is  in  addition  an  effervescing  alcoholic  fluid.  Koumiss  possesses 
great  value  in  the  treatment  of  phthisis,  chronic  bronchitis,  the  low 
stage  of  fevers,  the  stage  of  convalescence  from  acute  diseases,  and  in 


60  RESTORATIVE   AGENTS. 

fact  in  all  adynamic  states  in  which  the  combined  effect  of  alcohol  and 
nutrients  may  be  desirable. 

BUTTERMILK-CURE. — To  the  efforts  of  Dr.  Ballot,  of  Rotterdam,  is 
due  the  knowledge  we  now  possess  of  the  value  of  buttermilk  as  a  food 
for  infants.  The  relative  composition  of  buttermilk  and  mother's-milk 
is  given  in  the  following  table  : 


CONSTITUENTS. 

Buttermilk. 

Mother's-milk. 

Casein                   

43-8 

34-3 

Milk-su^ar  . 

23-6 

48-2 

Butter  

2'0 

23-3 

Salts  

5'6 

2-3 

Water  

921-75 

883'6 

78-25 

116*4 

2-75 

nil. 

It  is  probably  in  consequence  of  the  presence  of  lactic  acid,  as  Dr.  Ballot 
suggests,  that  buttermilk  is  easily  digested.  His  manner  of  preparing 
the  food  for  infants  is  as  follows  :  To  a  pint  of  buttermilk  is  added  a 
spoonful  of  wheat-flour.  This  is  boiled  a  few  minutes.  The  pap  must 
be  thin.  To  this  quantity  of  buttermilk,  after  it  is  boiled,  is  added  half 
a  drachm  of  sugar.  It  should  have  a  sweet  taste. 

In  the  beginning  some  teaspoonf  uls  are  given  to  habituate  the  infant 
to  the  smell  and  taste,  but  as  soon  as  possible  it  should  be  administered 
in  a  nursing-bottle.  The  temperature  should  be  about  96°  Fahr.  When 
the  infant  acquires  a  taste  for  the  preparation,  it  may  be  given  ad  libi- 
tum twice  a  day. 

Buttermilk-cure  may  be  substituted  for  the  milk-cure  in  cases  of 
stomach  disease,  in  which  the  former  has  proved  so  successful,  and  in 
cases  of  albuminuria  and  diabetes.  In  consequence  of  the  large  propor- 
tion of  lactic  acid  which  it  contains,  buttermilk  is  more  especially  indi- 
cated in  diabetes. 

INFANT-FEEDING. — It  has  already  been  stated  that  fresh  milk  of  the 
cow  is  the  best  substitute  for  the  mother's-milk.  Some  additional  obser- 
vations as  to  the  management  of  cow's-milk,  and  as  to  the  substitutes 
therefor,  may,  however,  be  necessary.  There  can  be  no  doubt  that  cow's- 
milk  is  better  than  goats'  or  asses'  as  a  rule,  although  there  are  infants 
who  thrive  on  the  two  last-named  better.  In  the  large  cities  where  it 
is  impossible  to  procure  fresh  milk,  condensed  milk  is  an  efficient  sub- 
stitute. As  in  the  preparation  of  this  the  temperature  is  raised  to  near 
the  boiling-point  of  water,  it  undergoes  no  change,  and  can  be  used 
when  fresh  milk  is  not  to  be  procured,  or  can  not  be  preserved.  Con- 
densed milk  is  ready  for  use  by  mixing  it  with  water  in  the  proportion 
of  one  teaspoonf ul  of  milk  to  seven  of  warm  water.  When  the  addition 
of  lime-water  is  desirable,  it  can  be  added  in  proper  proportion.  In  the 
author's  experience,  children,  with  few  exceptions,  do  well  on  condensed 
milk. 


MILK-JELLY.  61 

Casein  is  that  constituent  of  milk  which  is  most  likely  to  disagree 
with  infants.  Dilution  with  water,  lime-water,  barley-water,  etc.,  is 
not  unfrequently  effective  in  securing  the  digestion  and  absorption  of 
the  casein ;  but  some  infants  are  unable  to  digest  it  at  all.  Various 
expedients  are  resorted  to  when  the  casein  fails  entirely  of  digestion. 
Cream  diluted  with  barley-water  sometimes  succeeds  extremely  well. 
The  indigestion  of  the  casein  of  a  given  specimen  of  milk  may  be 
due  to  an  insufficient  quantity  of  cream  ;  this  defect  can  be  obviated 
by  adding  it  artificially.  When  the  infant  is  not  nourished  suffi- 
ciently, and  yet  does  not  pass  undigested  casein,  the  proportion  of 
cream  is  probably  too  low.  To  assist  the  digestion  of  casein,  Jacobi 
recommends  that  a  little  well-sweetened  oatmeal-gruel  be  given  the 
infant  before  taking  the  bottle,  or  be  mixed  with  the  milk.  His 
method  of  preparing  the  food  is  as  follows  : 

"  A  teaspoonf ul  of  either  oatmeal  or  barley  is  boiled  in  from  three 
to  six  ounces  of  water,  with  some  salt,  for  twelve  or  fifteen  minutes, 
the  decoction  to  be  quite  thin  for  very  young  infants,  thicker  for 
later  months,  and  then  strained  through  a  linen  cloth.  Infants  of 
four  or  six  months  are  to  have  equal  parts  of  this  decoction,  which 
ought  to  be  made  fresh  for  every  meal  ;  and  boiled  and  skimmed 
cow's-milk  and  sugar  are  to  be  added.  At  an  early  age,  the  thin  de- 
ooction  ;  at  a  later,  the  milk  ought  to  prevail  in  the  mixture,  which 
ought  to  be  given  at  a  temperature  of  80°  to  90°  ;  ought  to  be  neu- 
tralized, when  acid,  with  a  few  grains  of  bicarbonate  or  carbonate 
of  potassa  or  soda,  and,  until  infants  are  eight  or  ten  months  old,  thin 
enough  to  be  taken  through  a  nursing-bottle." 

Various  substitutes  have  been  proposed  for  cow's-milk  ;  but  they 
are  at  best  constructed  on  doubtful  principles,  and  vary  greatly  in 
composition.  Liebig's  preparation  has  had  the  greatest  celebrity,  be- 
cause of  the  reputation  of  its  inventor,  rather  than  of  its  intrinsic 
merit.  It  is  prepared  as  follows  :  An  ounce  of  wheaten  flour  is  mixed 
with  ten  ounces  of  milk  ;  it  is  then  boiled  for  ten  minutes,  removed 
from  the  fire,  and  allowed  to  cool  to  90°  Fahr.  An  ounce  of  malt- 
powder  containing  fifteen  grains  of  potassium  bicarbonate,  and  two 
ounces  of  water,  are  then  stirred  into  it,  and  the  vessel,  covered, 
stands  for  an  hour  and  a  half  at  a  temperature  of  100°  Fahr.  It  is 
boiled  for  a  few  minutes  again,  and  then  strained,  when  it  is  ready 
for  use.  The  object  of  the  malt  is  to  transform  the  starch  into  glu- 
cose. 

MILK-JELLY. — Prof.  Liebreich  recommends  the  following  : 

Heat  one  quart  of  milk  with  one  pound  of  sugar,  and,  when  the 
sugar  is  dissolved,  continue  the  heat  at  a  boiling  temperature  for  about 
ten  minutes. 

Now  cool  it  well,  and  then  add,  slowly  stirring,  a  solution  of  one 
ounce  of  gelatin  in  a  cupful  of  water.  Next  add  the  juice  of  three  or 


62  RESTORATIVE   AGENTS. 

four  lemons,  and  three  wineglassfuls  of  wine  or  brandy.  Set  in  a  cold 
place.  The  milk  must  be  quite  cold  before  the  other  ingredients  are 
added,  as  it  would  otherwise  curdle. 

At  the  expiration  of  six  months  the  milk  should  be  given  undiluted. 
An  infant's  food  should  always  be  raised  to  the  temperature  of  95°  Fahr. 
Regularity  in  the  time  of  feeding  is  of  very  great  importance  :  for  the 
first  six  weeks,  every  two  hours,  and  subsequently,  every  three  hours. 

Prof.  Frankland  proposes  the  following  method  of  converting 
cow's  milk  into  a  milk  having  the  same  composition  as  human  milk. 
It  has  much  to  recommend  it,  and  hence  the  author  invites  the  atten- 
tion of  his  readers  to  the  process  of  preparation  : 

"  Allow  one  third  of  a  pint  of  new  milk  to  stand  for  twelve  hours, 
remove  the  cream,  and  add  to  it  two  thirds  of  a  pint  of  new  milk  as 
fresh  from  the  cow  as  possible.  Into  the  one  third  of  a  pint  of  the 
blue  milk  left  after  the  abstraction  of  the  cream,  put  a  piece  of  rennet 
about  an  inch  square.  Set  the  vessel  in  warm  water  till  the  milk  is 
fairly  curdled,  which  requires  from  five  to  fifteen  minutes,  the  rennet 
being  removed  as  soon  as  curdling  commences,  and  put  it  into  an  egg- 
cup  for  future  use,  as  it  can  be  employed  daily  for  a  month  or  two. 
Break  up  the  curd  thoroughly  and  separate  the  whole  of  the  wheyr 
which  should  be  rapidly  heated  to  boiling,  when  a  little  more  casein 
separates,  and  may  be  removed  by  straining ;  one  hundred  and  ten 
grains  of  powdered  milk  is  to  be  dissolved  in  this  hot  whey,  and  the 
sweetened  fluid  added  to  the  two  thirds  of  a  pint  of  new  milk." 

By  the  foregoing  process  the  cow's  milk  loses  a  portion  of  its  casein* 
and  gains  in  sugar  and  salts. 

Poisonous  Milk  and  Cream. — The  importance  of  milk  as  an  ex- 
clusive article  of  diet,  as  an  addition  to  ordinary  aliments,  and  as  a 
constituent  of  various  foods,  is  so  great  that  some  reference  must  be 
made  to  the  accidents  caused  by  it  under  certain  circumstances.  It 
has  long  been  observed  that  milk  and  cream  during  the  hot  season, 
and  sometimes  cheese  at  all  seasons,  brought  on  extreme  gastric  dis- 
turbance accompanied  by  profound  prostration.  The  cause  of  this 
change  in  a  fluid  so  innocuous  under  other  circumstances  remained  un- 
known until  Prof.  C.  Vaughan,  M.  D.,  of  the  University  of  Michi- 
gan, made  the  important  discovery.  He  first  isolated  &  ptomaine  in 
poisonous  cheese.  Subsequently  his  technical  skill  was  invoked  to 
determine  the  cause  of  wholesale  poisoning  from  ice-cream,  when  he 
was  able  to  confirm  his  former  research  by  the  discovery  of  the  toxic 
principle,  to  which  he  gave  the  name  tyrotoxicon.  This  is  a  crystalli* 
zable  principle  formed  during  the  course  of  the  butyric  fermentation  by 
the  action  of  the  microbe  of  this  process.  It  is  a  powerful  irritant 
poison,  is  acrid  in  taste,  and  causes  a  sense  of  constriction  and  a  per- 
sistent after-acridity  in  the  fauces  ;  sets  up  an  intense  gastro-intestinal 
disturbance,  nausea,  vomiting,  and  purging,  followed  by  profound 


ALIMENTATION   IN  DISEASES.  63 

depression  of  the  powers  of  life.  Milk  has  its  disadvantages.  Large 
draughts  of  cold  milk  at  meals  form  a  heavy  curd  that  may  try  the 
stomach  severely.  There  is  reason  to  believe,  also,  that  milk  is  hurt- 
ful to  the  rheumatic  and  gouty.  As  lactic  acid  results  from  the  fer- 
mentation of  milk-sugar,  or  lactose,  one  of  the  results  of  the  use  of 
milk  may  be  rheumatic  fever — for  it  is  pretty  generally  held  that  a 
yariety  of  lactic  acid  is  the  real  cause  of  this  disease. 

ALIMENTATION   IN  DISEASES. 

ALIMENT  IN  ACUTE  INFLAMMATIONS  AND  FEVERS. — The  febrile 
state  induces  serious  changes  in  the  constitution  of  solids  and  liquids. 
The  interstitial  fat  disappears  from  the  tissues,  which  become  soft 
and  watery.  The  muscles  grow  flabby  and  pale,  and  decline  in  con- 
tractile energy.  Digestion  is  feeble,  or  suspended  or  abnormal,  and 
the  food  supplied  is  either  rejected  or  enters  the  blood  in  an  imper- 
fectly-prepared state.  The  blood  suffers  material  alterations  ;  the  red 
corpuscles  diminish  in  number  ;  the  fibrin  increases,  and  the  products 
of  imperfect  tissue-metamorphosis  accumulate.  The  urine  is  usually 
scanty  and  high-colored,  and  loaded  with  uric  acid  and  urates.  The 
chlorides  more  or  less  diminish  in  or  disappear  from  the  urine,  but 
accumulate  in  the  inflamed  tissues.  The  excretion  of  phosphates  is 
increased.  In  the  tissues,  the  seat  of  organic  alterations,  rapid  but 
imperfect  metamorphosis  ensues,  and  on  the  one  side  pathological  ma- 
terials crowd  the  interstices  in  the  anatomical  elements,  and  on  the 
other  the  products  of  waste  struggle  for  elimination.  Avoiding  fur- 
ther speculation  as  to  the  fever-process,  it  will  suffice  to  state  that  an 
enormous  increase  of  the  urea-discharge  takes  place,  and  that  the 
organs  and  tissues  of  the  body  undergo  a  granular  disintegration, 
which  has  been  designated  "  parenchymatous  degeneration  "  ;  or,  as 
it  may  be  stated,  the  increased  temperature  of  fever  represents  an 
enormous  consumption  of  the  nitrogenous  elements.  The  higher  the 
range  of  temperature,  as  a  rule,  the  more  extensive  the  parenchyma- 
tous degeneration. 

In  fevers  and  inflammations  not  of  the  digestive  tract,  the  most 
useful  aliments  are  milk  and  beef -juice.  These  should  be  given  at  in- 
tervals determined  by  their  rate  of  digestibility,  usually  about  every 
three  hours.  Fresh  milk  only  should  be  used,  and,  if  the  stomach  be 
irritable,  it  may  be  diluted  with  one  half  to  one  fourth  of  lime-water. 
It  has  been  conclusively  demonstrated  that  fresh  milk  is  the  most 
suitable  aliment  in  typhoid,  and  it  may  be  depended  on  wholly  (John- 
son). It  is  equally  applicable  as  the  aliment  in  scarlatina,  partly  as  a 
nutrient,  and  partly  as  a  diuretic,  for  in  this  disease  one  of  the  chief 
dangers  is  from  arrest  of  the  urinary  secretion. 

The  author  is  convinced  that  beef-tea  and  beef-essence  are  too 
exclusively  used  in  the  treatment  of  the  fevers  and  inflammatory  dis- 


64  RESTORATIVE  AGENTS. 

eases.  As  an  aliment,  beef-tea  is  comparatively  inferior,  and  is  also 
difficult  of  digestion.  It  is  not  unusual  to  see,  in  cases  of  typhoid, 
the  beef-tea  floating  on  the  peculiar  dejections  of  this  disease.  It 
ought,  therefore,  never  to  be  used  as  the  exclusive  aliment  in  typhoid 
cases.  Another  fallacy  of  a  very  dangerous  kind  is  current  in  do- 
mestic practice,  viz.,  the  belief  that  beef -tea,  which  gelatinizes  on 
cooling,  is  especially  rich  in  nutritive  elements.  Such  beef -tea  con- 
sists chiefly  of  gelatin,  which  has  very  little  value  as  a  nutrient. 

FORMULAE  FOR  ANIMAL  BROTHS. 

"  Beef-  Tea. — A  pound  of  lean  beef  should  be  freed  from  fat.  tendon,  carti- 
lage, bone,  and  vessels ;  it  must  be  chopped  up  fine,  and  put  in  a  pint  of  cold 
water  to  digest  for  two  hours.  It  should  simmer  on  the  range  or  stove  for  three 
hours,  but  the  temperature  should  not  exceed  160°  Fahr.  The  water  lost  by 
evaporation  should  be  made  up  by  the  addition  of  cold  water,  so  tbat  a  pint  of 
beef-tea  should  represent  one  pound  of  beef.  It  should  be  strained,  the  beef 
being  carefully  expressed.  A  wineglassful  every  three  hours  is  a  suitable  quan- 
tity for  administration  in  ordinary  acute  cases. 

"  Mutton-Broth. — Lean  loin  of  mutton,  one  pound,  exclusive  of  bone ;  waterr 
three  pints.  Boil  very  gently  till  tender,  throwing  in  a  little  salt  and  onion  ac- 
cording to  taste.  Pour  out  the  brotb  into  a  basin,  and,  when  it  is  cold,  skim 
off  all  the  fat.  It  can  be  warmed  up  as  wanted. 

"  Chicken-Broth. — Skin,  and  chop  up  small,  a  small  chicken,  or  half  a  large 
fowl,  and  boil  it,  bones  and  all,  with  a  blade  of  mace,  a  sprig  of  parsley,  and  a 
crust  of  bread,  in  a  quart  of  water,  for  an  hour,  skimming  it  from  time  to  time.  . 
Strain  it  through  a  coarse  colander." 

•» 

The  digestibility  of  these  animal  broths  is  improved  by  the  addi- 
tion of  pepsin  and  muriatic  or  lactic  acids.  Beef-essence,  obtained  by 
pounding  finely-divided  beef  in  a  mortar  until  the  nutritive  elements 
are  separated  from  the  fiber,  may  be  administered  instead  of  the 
broths  above  described.  Essence  of  this  kind  may  be  mixed  with 
sherry  or  other  wines,  whisky,  or  brandy,  provided  alcoholic  stimu- 
lants be  also  indicated.  The  meat  solution  which  Leube  employs  so 
successfully  in  the  treatment  of  gastric  ulcer  and  other  stomach-dis- 
eases, is  prepared  by  digesting  meat,  with  muriatic  acid  and  pepsin,  in 
air-tight  vessels,  at  a  high  temperature.  By  this  process  the  meat  is 
converted  into  peptones,  ready  for  absorption. 

FORMULAE   FOR   DIET-DRINKS. 

"  Wine-  Whey. — Put  two  pints  of  new  milk  in  a  saucepan,  and  stir  it  over  a 
clear  fire  till  it  is  nearly  boiling ;  then  add  a  gill  of  sherry,  and  simmer  it  for  a 
quarter  of  an  hour,  skimming  off  the  curd  as  it  rises.  Then  add  a  tablespoonful 
more  sherry,  and  skim  again  for  a  few  minutes. 

" Flaxteed- Tea. — Flaxseed,  whole,  one  ounce;  white  sugar,  one  ounce; 
liquorice-root,  half  an  ounce ;  lemon-juice,  four  tablespoonfuls.  Pour  on  these 
materials  two  pints  of  boiling  water ;  let  them  stand  in  a  hot  place  four  hours^ 
and  then  strain  off  the  liquor. 


ALIMENTATION  IN  DISEASES.  65 

"  Barley-  Water. — Wash  two  ounces  of  pearl-barley  with  cold  water.  Then 
boil  it  for  five  minutes  in  some  fresh  water,  and  throw  both  waters  away.  Then 
pour  on  two  quarts  of  boiling  water,  and  boil  it  down  to  a  quart.  Flavor  with 
thiuly-cut  lemon-rind,  and  sugar  to  the  taste ;  but  do  not  strain  unless  at  the 
patient's  request." 

Other  foods  frequently  prescribed  for  the  inflammatory  and  febrile  states  are 
wine-whey  and  "  eggnog,"  or  "  egg-flip."  To  a  pint  of  boiling  milk  add  four 
ounces  of  sherry ;  strain  and  sweeten  the  whey  to  the  taste.  This  is  a  grateful 
subacid  drink,  but  slightly  nutritive.  Eggnog  may  be  prepared  as  follows : 
"Scald  some  new  milk  by  putting  it,  contained  in  a  jug,  into  a  saucepan  of  boil- 
ing water,  but  it  must  not  be  allowed  to  boil.  When  quite  cold,  beat  up  a  fresh 
egg  with  a  fork  in  a  tumbler  with  some  sugar  ;  beat  quite  to  a  froth,  add  a  des- 
sert-spoonful of  brandy,  and  fill  up  the  tumbler  with  scalded  milk."  This  may 
be  used  in  alternation  with  beef-tea,  or  exclusively  in  acute  inflammatory  or 
febrile  affections,  but  its  administration  should  not  usually  be  more  often  than 
every  three  hours.  Milk  and  egg  may  be  served  separately  with  wine  or  brandy, 
as  follows:  "To  one  tablespoonful  of  brandy,  or  one  wineglassful  of  sherry,  in 
a  bowl  or  cup,  add  powdered  sugar  and  a  very  little  nutmeg  to  taste.  Warm  a 
breakfast-cup  full  of  new  milk  and  pour  it  into  a  spouted  jug.  Pour  the  con- 
tents from  a  height  over  the  sugar,  wine,  etc.  The  milk  must  not  boil." 

"  Beat  up  with  a  fork  an  egg  till  it  froths ;  add  a  lump  of  sugar  and  two 
tablespoonf uls  of  water ;  mix  well,  pour  in  a  wineglass  of  sherry,  and  serve  be- 
fore it  gets  flat.  Half  the  quantity  of  brandy  may  be  used  instead  of  sherry." 

The  foregoing  are  the  most  accessible  and  the  most  nutritious  ali- 
ments for  the  acute  stage  of  fevers  and  inflammations.  They  contain 
the  materials  necessary  to  supply  the  loss  taking  place  in  the  organism 
at  large,  and  to  repair  the  damage  to  tissues  in  the  state  of  inflam- 
mation. 

ALIMENTS  IN  DISEASES  OF  THE  DIGESTIVE  ORGANS. — In  acute  and 
chronic  affections  of  the  digestive  organs,  especially  the  latter,  the 
skim-milk  treatment,  already  described,  possesses  the  highest  value. 
When  the  trouble  is  localized  to  the  stomach  and  is  of  an  acute  char- 
acter, only  the  most  easily-digested  aliments  are  borne,  as,  for  ex- 
ample, milk  and  lime-water,  barley-water,  tamarind-whey,  carbonic- 
acid  water,  effervescent  lemonade,  etc.  The  following  formulae  are 
useful  : 

"  To  a  tablespoonfnl  of  pearl-barley,  washed  in  cold  water,  add  two  or  three 
lumps  of  sugar,  the  rind  of  one  lemon,  and  the  juice  of  half  a  lemon.  On  these 
pour  a  quart  of  boiling  water  and  let  it  stand  for  seven  or  eight  hours.  Strain 
it." 

"  Boil  an  ounce  of  tamarind-pulp  with  a  pint  of  milk,  and  strain." 
"  Squeeze  two  large  lemons,  and  add  a  pint  of  spring  or  cistern  water  to  the 
juice  and  three  or  four  lumps  of  white  sugar.    When  required  for  use,  pour  half 
of  it  into  a  tumbler,  and  add  half  a  small  teaspoonful  of  bicarbonate  of  soda ; 
stir  and  drink  while  effervescing." 

In  the  chronic  affections  of  the  stomach,  when  digestion  is  feeble, 
especially  of  the  nitrogenous  elements  (deficiency  of  gastric  juice). 


66  RESTORATIVE   AGENTS. 

such  aliments  as  boiled  rice,  tapioca,  arrow-root,  unfermented  bread 
(aerated  bread),  and  the  farinaceous  vegetables,  are  indicated,  for 
these  foods  are  digested  chiefly  in  the  small  intestine.  Cases  of  acid- 
ity and  heart-burn,  dependent  on  the  fermentation  of  the  starchy  and 
fatty  elements  of  the  food,  require  abstinence  from  the  articles  con- 
taining them.  The  acid  fruits  and  vegetables  (apples,  peaches,  toma- 
toes, etc.)  are  to  be  preferred  under  such  circumstances  to  the  farina- 
ceous foods.  An  acid  wine  (Rhenish  or  Catawba),  taken  at  the 
principal  meal,  will  often  correct  the  acidity  derived  from  the  fermen- 
tation of  starch  and  fat. 

In  intestinal  indigestion,  summer  diarrhoea,  and  cholera  infantum, 
it  is  necessary  to  supply  those  foods  which  undergo  solution  in  the 
stomach,  in  compliance  with  the  fundamental  therapeutical  principle 
of  giving  a  suffering  organ  (the  intestine)  rest.  Starches  and  fats 
should  therefore  be  withheld.  Bread,  arrow-root,  potato,  beans,  peas, 
butter,  and  other  fats,  increase  the  disease,  because  on  reaching  the 
affected  organ  they  are  not  finally  digested,  but  act  as  irritants.  This 
result  is  well  seen  in  the  summer  diarrhoea  of  infants.  Milk,  eggs, 
animal  broths,  broiled  or  raw  beefsteak,  oysters,  white-fish,  are  suita- 
ble aliments  under  these  circumstances.  Similar  rules  obtain  in  the 
treatment  of  jaundice  from  catarrh  of  the  gall-ducts  and  of  biliary 
concretions.  The  starches  and  fats  are  especially  active  in  setting  up 
those  local  disturbances  which  result  in  the  production  of  jaundice  by 
extension  of  the  catarrhal  process  from  the  duodenum  along  the  he- 
patic duct.  The  use  of  fat  and  oil  has  an  immediate  result  in  favor- 
ing the  crystallization  of  the  cholesterin,  or  in  causing  inspissation" 
of  the  bile. 

Cases  of  chronic  diarrhoea  are  sometimes  remarkably  benefited  by 
a  diet  of  grape-juice,  peaches,  and  such  succulent  vegetables  as  tomato, 
celery,  and  raw  cabbage.  It  is  probable  that  the  cases  so  benefited 
are  really  scorbutic  in  character.  The  author  has  known  many  obsti- 
nate cases  of  summer  diarrhoea  of  infants  to  be  improved  by  the  ad- 
dition of  ripe  peaches  to  the  milk-diet. 

A  proper  regulation  of  the  diet  is  of  great  importance  in  the  treat- 
ment of  habitual  constipation.  This  usually  depends  on  deficient  se- 
cretion, or  torpor  (a  paretic  state)  of  the  muscular  layer t of  the  intes- 
tines. Corn-bread,  cracked  wheat,  oatmeal,  bread  of  unbolted  flour, 
fruits,  and  such  vegetables  as  green  corn,  tomatoes,  and  celery,  are  in- 
dicated. Those  troubled  with  habitual  constipation,  to  a  moderate 
extent,  may  overcome  it  by  the  daily  use  at  dessert  of  a  few  almonds 
and  raisins,  about  six  of  each.  Hemorrhoids  due  to  congestion  of  the 
portal  vein,  or  to  constipation,  are  much  benefited  by  the  grape-cure, 
or  a  diet  of  fruits  and  succulent  vegetables. 

ALIMENT  IN  CACHECTIC  STATES. — To  store  up  fat  in  the  tissues  and 
to  increase  muscular  power,  the  diet  must  consist  of  both  nitrogenous 


ALIMENTATION   IN   DISEASES.  67 

and  carbonaceous  elements.  The  fats  themselves  hold  the  first  place 
as  fat-forming  foods.  Those  most  frequently  employed  for  this  pur- 
pose are  the  fat  of  meat,  butter,  olive-oil,  cream,  and  milk.  Sugar 
and  saccharine  fruits  and  vegetables  rank  next  in  importance  as  fat- 
formers.  The  organism  has  the  power  of  transforming  starch  into 
fat,  whence  bread,  potato,  pastry,  rice,  arrow-root,  etc.,  belong  to  this 
class.  The  malt  liquors  undoubtedly  possess  an  extraordinary  energy 
in  the  same  direction,  hence  the  use  of  beer  and  ale  by  nursing  women  ; 
but  it  is  undoubtedly  true  that  milk  is  better  for  increasing  the  pro- 
duction of  milk.  Less  force  is  lost  in  the  conversion  of  cow's  milk 
into  human  milk  than  in  the  complex  process  needed  for  transforming 
the  nutritive  elements  of  malt  liquor.  The  same  fact  is  true  in  regard 
to  the  relative  facility  of  the  appropriation  of  fatty  aliment  and  of 
the  conversion  of  saccharine  and  farinaceous  food  into  fat.  It  is  also 
true  that,  for  the  increase  of  muscular  power,  muscular  tissues  and 
juices  are  more  easily  applied  by  the  organism. 

In  the  scrofulous,  mercurial,  plumbic,  syphilitic,  and  paludal  ca- 
chexiaB,  and  in  phthisis,  a  combination  of  the  flesh  and  fat  forming 
foods  is  necessary.  The  hunger  or  denutrition,  cure,  as  already  ex- 
plained, may  be  applied  to  the  treatment  of  these  cachexiae,  the  object 
being  to  produce  such  waste  and  molecular  changes  as  to  cause  the 
elimination  of  the  morbific  matters.  On  the  other  hand,  the  object 
sought  to  be  accomplished  in  these  states  of  disease  and  in  phthisis, 
by  improving  the  body  nutrition,  is  to  supplant  by  fresh  material  the 
lesions  of  the  anatomical  elements. 

In  rickets  (mollities  ossium)  it  is  necessary  to  supply  a  food  rich  in 
phosphate  of  lime  and  other  phosphate  salts.  Oatmeal,  bread  of  un- 
bolted flour,  cracked  wheat,  etc.,  should  be  added  to  the  dietary. 

Gout,  rheumatism,  and  the  so-called  uric-acid  diathesis,  require  a 
diet  composed  chiefly  of  farinaceous  vegetables  and  acid  fruits.  Animal 
food  and  saccharine  substances  are  contraindicated  in  these  disorders. 

In  no  disease  is  the  influence  of  diet  more  conspicuous  for  good  or 
evil  than  in  diabetes.  I  have  already  alluded  to  the  milk-cure,  revived 
by  the  Montpellier  school  and  popularized  in  England  by  Dr.  Donkin. 
All  saccharine  substances  and  fruits  and  vegetables  containing  them, 
and  all  farinaceous  foods  the  starch  of  which  is  easily  convertible  into 
dextrine  and  sugar,  are  injurious  in  diabetes.  In  this  prohibition  are 
included  bread,  potato,  beets,  beans,  peas,  sugar,  milk,  pastry,  and 
sweetmeats  of  all  kinds.  Tomatoes,  celery,  and  raw  cabbage,  are  not 
objectionable.  In  order  to  compensate  for  the  loss  of  bread,  the  great- 
est deprivation  endured  by  these  diabetics,  gluten  and  almond  bread 
are  now  prepared.  To  supply  the  deficiency  in  the  alimentation  of 
diabetics  caused  by  the  withdrawal  of  the  starch  elements  of  the 
food,  fats  must  be  used,  as  butter,  olive  and  cod-liver  oil,  fat  of  meat, 
cream,  etc. 

7 


68  RESTORATIVE  AGENTS. 

FORMULAE   FOR  VARIOUS   ARTICLES  OF  DIET. 

Lemonade. — "  Put  the  juice  of  a  lemon  to  a  pint  of  water,  in  which  an  ounce 
of  sugar  has  been  dissolved  ;  then  add  the  white  of  an  egg  and  froth  it  up.  It 
may  be  iced." 

Farina-Gruel. — "  Stir  two  tablespoonfuls  of  farina  into  a  quart  of  water  in 
a  milk  saucepan  ;  let  this  boil  until  it  has  grown  quite  thick  ;  add  a  pint  of  milk, 
a  little  salt,  and  let  it  boil  fifteen  minutes  longer ;  turn  out  into  a  bowl,  and 
sweeten  to  taste." 

Oatmeal- Gruel. — "Put  a  pint  of  boiling  water  into  a  saucepan;  into  this 
stir  a  couple  of  tablespoonfuls  of  oatmeal  until  quite  smooth  ;  let  this  boil  well 
for  ten  or  fifteen  minutes,  season  with  salt,  then  strain  through  a  strainer,  and 
add  a  little  port  wine  and  sugar,  if  the  patient  may  have  it." 

Corn-Meal  Milk- Gruel. — "Sweeten  a  quart  of  milk,  and  stir  in  two  table- 
spoonfuls  of  corn-meal.  This  must  be  carefully  cooked,  as  the  meal  is  apt  to 
scorch,  and  must  be  stirred  while  cooking.  A  little  nutmeg  grated  on  top  after 
it  is  done  makes  a  pleasant  flavor.  If  the  gruel  is  desired  thick,  more  meal  will 
be  needed." 

Tapioca  Jelly. — "  One  cup  of  best  tapioca  put  to  soak  with  a  pint  of  cold 
water ;  when  soft  put  in  a  saucepan  with  one  cup  of  sugar,  the  rind  and  juice 
of  one  lemon,  a  little  salt,  one  pint  more  water';  stir  until  it  boils  ;  turn  into  a 
mold  ;  set  to  cool ;  add  one  glass  of  wine  if  desired." 

Sago. — "  Put  half  an  ounce  of  sago  into  an  enameled  saucepan  with  three 
quarters  of  a  pint  of  cold  water,  and  boil  gently  for  an  hour  and  a  quarter. 
Skim  when  it  comes  to  a  boil,  and  stir  frequently.  Sweeten  with  a  dessert- 
spoonful of  sifted  loaf-sugar.  If  wine  be  ordered,  two  dessert-spoonfuls ;  and, 
if  brandy,  one  dessert-spoonful." 

Arrow-root. — "  Mix  two  teaspoonfuls  of  the  best  arrow-root  with  half  a 
wineglassful  of  cold  water;  add  a  pint  of  boiling  water;  put  it  into  an  enam-" 
eled  saucepan,  and  stir  over  the  fire  for  three  minutes.     Sweeten  with  three  tea- 
spoonfuls  of  sifted  loaf-sugar.     Add  either  a  wineglassful  of  white  wine,  or  a 
tablespoonful  of  brandy,  if  permitted." 

Arrow-root  Milk. — "  Mix  two  teaspoonfuls  of  arrow-root  with  a  wineglassful 
of  new  milk  ;  add  half  a  pint  of  boiling  milk ;  put  it  into  an  enameled  saucepan, 
and  stir  over  the  fire  for  three  minutes.  Sweeten  with  a  dessert-spoonful  of 
sifted  loaf-sugar." 

Whipped  Cream. — "  Beat  half  a  pint  of  fresh  double  cream  with  a  whisk,  add 
a  dessert-spoonful  of  very  finely  powdered  loaf-sugar,  and  twenty  drops  of  es- 
eence  of  vanilla  or  any  other  flavoring ;  when  firm  it  is  ready  for  use,  but  much 
improved  by  being  on  the  ice  for  an  hour  or  two." 

Corn-Starch  Pudding. — "  One  quart  of  milk,  four  tablespoonfuls  of  corn- 
starch,  four  eggs,  one  tablespoonful  of  butter,  six  tablespoonfuls  of  sugar.  Dis- 
solve the  corn-starch  in  a  little  cold  milk,  and,  having  heated  the  rest  of  the 
milk  to  boiling,  stir  this  in  and  boil  three  minutes,  stirring  all  the  time.  Take 
from  the  fire,  and  while  still  hot  put  in  the  butter.  Set  away  until  cold.  Beat 
the  eggs  very  light,  whites  and  yolks  separately.  Stir  the  sugar  and  any  flavor- 
ing desired  in  the  yolks  and  then  add  the  beaten  whites,  and  stir  in  the  corn- 
starch,  beating  thoroughly  to  a  smooth  custard.  Turn  into  a  buttered  dish  and 
bake  half  an  hour.  To  be  eaten  cold." 

Beef-Juice. — "  Broil  quickly  some  pieces  of  round  or  sirloin,  of  a  size  to  fit 
in  the  cavity  of  a  lemon-squeezer.  Both  sides  of  the  beef  should  be  quickly 


ALIMENTATION  IN  DISEASES.  69 

scorched  to  prevent  the  escape  of  the  juices,  but  the  interior  should  not  be  fully 
cooked.  As  soon  as  ready,  the  pieces  should  be  pressed  in  the  leinon-squeezer, 
previously  heated  by  being  dipped  in  hot  water.  The  juice,  as  it  flows  away, 
should  be  received  into  a  hot  wineglass,  and,  after  being  seasoned  to  the  taste 
with  salt  and  a  little  Cayenne  pepper,  eaten  while  hot.  If  preferred,  the  juice 
may  be  frozen." 

Meat-Tea. — "Put  one  pound  each  of  beef,  mutton,  and  veal,  cut  into  small 
pieces,  into  three  pints  of  cold  water.  It  should  simmer  for  three  or  four  hours, 
but  not  boil.  When  finished,  the  tea  should  be  carefully  strained,  and  seasoned 
with  salt,  and  Cayenne  pepper  if  preferred." 

Cream-Soup. — "Take  one  quart  of  good  stock  (mutton  or  veal),  cut  one 
onion  into  quarters,  slice  three  potatoes  very  thin,  and  put  them  into  the  stock 
with  a  small  piece  of  mace  ;  boil  gently  for  an  hour  ;  then  strain  out  the  onion 
and  mace ;  the  potatoes  should,  by  this  time,  have  dissolved  in  the  stock.  Add 
one  pint  of  milk,  mixed  with  a  very  little  corn-flour  to  make  it  about  as  thick  as 
cream.  A  little  butter  improves  it.  This  soup  may  be  made  with  milk  instead 
of  stock,  if  a  little  cream  is  used." 

Oatmeal- Soup. — "  Put  two  ounces  of  oatmeal  in  a  basin,  pour  over  it  a  pint 
of  cold  water,  stir  it,  and  let  it  stand  a  minute ;  then  pour  over  it5<  quickly  stir- 
ring all  the  time,  a  pint  of  good  broth,  pour  through  a  fine  strainer  into  a  sauce- 
pan, taking  care  that  none  of  the  coarse  part  of  the  meal  goes  into  the  soup. 
Boil  the  soup  for  ten  minutes,  season  and  serve." 

ARTIFICIAL  DIGESTION. 

We  owe  to  Dr.  Roberts,  of  Manchester,  the  introduction  of  partly- 
digested  foods,  under  the  term  "  peptonized."  The  formulae  below 
show  the  manner  in  which  they  are  prepared.  The  liquor  pancreati- 
cus  mentioned  is  a  solution  of  the  pancreatic  juice.  This  differs  from 
the  stomach-juice  in  that  it  requires  an  alkali  to  give  it  activity.  It 
can  now  be  obtained  of  the  pharmaceutists  or  druggists. 

Peptonized  Milk. — "  Fresh  milk  is  diluted  with  water  in  the  proportion  of 
three  parts  of  milk  to  one  part  of  water.  A  pint  of  this  mixture  is  heated  to 
boiling,  and  then  poured  into  a  covered  jug.  When  it  has  cooled  down  to  about 
140°  Fahr.,  one  or  two  teaspoonfuls  of  the  liquor  pancreaticus,  and  a  small  pinch 
of  bicarbonate  of  soda  (in  solution),  are  mixed  therewith.  The  jug  is  then 
placed  under  a  '  cozy '  in  a  warm  situation  for  one  hour.  At  the  end  of  this 
time  the  product  is  again  boiled  for  a  couple  of  minutes.  It  can  then  be  used 
like  ordinary  milk." 

Peptonized  MilJc- Gruel.— "  Half  a  pint  of  well-boiled  gruel  is  added,  while  still 
boiling  hot,  to  half  a  pint  of  cold  milk  in  a  covered  jug.  The  mixture  will  have 
a  temperature  of  about  125°  Fahr.  The  liquor  pancreaticus  and  the  bicarbonate 
of  soda  are  then  added  in  the  same  proportion  as  in  the  preceding  process. 
The  jug  is  placed  under  a  '  cozy  '  and  kept  warm  for  an  hour  and  a  half.  The 
contents  are  then  boiled  for  a  couple  of  minutes,  and  the  product  is  ready  for 
use.  By  this  second  method  the  use  of  the  thermometer  is  dispensed  with." 

Farinaceous  foods  are  predigested  by  acting  on  their  starchy  con- 
stituents with  malt  or  diastase.  Of  this  variety  are  Mettirfs,  Hor- 


70  RESTORATIVE   AGENTS. 


and  Benger's.  Mellin's  is  prepared  of  coarsely  ground  flour,  to 
which  malt  and  potash  are  added.  The  mixture  is  then  exposed  with 
some  water  to  a  moderate  temperature,  and  dextrin  and  sugar  formed. 
When  used,  a  teaspoonful  of  the  powder  is  mixed  with  two  ounces  of 
water  and  a  half  pint  of  milk.  Horlick's  food  is  similar.  Both  con- 
tain 60  to  70  per  cent  of  carbohydrates  in  a  soluble  form,  and  about 
10  per  cent  of  albuminoids.  Benger's  is  also  a  preparation  of  wheat 
flour  to  which  pancreatic  extract  is  added.  In  preparing  for  use,  a 
tablespoonful  is  dissolved  in  two  ounces  of  cold  milk,  and  to  this  is 
added,  slowly,  a  half  pint  of  boiling  milk.  To  prevent  further  ac- 
tion of  the  ferment,  it  is  then  raised  to  the  boiling  point  for  a  few 
minutes. 

Another  variety  of  predigested  foods  consists  of  those  acted  on  by 
diastase  and  then  evaporated  with  milk  and  cream.  The  mode  in 
which  these  foods  are  prepared  is  as  follows  :  Flour  of  wheat,  rye, 
or  other  grains,  but  chiefly  wheat,  is  first  made  into  dough,  which  is 
baked,  ground,  and,  mixed  with  condensed  cream  or  milk,  is  then  dried 
at  a  regulated  temperature.  Malt  or  diastase  added,  the  starch  is  con- 
verted into  maltose  and  dextrin,  and  the  albuminoids  become  more 
soluble. 

Nestles  food,  one  of  the  most  popular,  is  prepared  from  fresh 
cow's  milk  which  is  sterilized,  and  then  wheaten  bread  crust,  previ- 
ously acted  on  by  dextrin  at  a  proper  temperature,  is  added.  Suffi- 
cient cane  sugar  is  also  added,  and  the  mass  is  finally  dried  and  pul- 
verized. \ 

Malted  milk  belongs  to  this  group  of  predigested  aliments.  It  is 
sterilized  milk  mixed  with  extracts  of  barley  and  wheat,  and  dried  in 
vacuo.  The  starch  is  converted  into  dextrin,  and  the  casein  is  predi- 
gested. The  powder  thus  prepared  is  used  by  mixing  a  teaspoonful 
with  a  pint  of  water. 

Various  objections  are  now  urged  against  the  use  of  predigested 
aliments.  As  a  rule  they  have  a  bitter  and  disagreeable  taste,  and  are 
not  relished  by  the  sick.  As  regards  milk  —  which  may  be  referred  to 
as  representative  —  the  following  changes  occur  in  its  composition,  ac- 
cording to  Leeds  :  By  sterilization  at  212°  Fahr.  milk  loses  its  amylo- 
lytic  ferment,  the  casein  coagulates  less  readily  by  the  action  of  rennet, 
and  the  digestibility  of  the  casein  is  impaired.  Of  the  foods  acted  on 
by  predigestion,  the  theory  is  that  they  do  not  require  the  agency  of 
the  stomach,  and  are  already  prepared  for  absorption.  Recent  expe- 
riences render  this  doubtful.  Foods  thus  prepared  do  not  seem  to  pos- 
sess the  active  nutritive  properties  of  aliments  that  undergo  ordinary 
digestion.  Whenever,  therefore,  the  stomach  can  dispose  of  foods  in 
the  ordinary  way,  the  method  of  predigestion  should  not  be  employed. 

NUTBIENT  ENEMATA.  —  It  not  unfrequently  happens  that  the  stom- 
ach will  not  receive  and  dispose  of  nutrient  materials,  when  it  becomes 


ALIMENTATION  IN  DISEASES.  71 

necessary  to  employ  nutrient  rectal  injections.  It  has  been  proposed 
to  treat  ulcer  of  the  stomach  by  absolute  rest  of  the  organ,  and  the 
introduction  of  foods  by  the  rectum.  In  cases  of  excessive  irritabil- 
ity of  the  stomach  the  same  practice  is  sometimes  necessary.  (Eso- 
phagotomy  and  gastrotomy,  as  also  wounds  of  the  stomach,  may  ren- 
der the  use  of  nutrient  enemata  indispensable  to  save  life.  It  should 
not  be  forgotten  that  the  rectum  is  not  an  organ  of  digestion  ;  hence 
nutrient  enemata  must  contain  the  materials  for  artificial  digestion. 
Furthermore,  the  mucus  and  fluids  of  the  rectum  are  alkaline  in  reac- 
tion. To  secure  rapid  osmosis,  therefore,  the  enemata  should  have  an 
acid  reaction.  The  following  formula  is  suitable  for  the  purpose  : 

Beef -tea,  prepared  as  before  described,  four  ounces  ;  hydrochloric 
acid,  ten  minims  ;  glycerole  of  pepsin  (Scheffer's),  two  drachms. 

If  the  rectum  is  irritable,  ten  to  twenty  drops  of  the  tincture  of 
opium  may  be  added  to  the  injection.  If  stimulants  are  indicated, 
brandy  may  also  be  added.  The  rectum  soon  becomes  intolerant  of 
injections  ;  hence,  the  greatest  care  should  be  used  in  practicing  them, 
to  avoid  sudden  distention  of  the  bowel,  and  frequent  introduction  of 
nutrient  materials  should  be  avoided.  Five  times  in  the  twenty-four 
hours  should  be  the  maximum — for  artificial  digestion  is  much  slower 
than  normal  stomach  digestion. 

Leube  recommends  the  following  as  a  nutrient  injection  :  "  Take 
about  five  ounces  of  finely-scraped  meat ;  chop  it  still  finer,  add  to  it 
one  and  a  half  ounce  of  finely-chopped  pancreas  free  from  fat,  then 
add  about  three  ounces  of  lukewarm  water,  and  stir  to  the  consistence 
of  a  thick  pulp." 

Or  the  following  peptonized  formula  may  be  used  :  "  A  nutritive 
enema  should  be  prepared  in  the  usual  way — of  milk — or  of  milk  with 
beef -tea  or  eggs — or  of  milk-gruel.  To  half  a  pint  of  the  warm  enema 
a  tablespoonful  of  the  liquor  pancreaticus  and  thirty  grains  of  bicar- 
bonate of  soda  should  be  added.  The  enema  can  then  be  administered 
at  once." 

Supplementary  Itectal  Alimentation. — Under  this  designation,  Dr. 
A.  H.  Smith,  of  New  York,  describes  a  method  of  rectal  alimentation 
with  defibrinated  blood,  which  seems  in  a  high  degree  useful.  He 
ascertained  that  "  three  to  four  ounces  of  blood  administered  at  night 
would  be  so  completely  absorbed  in  the  course  of  eight  or  ten  hours 
that  no  trace  of  it  could  be  found  in  the  morning  evacuation."  To  re- 
tain the  blood  fluid,  it  must  be  defibrinated  at  the  moment  it  is  drawn, 
which  may  be  done  by  stirring  it  with  a  bundle  of  twigs  as  it  flows 
away.  In  chronic  cases  three  to  six  ounces  may  be  thrown  into  the 
rectum  morning  and  evening  ;  in  acute  cases  every  two  to  three  hours. 
It  may  be  used  cold,  but  it  is  better  to  raise  it  to  the  temperature  of 
the  rectum.  Constipation  usually  results,  and  in  some  instances  the 
body  exhales  a  rather  fetid  odor,  and  the  stools  are  offensive.  Another 


72  RESTORATIVE   AGENTS. 

objection  may  be  urged  against  this  method  :  sometimes  a  foul-smell- 
ing and  tenacious  material  coats  the  surface  of  the  mucous  membrane 
and  prevents  absorption.  For  this  reason,  and  to  promote  a  favorable 
disposition  of  the  blood,  the  bowel  should  be  irrigated  with  water 
once  or  twice  a  week  to  clear  away  any  retained  or  adherent  mat- 
ters. If  the  rectum  is  irritable,  a  little  laudanum  may  be  added  to 
each  blood-enema. 

Forced  Alimentation. — A  method  of  involuntary  feeding,  proposed 
by  Debove,  has  accomplished  so  much  good  that  it  is  necessary  to 
give  an  account  of  the  mode  of  procedure.  It  is  entitled  forced  ali- 
mentation, because  the  nutritive  material  is  introduced  into  the  stom- 
ach through  a  flexible  tube,  which  has  sufficient  capacity  to  conduct 
it,  and  yet  is  not  too  large  to  pass  the  oesophagus.  The  tubes  now 
made  for  the  purpose  are  of  non-vulcanized  rubber,  and  have  a  mark 
at  the  outer  extremity  to  indicate  the  distance  to  the  stomach.  The 
outer  end  has,  also,  a  funnel-shaped  orifice,  for  the  more  ready  intro- 
duction of  the  nutritive  and  liquid  materials. 

The  mode  of  introducing  the  tube  is  simple.  After  being  washed 
out  with  a  warm  antiseptic  solution,  it  is  lubricated  with  a  little  vase- 
line. The  patient  lies  down  on  a  bed  or  lounge,  the  head  extended, 
and  the  mouth  wide  open.  With  the  right  hand,  as  if  holding  a  pen, 
the  operator  passes  the  tube  into  the  pharynx,  taking  care  to  clear  the 
epiglottis  by  keeping  close  to  the  posterior  wall,  the  patient  making 
successive  efforts  of  deglutition.  The  stomach  is  ascertained  to  be 
entered  by  the  mark  on  the  tube  which  comes  on  a  line  with  the  teeth. 
Retching  usually  occurs  at  first,  and  more  or  less  pain  is  experienced 
by  the  passage  of  the  tube  down  the  oesophagus,  but  after  a  few  times 
these  troubles  cease,  and  neither  pain  nor  discomfort  is  felt.  Some- 
times spasm  of  the  oesophagus  occurs,  and  the  onward  movement  of 
the  tube  is  arrested  ;  no  violence  must  be  used  ;  the  tube  should  be 
slowly  drawn  back  a  little,  and  then  by  a  gentle  movement  passed  on 
again.  If  the  resistance  persists,  the  attempt  should  be  abandoned 
for  the  time  being,  and  another  made  after  an  interval.  When  the 
tube  is  duly  in  the  stomach  and  the  retching  or  nausea  is  ended,  the 
funnel  end  is  turned  up  vertically,  and  the  alimentary  material  is  poured 
slowly  down.  It  sometimes  happens  during  the  first  trials  that  por- 
tions of  the  aliment  are  returned  by  regurgitation,  but  this  accident 
does  not  persist  after  the  few  trials  necessary  to  habituate  the  parts  to 
the  procedure. 

Debove's  powder  is  the  nutritive  material  now  most  employed  ;  it 
is  desiccated  fresh  beef,  reduced  to  the  finest  powder.  This  powder, 
mixed  with  water,  with  bouillon,  with  milk,  etc.,  is  readily  poured  into 
the  stomach,  and,  in  consequence  of  its  extreme  tenuity,  is  easily  acted 
on  by  the  gastric  juice.  The  quantity  first  given  is  small,  but  a  rapid 
increase  can  be  made.  From  half  an  ounce  to  an  ounce  of  the  pow- 


ALIMENTATION  IN  DISEASES.  73 

dered  beef  is  administered  on  the  first  day,  but  this  quantity  is  soon 
raised  to  three  or  four  ounces,  which  is  equivalent  to  four  times  the 
amount  of  fresh  beef.  At  the  outset  a  single  dose  is  given  each  day, 
but,  as  the  tolerance  increases,  two,  three,  even  four  administrations 
are  made  daily.  No  other  mode  of  alimentation  is  attempted,  and 
all  the  alimentary  matters  are  conveyed  by  the  tube  into  the  stomach. 

A  remarkable  improvement  in  the  condition  of  the  phthisical  takes 
place.  In  a  week  to  ten  days  the  sweats  and  diarrhoea  cease,  the 
cough  and  expectoration  diminish,  and  a  considerable  gain  in  weight 
results.  A  corresponding  improvement  in  the  local  condition  is  ob- 
served :  the  rales  lessen  and  may  even  disappear,  and  cavities  slowly 
contract.  The  method  can  be  employed  in  all  forms  of  phthisis  ex- 
cept those  accompanied  by  high  fever  ;  but  good  results  are  in  pro- 
portion to  the  limited  extent  of  the  lesions.  When  restoration  has 
been  effected,  the  artificial  feeding  should  not  be  abruptly  stopped, 
but  gradually,  as  the  natural  manner  is  slowly  substituted. 

The  method  of  forced  alimentation  is  not  without  its  inconven- 
iences and  dangers.  The  patient  may  never  acquire  the  tolerance 
necessary,  and  hence  the  method  can  not  be  persevered  in.  By  pro- 
ceeding slowly  and  giving  a  small  quantity  at  a  time,  gradually  the 
maximum  amount  may  be  reached.  It  is  only  when  anorexia  is  com- 
plete that  forced  alimentation  need  be  employed — for  those  who  can 
eat  sufficiently  in  the  natural  way  do  not  require  such  an  addition  to 
their  alimentary  resources. 

As  a  therapeutical  expedient,  properly  speaking,  forced  alimenta- 
tion has  an  important  place.  Associated  with  the  process  of  stomach 
irrigation,  it  may  be  useful  in  a  high  degree  in  such  stomachal  disor- 
ders as  catarrh,  ulcer,  cancer,  dilatation,  etc. 

In  the  preparation  of  Debove's  powder,  the  beef  is  first  cut  up  finely 
or  "  minced  "  by  one  of  the  machines  now  used  for  that  purpose.  It  is 
then  placed  in  an  oven,  dried  at  a  temperature  of  110°  C.  or  230° 
Fahr.,  and  when  completely  desiccated  is  reduced  to  the  finest  powder. 
When  completed,  the  powder  has  a  reddish  color,  and  the  taste  of 
roasted  meat.  When  mixed  with  milk  it  presents  the  appearance  of 
chocolate,  is  very  homogeneous,  and  passes  easily  through  the  tube. 
If  the  patient  is  disinclined  to  submit  to  the  forced  process,  the  pow- 
der can  be  mixed  with  malt  extract,  with  bouillon,  with  soft-boiled 
eggs,  and  will  in  this  form  usually  be  taken  readily,  and  as  an  aliment 
is  much  superior  to  fresh  meat  (Dujardin-JSeaumetz,  Perret,  Robin, 
and  others). 

It  is  really  doubtful  that  the  forcing  method  has  advantages. 
When  food  enters  the  stomach,  the  gastric  juice  is  poured  out  more 
or  less  freely  whether  or  no  the  salivary  secretion  is  correspondingly 
increased.  If  the  patient  can  swallow  the  necessary  quantity,  it  would 
seem  to  be  entirely  indifferent  how  the  nutritive  powder  got  into  the 


74  RESTORATIVE   AGEXTS. 

stomach.  TVre  learn,  also,  that  appetite,  hunger,  etc.,  contribute  no 
element  to  the  process,  but  serve  merely  as  a  reminder  that  the  time 
for  taking  food  has  come.  It  follows,  also,  from  the  foregoing  con- 
siderations, that  Debove's  powder,  or  similar  aliment,  may  be  admin- 
istered as  a  medicament,  and  that  the  nutrition  will  be  as  favorably 
affected  by  it  as  various  morbid  states  are  by  an  involuntary  medi- 
cation. 

BEVERAGES. 

Coffee. — The  seed  of  Gaffea  Arabica  ;  cafe,  Fr. ;  Kaffee,  Ger. 

COMPOSITION. — Coffee  contains  an  alkaloid  —  caffeine  —  which  is 
nearly,  if  not  quite,  identical  with  theine,  a  principle  found  in  tea ;  a 
volatile  oil ;  a  form  of  tannic  acid  ;  sugar,  gum,  etc.  The  tannic  acid 
is  that  variety  known  as  caffeo-tannic,  or  caffeic. 

The  peculiar  odor  and  flavor  of  roasted  coffee  are  due  to  the  caffeic 
acid,  which  is,  in  part,  converted  into  methylamine  ;  to  the  aromatic 
oil ;  doubtless,  also,  to  the  sugar,  which  is  changed  into  caramel. 

PREPARATIONS. — Coffee  is  never  used  in  the  raw  state  as  a  bever- 
age. After  roasting,  it  is  made  into  an  infusion  or  decoction.  An 
infusion  made  at  a  low  temperature,  which  should  not  exceed  200° 
Fahr.,  is  better  than  a  decoction.  If  the  heat  be  too  great,  those  aro- 
matic constituents  which  impart  to  coffee  its  special  aroma,  are  dissi- 
pated. Coffee  is  now  usually  prepared  by  the  process  of  percolation. 
The  best  product  is  obtained  by  steeping  the  coffee  for  some  time  in 
hot  water.  Coffee  can  be  "  settled,"  or  clarified,  by  the  addition  of 
some  white  of  egg,  or  isinglass,  or  by  pouring  on  from  a  height  some 
cold  water. 

Tea. — The  dried  leaves  of  Camellia  Thea  ;  the,  Fr.  ;   Thee,  Ger. 

COMPOSITION. — The  constituents  of  tea  are  very  much  the  same  as 
those  of  coffee  :  theine  ;  an  aromatic  oil ;  sugar  and  gum,  and  a  pe- 
culiar form  of  tannic  acid. 

PREPARATIONS. — Tea  is  only  used  in  the  form  of  infusion.  The 
character  and  quality  of  the  beverage  vary  greatly  with  the  kind  of 
tea  used  in  the  preparation  of  the  infusion.  It  will  suffice  to  state  that 
green  tea  is  more  astringent  than  the  other  varieties,  partly  because  it 
contains  more  tannin,  and  partly  because  it  is  sophisticated  to  adapt  it 
to  a  peculiar  taste. 

Cocoa. —  Obtained  from  the  seeds  of  Theobroma  Cacao  /  cocoa, 
Fr.  ;  Kakao,  Ger.  , 

COMPOSITION. — The  active  principle  is  theobromine,  a  substance 
which  resembles  the  alkaloids  of  coffee  and  tea,  except  that  it  contains 
more  nitrogen  than  theine  and  caffeine.  Another  important  difference 
between  cacao  and  coffee  and.  tea  is  the  large  amount  of  a  peculiar  fat 
(cacao-butter)  contained  in  cocoa.  There  is  also  present  a  minute  quan- 
tity of  a  volatile  oil,  on  which  depends  in  part  the  characteristic  aroma. 


BEVERAGES.  75 

ACTIONS  AND  USES. — The  use  of  coffee  and  tea,  or  of  a  correspond- 
ing beverage,  is  almost  universal  among  civilized  nations.  This  fact 
is  supposed  to  indicate  that  a  need  exists  in  the  human  constitution 
which  these  beverages  supply.  Such  a  view  is  hardly  tenable,  the 
highest  physical  and  mental  activity  not  being  incompatible  with 
entire  abstinence  from  them.  Under  some  circumstances,  however, 
they  are  peculiarly  grateful  ;  for  example,  to  remove  the  sense  of 
fatigue  and  hunger,  and  to  allay  the  mental  unrest  produced  by  fa- 
tigue and  anxiety. 

Coffee  has  a  somewhat  laxative  action  on  most  persons  ;  on  the 
other  hand,  tea  has  astringent  properties  —  especially  that  variety 
known  as  green  tea.  It  has  been  affirmed  and  denied  that  coffee  and 
tea  lessen  the  rate  of  tissue  metamorphosis,  and  consequently  the  ex- 
cretion of  urea.  If  these  beverages  check  waste,  they  may  be  consid- 
ered as  indirect  nutrients.  If  used  to  excess  as  beverages,  they  derange 
the  organs  of  digestion  and  excite  functional  disturbances  of  the  nerv- 
ous system — on  the  part  of  the  digestive  organs  :  acidity,  flatulence, 
pyrosis,  eructations,  etc.  ;  on  the  part  of  the  nervous  system  :  head- 
ache, vertigo,  tinnitus  aurium,  and  confusion  of  mind.  The  evil  results 
of  habitual  excess  are  best  seen  in  sewing-women  addicted  to  tea-tip- 
pling. It  is  not  uncommon  for  these  women  to  live  upon  tea  and  bread 
for  long  periods,  resulting  in  their  becoming  excessively  nervous  and 
dyspeptic.  The  mucus  of  the  stomach  plays  the  part  of  a  ferment ; 
the  bread  undergoes  the  acetic  fermentation,  and  this  process  is  facili- 
tated by  the  presence  of  a  quantity  of  a  weak  astringent  solution. 
Disorders  of  digestion  due  to  this  cause  can  be  removed  by  withdrawal 
of  the  offending  beverage.  It  is  not  less  true  that  the  after-dinner  cup 
of  coffee  not  unfrequently  assists  the  digestion  of  a  too  elaborate  din- 
ner. Those  accustomed  to  the  morning  cup  of  coffee  are  apt  to  suffer 
from  headache  if  deprived  of  their  usual  beverage,  partly  because  it 
hastens  the  intestinal  movements  and  assists  the  morning  evacuation, 
and  partly  because  it  favors  the  stomach  digestion  if  not  taken  in 
excess. 

A  cup  of  strong  coffee  taken  in  the  early  morning  is  held  to  be 
prophylactic  against  malarial  infection.  Coffee  produces  wakefulness, 
and  opposes  opium  narcosis  ;  hence  strong  black  coffee  is  one  of  the 
means  resorted  to  in  the  treatment  of  opium-poisoning. 

Cocoa,  as  already  set  forth,  is  more  directly  nutritious  than  coffee 
or  tea,  and,  as  it  is  rich  in  fatty  matters,  is  much  more  difficult  of  di- 
gestion, so  that  many  dyspeptics  can  not  use  it  at  all.  Cocoa  is  the 
most  useful  beverage  in  those  conditions  of  the  system  requiring  nu- 
tritious aliment,  especially  in  phthisis  and  similar  wasting  diseases, 
and  should  constitute  a  part  of  the  diet  in  these  maladies  unless  it 
disagrees. 

Caffeine  as  a  remedy  will  be  considered  in  its  appropriate  place. 


76  RESTORATIVE   AGENTS. 

Milk. — Regarded  from  all  points  of  view,  milk  is  the  most  impor- 
tant beverage.  Enough  has  been  said  on  the  subject  of  milk  as  a  food 
for  invalids  ;  but  something  additional  may  be  necessary  on  its  die- 
tetic position  as  an  ordinary  beverage. 

When  coffee,  tea,  and  cocoa  disagree,  milk  may  be  adopted  as  the 
ordinary  beverage,  and  usually  with  great  advantage.  For  breakfast 
it  may  be  drunk  warm.  Large  draughts  of  iced  milk,  according  to 
the  American  custom,  are  injurious  when  drunk  at  meals  ;  its  tem- 
perature should  not  be  lower  than  60°  Fahr.  If  a  sense  of  weight 
and  uneasiness  follow  its  use,  it  will  be  better  borne  if  diluted  one 
fourth  to  one  half  with  lime-water.  If  it  be  desired  to  improve  its 
nutritive  qualities,  cream  to  one  fourth  or  to  one  half  may  be  added. 
In  the  indigestion  of  the  obese,  or  in  the  case  of  those  who  suffer  from 
hepatic  disorders,  the  milk  should  be  skimmed.  A  very  valuable  nu- 
trient, but  which  is,  unfortunately,  not  very  digestible,  is  chocolate 
made  with  milk  and  cream.  Such  an  aliment  is  especially  suited  to 
invalids  with  wasting  diseases,  but  who  yet  retain  the  power  to  digest 
fats. 

Some  find  it  impossible  to  drink  milk,  because  it  induces  "  bilious- 
ness." In  this  case  skimmed  milk  should  be  used.  Generally  the  in- 
digestion called  "  biliousness  "  means  errors  of  diet  in  other  directions, 
so  that  regulation  of  the  food  suffices  to  prevent  this  form  of  indis- 
position. 

Authorities  referred  to  in  this  section  : 

BALLOT.  On  the  Food  of  Infants,  etc.,  Medical  Times  and  Gazette,  vol.  i,  1870,  p. 
331. 

BANTING.     Letter  on  Corpulence,  pamphlet. 

BENNET,  DR.  JAMES  HENRY.  Nutrition  in  Health  and  Disease,  second  edition,  Phila- 
delphia, Lindsay  &  Blakiston,  1876. 

CHAMBERS,  DR.  THOMAS  KINO.  A  Manual  of  Diet  in  Health  and  Disease,  Philadel- 
phia, Henry  C.  Lea,  1875. 

CYR,  DR.  JULES.     Traite  de  Alimentation,  Paris,  1869,  pp.  575. 

DEBOVE,  DR.     Bui  Gen.  de  Therap.,  1883,  1884,  and  1885. 

DONKIN,  DR.  ARTHUR  SCOTT.  On  a  Purely  Milk-Diet  in  the  Treatment  of  Diabetes 
Mellitus,  Bright  s  Disease,  Disease  of  the  Supra-renal  Capsules,  Fatty  Degeneration,  etc.. 
Lancet,  vol.  ii,  1869,  and  vol.  i,  1870. 

DUJARDIN-BEAUMETZ.     Bui.  Gen.  de  Therap.,  vol.  iii,  p.  1,  et  seq. 

FONSSAGRIVES,  J.  B.  Hygiene  Alimentaire,  deuxieme  Edition,  Paris,  1867,  pp. 
670. 

JACOBI,  DR.  A.  AND  DR.  MARY  PUTNAM.  Infant  Diet,  New  York,  G.  P.  Putnam's 
Sons,  1876. 

LETHEBY,  DR.  H.     On  Food,  second  edition,  New  York,  1872,  pp.  255. 

LEBERT,  DR.  HERMANN.     Ueber  Milch-  und  Molken-Kuren,  Berlin,  1869. 

MITCHELL,  DR.  S.  WKIH.  On  the  Use  of  Skimmed  Milk  as  an  Exclusive  Diet  in  Di» 
ease,  Philadelphia  Medical  Times. 

NOTHNAGEL,  DR.  HERMANN.     Handbuch  der  Arzneimittellehre,  Berlin,  1870,  p.  676. 

PARKES,  DR.  E.  A.  A  Manual  of  Practical  Hygiene,  second  edition,  London,  1866, 
pp.  624. 


BEVERAGES.  77 

PEREIRA,  DR.  JONATHAN.     A  Treatise  on  Food  and  Diet,  London,  1843,  pp.  542. 

RICHTER,  DR.  H.  E.  Bericht  iiber  Milch-,  Molken-,  und  Kumys-Kuren,  Schmidfs 
Jahrbiicher  der  gcsammlen  Medicin,  vol.  cxlviii,  p.  201. 

ROBIN,  DR.     These  de  Paris,  Annuaire  de  Therap.,  1884. 

SMITH,  DR.  A.  H.  Archives  of  Medicine,  New  York,  Seguin,  I,  1879,  vol.  i,  No.  2, 
p.  113. 

SMITH,  DR.  EDWARD.  Foods,  New  York,  1873  (International  Scientific  Series),  pp. 
485. 

TARDIEU.     Dictionnaire  d1  Hygiene  Publique,  tome  xi,  Article  "  Lait" 

TROUSSEAU.     Clinique  Medicale,  vol.  ii,  p.  695. 

VAPGHAN,  PROF.  VICTOR  C.     Michigan  State  Board  of  Health,  1886,  July  13. 

Water. — Aqua,  water  ;  eau,  Fr.  ;  Wasser,  Ger.  ;  Aqua  destillata, 
distilled  water — water  freed  from  its  organic  and  inorganic  impurities 
by  distillation.  This  is  alone  official. 

Aqua  Fluvialis. — River- water. 

Aqua  Fontana. — Well  or  spring  water. 

Water  as  a  remedial  agent,  when  employed  in  internal  maladies, 
and  as  a  means  of  applying  heat  and  cold  externally,  are  the  depart- 
ments of  the  subject  coming  within  the  scope  of  this  article. 

PHYSIOLOGICAL  EFFECTS  OF  WATER— INTERNAL. — It  need  hardly 
be  stated  that  water  is  an  essential  constituent  of  the  tissues. 

A  certain  quantity  of  water  or  fluid  aliment  is  necessary  to  the 
digestive  process.  An  excessive  quantity  impairs  digestion,  by  so  far 
diluting  the  gastric  juice  as  to  render  it  incapable  of  dissolving  the 
foods.  Pepsin — the  digestive  ferment — is  also  weakened  by  too  great 
fluidity  of  the  stomach  contents.  The  free  use  of  cold  drinks — ices 
and  iced  water — seriously  disorders  digestion  by  suspending  the  action 
of  the  pepsin,  by  diminishing  the  blood-supply  needed  by  the  stomach 
in  its  condition  of  functional  activity,  and  no  doubt  also  by  depressing 
the  nerves  of  the  organs  of  digestion.  To  this  state,  induced  by  the 
free  use  of  very  cold  drinks  during  meals,  or  during  the  time  of  di- 
gestion, has  been  applied  the  term  "  ice-water  dyspepsia"  a  very  com- 
mon malady  in  the  United  States. 

A  glass  of  cold  water  in  the  morning  before  breakfast  will  in  many 
persons  cause  a  satisfactory  evacuation  of  the  bowels.  The  activity 
of  the  water  is  increased  by  the  addition  to  it  of  a  teaspoonful  of 
common  salt. 

Although  water  is  essential  to  the  constitution  of  the  fluids  and 
solids  of  the  body,  there  is  no  doubt  that  large  and  frequent  draughts 
of  water  may  prove  injurious  by  too  great  increase  in  the  fluidity  of 
the  blood,  and  a  consequent  damage  to  the  red  corpuscles. 

The  free  use  of  water  promotes  nutritive  changes,  and  causes  in 
some  subjects  a  decided  increase  in  the  formation  and  deposition  of 
fat.  The  presence  of  water  is  essential,  of  course,  to  the  metamor- 
phosis of  tissue,  whether  physiological  or  pathological.  The  efficacy 
of  mineral  waters  is  in  part  due  to  the  quantity  of  water  taken,  besides 


78  RESTORATIVE   AGENTS. 

the  mineral  constituents.  Water  may  be  taken  with  the  view  to  cause 
increased  excretion  of  certain  substances.  As  a  large  part  of  that 
taken  passes  out  by  the  kidneys,  the  functional  activity  of  these  organs 
is  promoted  by  free  drinking.  With  the  water  also  passes  out  an  in- 
creased amount  of  urea,  chloride  of  sodium,  and  phosphoric  acid,  the 
product  of  the  more  rapid  tissue-changes  which  ensue.  The  increased 
elimination  of  chloride  of  sodium  does  not  continue,  however. 

Water  is  also  excreted  by  the  skin,  and  free  water-drinking  pro- 
motes the  cutaneous  transpiration,  especially  when  its  action  is  aided 
by  external  warmth.  The  vapor  of  water  also  passes  out  abundantly 
in  the  breath. 

PHYSIOLOGICAL  EFFECTS  OF  WATER — EXTERNAL. — The  influence  of 
temperature  must  necessarily  be  considered  in  connection  with  the  ef- 
fects of  wrater  when  applied  externally. 

EFFECTS  OF  COLD  WATEK. — When  an  extremity — for  example,  the 
hand — is  immersed  in  cold  water,  the  temperature  of  the  other  hand 
also  falls.  Cold  water  abstracts  the  heat  of  the  body,  at  least  of  its 
superficial  surface,  and  affects  the  condition  of  the  internal  organs 
through  the  nervous  system.  It  is  through  an  influence  transmitted 
from  the  peripheral  distribution  of  the  nerves  of  the  hand  to  the  cen- 
ter, and  thence  reflected  to  corresponding  anatomical  nervous  connec- 
tions on  the  other  side,  that  the  fall  of  temperature  in  the  one  hand 
is  due  when  the  other  hand  is  immersed  in  water.  We  have  a  right  to 
assume,  therefore,  that,  when  cold  water  is  applied  to  the  whole  sur- 
face of  the  body,  changes  of  temperature  take  place  within.  Indeed, 
it  has  been  shown  experimentally  by  Brown-Sequard,  that  ice  applied 
to  the  lumbar  region  causes  a  contraction  of  the  arterioles  of  the  kid- 
neys, and  consequent  diminished  blood-supply  to  these  organs. 

When  a  cold  bath  is  entered,  a  marked  sense  of  chilliness  is  expe- 
rienced, the  skin  becomes  pale  and  is  roughened  by  the  erection  of  the 
hair-follicles  (cutis  anserina),  the  lips  are  blue,  the  breath  has  a  spas- 
modic and  catching  character,  and  the  pulse  is  quickened.  The  tem- 
perature of  the  surface  is  lowered,  for  the  blood  accumulates  in  internal 
organs,  and  the  nerves  of  the  skin  are  depressed.  To  the  change  in 
the  conditions  of  the  blood-supply,  and  the  impression  of  the  cold  on 
the  peripheral  expansion  of  the  nervous  system,  are  due  the  coldness 
of  the  surface,  the  sobbing  respiration,  and  the  feeling  of  discomfort 
and  depression.  If  the  temperature  of  the  water  be  not  too  low,  and 
if  the  bodily  vigor  be  sufficient  to  withstand  the  shock,  the  condition 
known  as  "  reaction  "  speedily  ensues.  The  coldness  and  depression 
are  succeeded  by  warmth  and  a  feeling  of  exhilaration  ;  the  pulse 
quickens,  and  the  respiration  becomes  easy  and  unembarrassed  ;  and 
the  muscular  strength  is  increased.  If,  however,  the  body  be  immersed 
for  too  long  a  period,  the  condition  of  reaction  is  supplanted  by  cold- 
ness, depression,  weakened  pulse,  and  muscular  debility.  This  result 


HYDROTHERAPY.  79 

is  largely  due  to  the  continuous  abstraction  of  heat,  to  the  accumula- 
tion of  blood  in  the  great  venous  trunks,  and  the  consequent  interfer- 
ence with  the  metamorphosis  of  tissue.  If  healthy  reaction  comes  on 
after  bathing,  the  effects  are  those  to  which  we  apply  the  term  tonic. 
The  circulation  is  invigorated,  tissue-changes  take  place  more  rapidly, 
and  the  products  of  increased  tissue-metamorphosis  are  found  in  the 
urine.  With  the  increased  activity  of  the  function  of  assimilation, 
the  appetite  and  digestive  power  are  improved,  and  the  body  gains  in 
weight. 

EFFECTS  OF  WARM  WATER. — The  degree  of  effect  which  is  pro- 
duced by  the  immersion  of  the  body  in  warm  water  is  influenced  by 
the  temperature  ;  but  the  quality  of  the  effect  is  the  same  at  all  de- 
grees from  tepid  to  hot.  The  sense  of  warmth  is  at  first  grateful  to 
the  feelings  ;  the  skin  becomes  red  from  the  increased  activity  of  its 
vessels  ;  the  pulse  quickens  in  beats,  but  diminishes  in  tension  ;  the 
respiration  is  more  frequent ;  praecordial  oppression  is  experienced  ; 
an  unpleasant  sense  of  distention  is  felt  in  the  head,  and  giddiness, 
faintness,  and  muscular  languor,  finally,  are  produced,  if  immersion  be 
prolonged  or  the  temperature  be  too  high.  The  pulmonary  and  cutane- 
ous transpiration  are  increased  by  the  warm  bath  ;  the  temperature  of 
the  body  rises,  and  a  condition  is  established  by  a  hot  bath,  similar  to 
the  febrile  state.  Rapid  disintegration  of  tissue  ensues,  the  waste 
products  escape  chiefly  by  the  skin  and  pulmonary  mucous  membrane, 
and  decided  loss  of  weight  results. 

MODES  OP  APPLYING  WATER. — The  water  of  a  cold  bath  should 
have  a  temperature  of  40°  to  60°  Fahr.  If  employed  for  its  tonic 
action,  the  patient  should  not  remain  in  it  longer  than  the  period  of 
complete  reaction.  The  tepid  bath  has  a  temperature  of  from  85°  to 
95°,  the  warm  bath  from  95°  to  100°  Fahr.,  and  the  hot  bath  from 
100°  to  106°  Fahr.  The  duration  of  the  stay  in  these  will  depend  on 
the  purpose  to  be  accomplished,  whether  mere  excitation  of  the  circu- 
lation in  the  skin,  diaphoresis,  or  muscular  relaxation.  In  directing 
the  warm  and  hot  baths,  it  should  not  be  forgotten  that  a  diseased 
state  of  the  cerebral  arteries  is  a  contraindication  to  their  use. 

The  vapor  of  water  in  the  form  of  the  Russian  bath,  steam-bath,  or 
warm  or  hot  wet-packing ',  may  be  used  to  accomplish  the  same  objects 
as  those  obtained  by  the  warm  or  hot  bath.  Without  entering  unduly 
into  the  details,  it  will  suffice  to  state  that  the  Russian  bath  consists 
in  the  exposure  of  the  body  in  suitable  apartments  to  the  vapor  of  hot 
water,  at  a  temperature  gradually  increased  from  95°  to  110°  Fahr. 
The  bath  should  not,  under  ordinary  circumstances,  exceed  fifteen 
minutes  in  duration.  In  order  to  overcome  the  relaxing  and  debili- 
tating effects  of  the  bath,  the  patient  should  either  enter  a  cold  bath 
or  have  cold  water  dashed  over  his  body.  This  expedient,  conjoined 
with  friction  of  the  surface,  increases  materially  the  good  effects  of 


80  RESTORATIVE  AGENTS. 

the  Russian  bath.  In  the  absence  of  special  arrangements  for  giving 
the  Russian  bath,  simple  means  will  suffice.  The  patient  may  sit 
upon  a  low  stool  with  a  blanket  pinned  about  his  neck,  and  under  this 
the  vapor  of  water  may  be  conducted.  Or,  if  confined  to  bed,  the 
patient  may  be  placed  on  a  gum-cloth,  and  the  blanket  may  be  ele- 
vated above  him  by  hoops,  arranged  transversely,  under  which  the 
vapor  of  water  may  be  conveyed  from  an  ordinary  tea-kettle.  Fresh 
lime  is  sometimes  used  to  generate  hot  vapor.  The  patient  is  placed 
on  a  low  stool  and  surrounded  by  a  blanket.  Some  pieces  of.  freshly 
burned  lime  are  then  dropped  into  a  vessel  of  water  placed  under  the 
blanket.  The  slacking  of  the  lime  causes  great  heat,  and  the  conse- 
quent generation  of  a  considerable  quantity  of  watery  vapor,  which 
also  carries  up  with  it  minute  particles  of  lime.  This  proceeding  is 
said  to  be  especially  efficacious  in  membranous  croup  and  diphtheria. 

Enveloping  the  body  in  cloths  wrung  out  in  hot  water,  or  wrapping 
in  a  sheet  which  has  been  wrung  out  in  hot  water,  and  then  covering 
with  blankets,  is  a  mode  of  applying  moist  heat  which  may  be  advan- 
tageously used.  To  various  parts  of  the  body,  under  the  designation 
of  "  fomentations,"  warm  and  hot  water  applications  are  constantly 
used  in  domestic  practice. 

The  Wet- Pack. — This  efficient  means  of  producing  the  good  effects 
of  cold-water  applications  consists  in  wrapping  the  body  in  a  linen 
sheet  wrung  out  in  cold  water.  The  appliances  are  these  :  An  ordi- 
nary single  bedstead  ;  a  hard  mattress  covered  with  several  thicknesses 
of  blankets  or  comforters  ;  a  linen  sheet.  The  sheet  is  dipped  in  cold* 
water,  and,  when  thoroughly  wrung  out,  is  laid  smoothly  on  the  bed. 
The  patient  reclines  on  the  sheet,  his  head  supported  by  a  pillow.  One 
side  of  the  sheet  at  a  time  is  then  drawn  over  the  patient's  body  and 
neatly  tucked  under  the  opposite  side,  the  feet  and  legs  being  lifted 
up  and  the  sheet  made  to  entirely  envelop  them.  Some  blankets  or 
comforters  are  now  closely  applied  around  the  body  of  the  patient. 
There  is  at  first  experienced  a  disagreeable  sense  of  chilliness  and  dis- 
comfort, which  is  soon  succeeded  by  a  delightful  glow.  When  reac- 
tion is  fully  established,  the  wet-pack  should  be  removed,  and  the 
body  be  well  rubbed  with  dry  towels.  The  duration  of  this  applica- 
tion should  be  from  fifteen  minutes  to  an  hour.  When  active  dia- 
phoresis is  the  object  to  be  accomplished,  the  patient  must  be  well 
enveloped  in  blankets,  and  continue  in  the  bath  for  the  longest  period 
mentioned  above. 

The  Rubbing  'Wet-Pack. — This  is  a  convenient  mode  of  taking  the 
morning  bath  as  a  hygienic  measure,  and  also  of  procuring  more 
speedily  some  of  the  good  effects  of  the  wet-pack  as  applied  above. 
It  consists  in  enveloping  the  body  with  a  sheet  dipped  in  cold  water, 
and  rubbing  vigorously  with  the  sheet  to  induce  reaction  quickly. 
The  patient  stands  up  during  the  application,  and  an  attendant  rubs 


HYDROTHERAPY.  81 

those  parts  inaccessible  to  the  patient.  When  the  sheet  is  removed 
the  skin  is  dried  by  the  vigorous  application  of  coarse  towels,  and  the 
patient  immediately  puts  on  his  clothing. 

When  it  is  not  advisable  to  apply  the  wet-pack  to  the  whole  body, 
or  when  local  diseases  require  limited  application  of  the  wet-pack,  the 
sheet  may  be  wrapped  around  the  trunk  only,  or  be  confined  to  the 
region  of  the  affected  organ.  In  cases  of  extreme  debility,  or  in  very 
susceptible  persons,  the  sheet  may  for  the  first  applications  be  wrung 
out  in  tepid  water,  and  subsequently  the  temperature  of  the  water  be 
lowered  to  that  of  the  air  (40°  to  70°  Fahr.). 

The  Douche. — This  consists  in  the  impact  against  the  body  of  a 
column  of  water  from  a  height.  No  greater  height  than  ten  feet,  and 
a  column  not  larger  than  four  inches,  will  be  proper  or  safe  under  any 
circumstances.  A  hose  attached  to  a  water-pipe,  the  supply  being 
regulated  by  a  stopcock,  is  a  convenient  mode  of  using  the  douche. 
In  domestic  practice  a  large  pitcher  or  water-bucket,  if  provided  with 
a  suitable  spout,  may  be  utilized  for  this  purpose.  The  douche  may 
be  either  cold,  tepid,  or  hot ;  it  may  have  a  direction  descending,  as- 
cending, vertical,  horizontal,  or  oblique  ;  and  the  effect  may  be  regu- 
lated by  the  height  from  which  the  water  is  projected,  the  size  of  the 
stream,  and  the  force  with  which  it  is  thrown  against  the  part.  As 
the  effect  of  the  douche  is  very  great  when  the  water  is  cold,  when 
the  volume  of  the  stream  is  large,  and  when  it  is  thrown  with  force,  it 
is  obvious  that  care  must  be  used  in  directing  it  against  the  head,  the 
chest,  and  the  abdomen.  As  a  rule,  it  is  too  violent  a  measure  to  be 
employed  in  weak  and  susceptible  subjects  about  the  trunk,  but  it 
may  be  used  freely,  of  course,  on  the  extremities. 

Tlie  Hip  or  Sitz  Bath. — As  regards  temperature,  this  bath  may  be 
cold,  tepid,  warm,  or  hot,  according  to  the  indications  requiring  it.  The 
apparatus  for  administering  it  consists  of  a  tin  or  wooden  tub  of  suffi- 
cient capacity  to  contain  water  enough  to  cover  the  hips  and  lower  part 
of  the  abdomen  when  the  patient  sits  down  in  it.  The  tub  should  have 
a  raised  back  to  support  the  patient,  and  should  be  sufficiently  elevated 
above  the  floor,  so  that  the  feet  may  rest  comfortably  when  the  patient 
sits  down  in  the  water.  In  the  absence  of  a  special  arrangement  of 
this  kind,  any  ordinary  washing-tub  will  suffice.  The  duration  of  the 
hip  or  sitz  bath  will  be  from  five  to  thirty  minutes. 

Besides  these,  various  local  baths,  cold,  warm,  or  hot,  under  vari- 
ous designations,  are  used  in  medical  practice,  e.  g.,  foot,  hand,  elbow, 
and  head  bath.  The  effects  of  these  differ  in  no  wise  from  the  baths 
already  described,  except  in  degree. 

THERAPY. — The  applications  of  water  in  the  treatment  of  disease 
are  numerous  and  important. 

In  tonsillitis,  diphtheria,  and  croup,  ice  held  in  the  mouth  and  al» 
lowed  to  come  in  contact  with  the  fauces  is  extremely  serviceable.  The 


82  RESTORATIVE   AGENTS. 

wet-pack  to  the  neck  gives  great  relief  in  the  same  diseases.  The  mode 
of  applying  it  is  as  follows  :  A  napkin  is  wrung  out  in  iced  or  cold 
•water  and  wrapped  around  the  neck  ;  and  over  this  is  put  a  dry  towel 
or  napkin  to  prevent  evaporation,  and  also  the  wetting  of  the  patient's 
clothes.  In  spasmodic  croup  {laryngismus  stridulus)  the  application 
of  iced  water  in  this  way  will  frequently  very  quickly  stop  the  crow- 
ing inspiration  and  allay  the  distress  of  breathing.  A  cold  douche 
will  effect  the  same  result,  but  this  is  an  unnecessarily  harsh  remedy 
in  these  cases.  Sometimes  hot  applications  are  more  efficacious,  when 
the  napkin  or  towel  may  be  wrung  out  in  water  as  hot  as  can  be  borne. 
Cold  affusion,  or,  better,  sponging  of  the  body  with  cold  water,  is  an 
excellent  means  of  preventing  laryngismus  stridulus  when  it  arises 
from  cold. 

Habitual  constipation  may  sometimes  be  overcome  by  a  glass  of 
cold  water  taken  before  breakfast.  Hemorrhoids  that  bleed,  espe- 
cially when  attended  by  constipation,  are  improved  by  a  daily  rectal 
injection  of  cold  water.  When  cold  or  warm  water  injections  are  used 
to  cause  an  evacuation,  it  must  be  remembered  that,  usually  in  adults, 
a  large  amount  of  water  is  necessary — about  one  quart.  A  small 
quantity  of  iced  water  may  be  effective,  for  in  this  case  the  impression 
of  the  cold  on  the  nerves  of  the  rectum  excites  a  reflex  action  of  the 
whole  intestinal  canal. 

Pure  water  or  distilled  water  is  an  effective  diuretic,  especially 
adapted  to  the  relief  of  acute  desquamative  nephritis.  The  action  con- 
sists in  free  discharge  of  the  surplus  water  by  the  kidneys,  and  tha, 
consequent  washing  out  of  the  tubules  obstructed  by  the  cast-off  epi- 
thelium and  tube-casts.  Large  draughts  of  water,  as  has  already  been 
stated,  carry  out  from  the  kidneys  the  products  of  retrograde  metamor- 
phosis, and  hence  the  action  is  diuretic  in  the  widest  sense.  The  effi- 
ciency of  many  infusions,  decoctions,  and  ptisans,  employed  in  dropsies, 
is  largely  due  to  the  amount  of  water  ingested.  The  internal  use  of 
water  in  kidney-diseases  may  be  supplemented  by  hot  fomentations  to 
the  lumbar  region.  (See  article  DIGITALIS.)  As  irritation  of  the  skin 
of  the  back  has  been  shown  experimentally  to  influence  the  caliber  of 
the  renal  arterioles,  there  is  sufficient  warrant  for  the  practice  of  ap- 
plying these  fomentations  to  the  lumbar  region,  when  the  functional 
activity  of  the  kidneys  is  insufficient. 

When  renal  disease  is  so  far  advanced  that  the  elimination  of  urea 
is  seriously  hindered,  and  stupor,  somnolence,  muscular  twitchings,  and 
even  convulsions  occur,  great  relief  is  obtained  by  exciting  free  action 
of  the  skin  by  means  of  the  vapor-bath  or  hot  wet-pack,  the  patient 
being  well  enveloped  in  blankets  to  favor  powerful  diaphoresis.  The 
Turkish  bath  is  very  serviceable  to  restore  the  suppleness  of  joints 
and  muscles  after  an  attack  of  acute  rheumatism,  and  chronic  mus- 
cular rheumatism  is  benefited  by  the  same  means.  No  permanent 


HYDROTHERAPY.  83 

good  result  can  be  expected  from  these  baths  in  chronic  rheumatic 
arthritis. 

As  a  means  of  causing  elimination  of  mineral  poisons,  baths  are 
useful.  Lead,  mercurial,  and  paludal  cachexice,  are  relieved  by  the 
Turkish  bath  and  the  wet-pack,  and,  although  these  means  are  insuffi- 
cient of  themselves  to  effect  a  cure,  they  aid  very  materially  the  ac- 
tion of  other  remedies.  Increased  metamorphosis  of  tissue  and  increased 
excretion  are,  it  will  be  remembered,  constant  effects  of  these  baths. 
If  the  wet-packing  be  used,  free  diaphoresis  should  be  encouraged,  by 
abundant  covering  and  by  large  draughts  of  water. 

One  of  the  most  important  recent  improvements  in  therapeutics  is 
the  treatment  of  fevers  by  cold  baths.  This  is  an  old  expedient,  it  is 
true,  but  it  is  only  within  a  few  years  that  the  treatment  of  fevers  by 
baths  has  been  placed  within  the  domain  of  strictly  scientific  in- 
vestigation. Various  means  of  applying  water  in  fevers  have  been 
resorted  to — cold  affusion,  cold  baths,  cold  wet-pack,  ice-bags,  etc. 
Cold  affusion  consists  simply  in  dashing  successive  buckets  of  water 
over  the  patient,  stripped  and  lying  on  a  mattress  protected  by  a  gum- 
cloth.  The  applications  are  continued  until  the  temperature  is  re- 
duced. This  is  a  crude  method,  and  wears  an  aspect  of  harshness 
which  may  prevent  its  efficient  use  in  private  practice.  The  cold 
bath  is  more  serviceable,  and  is  free  from  the  objectionable  features  of 
cold  affusion.  As  practiced  according  to  the  method  of  Ziemssen, 
it  is  grateful  to  the  patient,  produces  no  shock,  and  exerts  a  powerful 
influence  over  the  temperature.  The  fever-patient  is  put  into  a  bath 
about  the  normal  temperature  of  the  body  (98°  Fahr.),  and  the  water 
is  cooled,  by  the  addition  of  ice,  to  80°  Fahr.,  to  60°  Fahr.,  or  even  to 
40°  Fahr.,  according  to  the  effect  produced  on  the  temperature,  which, 
for  this  purpose,  should  be  taken  in  the  rectum.  When  a  positive  re- 
duction of  the  fever-heat  has  occurred,  at  the  expiration  of  five  min- 
utes to  half  an  hour  usually,  or  longer  if  necessary,  the  patient  should 
be  wiped  dry,  placed  in  bed,  and  covered  with  blankets:.  The  bath 
may  be  used,  according  to  the  nature  of  the  case,  from  two  to  six 
times  each  day,  but  less  frequently  if  the  duration  be  longer  than  a 
half-hour.  The  appliances  for  administering  baths  to  fever-patients 
are  :  A  strong  sheet  for  lifting  the  patient  from  the  bed  into  the  bath- 
tub ;  a  bath-tub  provided  with  an  exit~pipe  for  drawing  off  the  surplus 
water  ;  a  thermometer  for  ascertaining  the  temperature  of  the  bath, 
and  a  clinical  thermometer  for  noting  the  variations  of  temperature 
of  the  patient.  Hospitals  should  be  provided  with  such  arrangements 
as  have  been  made  at  the  London  Hospital  for  the  use  of  baths  in 
fever.  These  consist  of  a  small  ward  with  two  beds  ;  a  bath-tub  sup- 
plied with  hot  and  cold  water  ;  a  tank,  with  which  the  cold-water  pipe 
communicates,  in  which  ice  may  be  put  if  necessary  ;  and  a  large 
waste-pipe  for  disposing  quickly  of  the  surplus  water. 


84  RESTORATIVE  AGENTS. 

In  the  absence  of  suitable  bath  appliances,  the  temperature  of  fever- 
patients  may  be  reduced  by  simpler  methods.  ,  Iced  water  may  be 
injected  into  the  rectum  frequently  ;  cloths  dipped  in  iced  water  may 
be  applied  to  the  trunk,  and  Chapman's  ice-bags  may  be  put  to  the 
spine.  More  suitable  than  these  methods  is  the  wet-packing.  Al- 
though the  wet-packing  is  not  so  effective  as  the  bath,  it  is  a  very 
powerful  means  of  reducing  fever-heat,  and  it  has  the  merit  of  sim- 
plicity of  application,  so  that  in  every  household  it  may  be  used  if 
necessary.  The  patient  may  be  put  into  the  wet-pack  several  times 
each  day,  according  to  the  state  of  the  temperature,  and  may  remain 
in  it  from  five  minutes  to  an  hour. 

If,  after  the  application  of  water  by  any  of  the  modes  above  men- 
tioned, the  circulation  becomes  feeble,  the  extremities  cold,  and  the 
fips  blue,  stimulants  should  be  administered  and  bottles  of  hot  water 
applied  to  the  feet.  The  good  effects  of  baths  are  these  :  the  temper- 
ature declines,  the  pulse  falls  and  becomes  soft  and  compressible,  the 
skin  grows  moist,  and  the  patient  feels  refreshed.  The  repetition  of 
the  bath  or  of  the  application  of  cold  water  will  be  determined  by  the 
rise  of  temperature,  and  of  the  pulse.  Some  practitioners  employ  them 
regularly,  as,  for  example,  Yon  Ziemssen  and  Immerman,  who  admin- 
ister them  at  6  A.  M.,  1  to  3  P.  M.,  and  7  P.  M.  ;  but  others — and  this  the 
author  thinks  the  better  plan — give  them  more  or  less  frequently  ac- 
cording to  the  range  of  temperature.  Not  only  is  the  mortality  of 
typhoid  greatly  less  under  hydro  therapy  than  under  any  other  method 
of  treatment,  but  the  complications  which  belong  to  it — except  ha3m* 
orrhage — occur  less  frequently. 

The  most  conspicuous  triumph  of  the  water-treatment  of  the  py- 
rexial  state  is  seen  in  the  management  of  hyperpyrexia,  a  condition  of 
things  in  which  a  sudden  and  rapid  rise  of  temperature  takes  place, 
the  range  being  in  extreme  cases  from  105°  to  112°  Fahr.  It  is  now 
perfectly  well  known  that  any  temperature  above  108°  Fahr.  is  almost 
necessarily  a  fatal  sign.  This  condition  of  hyperpyrexia  occurs  some- 
times in  acute  rheumatism,  delirium  tremens,  fevers,  etc.,  and  has  here- 
tofore not  been  amenable  to  treatment.  A  fatal  result  in  these  cases 
may  be  averted  by  cold  baths,  the  temperature  of  the  bath  being  rap- 
idly reduced  from  96°  to  about  60°  Fahr.,  by  the  addition  of  ice.  It 
is  sometimes  necessary  in  these  cases  to  prolong  the  stay  in  the  bath 
to  two  or  three  hours,  but  it  must  not  be  forgotten  that  no  absolute 
rule  can  be  made,  the  state  of  the  patient's  pulse,  respiration,  and  tem- 
perature being  the  guide  not  only  as  to  the  temperature  of  the  bath, 
but  the  duration  of  the  stay  in  it. 

Typho-malarial  fever  is  best  treated  by  the  same  means  ;  but  ma- 
larial fevers  are,  of  course,  so  unquestionably  remediable  by  quinine 
that  any  other  treatment  is  a  waste  of  time.  Baths  are,  however,  ex- 
tremely grateful  in  the  pyrexial  stage  of  malarial  fevers. 


HYDROTHERAPY.  85 

Cold  baths  are  of  equal  utility  in  scarlatina.  In  mild  and  uncom- 
plicated cases  of  this  disease,  no  remedies  are  required,  and  simple 
sponging  of  the  body,  followed  by  inunctions  of  oil,  is  all  that  is 
required.  "When,  however,  the  temperature  rises  to  104°,  105°,  106° 
Fahr.,  and  higher,  and  there  is  delirium  or  stupor,  the  rash  being  dark 
and  indistinct,  and  the  urine  scanty,  the  cold  wet-pack  will  often  ren- 
der most  signal  service.  The  rash  will  reappear  and  become  vividly 
red  ;  the  pulse,  respiration,  and  temperature,  will  decline.  The  cold 
wet-pack  to  the  neck,  and  frequent  gargling  of  the  throat  with  warm 
water,  relieve  the  sore-throat,  and  are  really  more  effective  than  the 
caustic  applications  so  commonly  resorted  to.  When  the  urine  becomes 
scanty  and  highly  albuminous,  hot  fomentations  to  the  lumbar  region, 
with  or  without  addition  of  medicaments,  are  often  very  serviceable. 
The  vapor-bath,  or  the  warm  wet-packing,  by  determining  free  dia- 
phoresis, relieves  the  brain  when  convulsions  are  threatened,  or  have 
actually  occurred,  from  uraemia. 

Other  eruptive  diseases,  measles,  small-pox,  cerebro-spinal  menin- 
gitis, are  advantageously  treated  in  the  same  way. 

Constitutional  syphilis  is  very  much  ameliorated,  and  the  cure  by 
specific  treatment  hastened,  by  a  course  of  Turkish  baths,  or  wet-pack- 
ing. Three  baths  should  be  taken  each  week.  If  the  wet-packing  be 
used,  the  patient  should  remain  in  it  until  free  diaphoresis  is  pro- 
duced. 

The  wet-packing  is  very  efficacious  in  acute  rheumatism,  but  the 
prejudices  of  the  patient,  and  of  the  patient's  friends,  often  interfere 
to  prevent  its  use.  If  there  be  much  pain  and  soreness,  the  front  of 
the  body  may  be  packed,  and  the  inflamed  joints  may  be  separately 
swathed,  but,  whenever  practicable,  the  packing  should  include  the 
whole  body.  A  vapor-bath  is  often  very  serviceable.  A  vinegar 
vapor-bath  has  been  used,  it  is  said,  with  great  advantage.  This  ap- 
plication may  be  readily  made  in  the  following  way  :  Some  bricks 
are  previously  heated  ;  the  bedclothes  are  elevated  above  the  patient 
by  hoops  transversely  placed  ;  and  vinegar  is  poured  over  the  heated 
bricks,  which  have  been  laid  under  the  bedclothes.  The  perspiration 
which  follows  these  baths  should  be  wiped  off,  the  skin  quickly  sponged 
with  tepid  water,  and  then  dried  with  a  soft  towel.  Great  relief  is 
experienced  from  these  applications  ;  the  joints  are  less  tender,  the 
fever  declines,  and  the  acid  perspirations  are  diminished.  Chronic 
rheumatism,  if  chiefly  muscular,  and  if  changes  have  not  occurred  in 
the  joints,  which  are  simply  stiff,  and  chronic  gout,  are  much  benefited 
by  the  Turkish  bath. 

In  acute  cerebral  congestion,  the  cold  douche  may  be  applied  to 
the  head,  while  the  feet  are  immersed  in  warm  water.  A  piece  of  ice, 
held  against  the  nape  of  the  neck,  acts  powerfully  in  the  same  way. 
The  alternate  application  of  ice  and  hot  water  is  often  more  effective 


86  RESTORATIVE   AGENTS. 

than  ice  alone.  The  author  has  seen  these  alternate  applications  of 
ice  and  hot  water  have  an  excellent  effect  in  the  stupor  of  opium  nar- 
cosis, of  uraemia,  and  in  carbonic-acid  poisoning,  occurring  under  vari- 
ous conditions. 

In  inflammatory  affections  of  the  meninges,  and  in  meningeal  haem- 
orrhage, a  bag  or  bladder  of  pounded  ice  has  the  sanction  of  universal 
use.  The  author  believes  that  these  applications  are  often  made  with- 
out due  discrimination  in  cerebral  hcemorrhage  and  other  allied  states. 
When  the  face  is  pale,  the  surface  cool,  and  the  circulation  depressed, 
cold  applications  to  the  head  are  harmful.  Ice  to  the  head,  and  fric- 
tions of  the  surface  with  ice,  are  very  serviceable  in  sunstroke  or  ther- 
mic fever,  when  the  surface  is  hot,  the  pupils  contracted,  and  the 
pulse  full  and  bounding.  The  cold  wet-packing  gives  great  relief 
under  the  same  circumstances,  but,  when  the  symptoms  of  depression 
exist,  these  cold  applications  are  hazardous.  Usually,  however,  in 
thermic  fever,  the  range  of  temperature  is  very  high,  and  the  most 
important  indication  is  to  abstract  the  heat,  which  can  be  best  accom- 
plished by  application  of  ice  or  the  cold  wet-pack,  or  the  cold  bath. 
The  results  of  the  practice  are  in  accordance  with  this  theory,  for 
these  applications  have  been  most  successful  in  restoring  patients  in 
imminent  danger  of  death.  When,  in  delirium  tremens,  the  head  is 
hot,  the  conjunctivas  injected,  the  face  flushed,  and  the  pulse  strong, 
an  ice-bag  to  the  head,  or  cold  affusion,  or  a  mild  douche,  will  assist 
in  quieting  the  patient,  and  favor  the  production  of  sleep  ;  but  these 
measures  will  do  mischief  when  considerable  depression  of  the  bodily 
powers  exists,  and  they  are  of  doubtful  utility  in  any  case  affording 
evidences  of  atheroma  of  the  cerebral  arteries,  or  of  cardiac  disease. 
Cold  affusion  to  the  head  and  spine,  and  cold  baths,  are  among  the 
most  important  means  of  relief  in  chorea.  Wakefulness  in  children 
and  adults  may  be  often  overcome,  and  quiet  sleep  insured,  by  a  tepid 
bath  taken  just  before  retiring  ;  but,  when  the  head  is  hot,  the  eyes 
brilliant,  and  the  circulation  active,  cold  should  be  applied  to  the  head, 
while  the  body  is  immersed  in  the  tepid  bath. 

The  shower-bath,  the  douche,  and  cold  affusion,  were  formerly 
much  used  to  calm  the  violence  of  acute  mania  and  maniacal  delirium. 
The  great  depression  of  the  powers  of  life  which  the  douche  and  the 
shower-bath  have  caused  in  some  cases,  and  the  fatal  results  which 
have  occurred  during  their  administration,  have  led  to  their  disuse  by 
many  alienist  physicians.  By  others,  they  are  held  to  be  extremely 
serviceable  in  appropriate  cases.  Bucknill  and  Tuke  advise  the  oc- 
casional use  of  the  shower-bath  in  the  excitement  of  intercurrent  mania 
and  monomania,  and  a  daily  shower-bath  in  melancholia.  They  ad- 
vise, further,  that  the  shower-bath  should,  in  the  first-named  group  of 
cases,  be  used  no  longer  than  three  minutes,  and  in  melancholia  from 
fifteen  to  thirty  seconds,  the  patient  being  dried  while  standing  in  a 


HYDROTHERAPY.  87 

pan  of  hot  water.  The  same  authors  prescribe  a  warm  bath  of  thirty 
minutes,  at  95°  Fahr.,  for  the  excitement  and  sleeplessness  of  various 
forms  of  insanity,  and  they  affirm  that  its  "tranquillizing  effect  is 
often  wonderful."  The  simultaneous  use  of  cold  affusion  to  the  head 
and  the  warm  bath  has  been  warmly  advocated  by  M.  Brierre  de 
Boismont,  and  is  decidedly  approved  by  Bucknill  and  Tuke,  who  ad- 
vise that  the  duration  of  the  bath  should  not  exceed  one  hour.  The 
wet-pack  is  an  exceedingly  valuable  remedy  in  the  excitement  of  acute 
mania,  but  this  measure  should  not  be  allowed  to  degenerate  into  a 
means  of  restraint  merely.  It  should  be  applied  in  the  mode  already 
described,  and  the  patient  should  continue  in  it  until  free  diaphoresis 
is  established. 

In  infantile  convulsions  great  benefit  is  derived  from  the  general 
warm  bath  combined  with  cold  affusion,  or  an  ice-bag,  to  the  head. 
Hysterical  convulsions  are  quickly  relieved  in  the  same  way,  and  the 
hysterical  state  is  much  improved  by  a  daily  shower-bath. 

Water,  cold  and  warm,  in  the  state  of  vapor,  as  ice,  has  been  largely 
applied  in  the  treatment  of  tetanus  and  hydrophobia,  but  without 
good  results  beyond  the  merest  temporary  assuagement  of  the  patient's 
sufferings. 

Lesions  of  the  spinal  meninges  and  of  the  cord,  corresponding 
pathologically  to  those  of  the  brain,  are  remediable  by  similar  means 
as  respects  hydrotherapy.  The  author  has  seen  remarkable  improve- 
ment follow  a  hot  douche  to  the  spine  in  a  case  of  paraplegia  of  syph- 
ilitic origin.  Erb  reports  remarkable  curative  results  from  the  use 
of  the  "  rubbing  wet-pack  "  in  chronic  myelitis.  He  advises  the  use 
of  merely  tepid  water,  and  opposes  the  application  of  the  extremes  of 
temperature,  whether  hot  or  cold.  The  backache  so  common  in  women, 
and  frequently  due  to  anaemia  of  the  cord,  may  be  much  relieved  by 
a  sponge  dipped  in  hot  water  and  passed  over  the  spine.  The  hot 
douche  to  the  spine  is  often  more  decidedly  serviceable  in  these  dis- 
tressing cases. 

Alterations  of  sensibility,  analgesia,  anaesthesia,  hyper  algesia,  hy- 
peroesthesia,  are  often  relieved  by  hydrotherapy — by  the  wet-pack,  by 
ice,  by  local  hot  and  cold  affusion.  Neuralgic  affections,  especially 
sciatica,  are  benefited  greatly  by  the  wet-pack.  Paralyzed  parts  that 
have  become  cold  and  that  waste,  and  that  are  undergoing  other  nu- 
tritive changes,  are  improved  in  condition  by  douches,  by  wet-pack- 
ing, and  other  methods  of  the  water-cure. 

In  inflammatory  affections  within  the  chest,  wet-packing  is  very 
useful.  As  a  rule,  a  hot  wet-pack  gives  more  relief  than  a  cold  one, 
but  the  feelings  of  the  patient  are  a  proper  guide.  In  acute  pleuritis  a 
cold  wet-pack  applied  to  the  side  unquestionably  diminishes  the  pain, 
and  no  doubt  relieves  the  inflammation.  In  pneumonia  remarkable 
results  have  been  obtained  by  the  cold  bath,  as  well  as  by  topical 


88  RESTORATIVE  AGENTS. 

applications  to  the  chest.  Jiirgensen  has  especially  done  much  to  estab- 
lish this  practice  on  a  sure  basis,  and  Dr.  Thomas  J.  Mays,  of  Phila- 
delphia, has  published  statistical  evidence  of  a  most  favorable  charac- 
ter. The  mode  of  procedure  is  the  same  as  in  hyperpyrexia  and  in 
fevers.  The  patient  is  immersed  in  tepid  water,  and  cold  water  is 
added  to  reduce  the  temperature  of  the  bath  to  60°  Fahr.  The  stay  in 
the  water  is  determined  by  the  effect  on  the  body  heat,  the  condition 
of  the  heart,  and  the  respiration.  The  reduction  of  the  febrile  heat  is 
coincident  with  a  decline  in  the  local  inflammation.  When  the  organs 
within  the  chest  are  inflamed,  it  is  good  practice  to  wrap  the  whole 
chest  tightly  in  a  pack  to  limit  the  motion  of  the  chest-walls.  The 
method  of  proceeding  is  as  follows  :  Wring  out  in  cold  or  hot  water 
a  large  towel,  fold  it  and  place  over  the  affected  side  or  part ;  have  in 
readiness  a  bandage  or  long  towel  sufficient  to  encircle  the  chest,  and 
confine  the  wet-pack  by  pinning  as  tightly  as  possible  around  the  chest 
the  bandage  or  towel.  Spongiopiline  is  an  excellent  material  for  mak- 
ing these  hot  or  cold  applications.  The  same  expedients — the  applica- 
tion of  cold  and  the  tight  bandage — are  of  great  utility  in  pulmonary 
hemorrhage,  but  a  more  decided  effect,  by  means  of  ice-bags  to  the 
chest  and  back,  may  be  procured  in  this  condition  of  things. 

Cold  and  hot  applications  have  unquestionable  value  in  inflamma- 
tory affections  of  the  abdominal  organs.  The  author  has  seen  excel- 
lent results  from  the  application  of  an  ice-bag  over  the  swelling  in  cases 
of  typhlitis  and  perityphlitis.  Peritonitis  is  similarly  treated  with  ad- 
vantage. When  the  inflammation  is  recent,  the  abdomen  may  be  cov-» 
ered  with  an  ice-bag  of  sufficient  size.  It  has  been  shown  that  not  only 
may  the  local  symptoms  of  inflammation  be  abated  in  this  way,  but  the 
general  temperature  of  the  body  be  thus  reduced.  It  is  proper,  in  mak- 
ing these  cold  applications,  to  interpose  a  napkin  or  towel  between  them 
and  the  skin. 

Pounded  ice  is  an  excellent  application  to  strangulated  hernia  to 
favor  reduction,  and  this  has  often  been  sufficient  when  the  taxis  failed. 
Haemorrhoids  that  are  much  swollen  and  painful,  or  that  bleed,  are  much 
improved  by  applications  of  ice.  Bubo  and  swelled  testicle  are  greatly 
benefited,  and  the  pain  attendant  on  them  relieved,  by  ice. 

Cold  to  the  abdomen  in  the  form  of  ice  or  cold  water,  and  ice-water 
thrown  into  the  uterus,  or  ice  introduced  into  the  cavity  of  the  womb, 
are  measures  of  great  utility  in  uterine  haemorrhage,  whether  from 
threatened  abortion  or  post  partum. 

Hot-water  injections,  or  the  hot  douche,  is  one  of  the  most  effective 
measures  to  be  used  in  chronic  metritis.  A  large  quantity  of  water  and 
frequent  applications  are  needed  to  procure  the  best  results.  Not  less 
than  a  quart  of  water  as  hot  as  can  be  borne,  and  three  applications 
each  day,  are  necessary.  A  Davidson's  syringe,  a  vessel  containing  hot 
water,  and  a  suitable  vessel  to  receive  the  water  as  it  flows  away,  are 


HYDROTHERAPY.  89 

the  materials  needed  for  the  vaginal  douche.  The  first  effect  of  this 
is  to  increase  the  blood-supply,  but  a  marked  degree  of  pallor  of  the 
mucous  membrane  follows,  the  opposite  effect  to  that  caused  by  cold 
water.  When  there  is  great  relaxation  of  the  vaginal  passage  and 
the  uterus  is  large  and  spongy,  the  cold  douche  is  more  serviceable. 
Excellent  results  are  sometimes  obtained  by  the  alternate  use  of  the 
hot  and  cold  douche.  The  free  use  of  filtered  rain-water  has  proved 
very  efficacious  in  albuminuria,  and  to  effect  the  solution  of  renal  cal- 
culi. It  must  be  drunk  in  large  quantity.  The  good  effects  of  Be- 
'hesda  and  of  other  weak  alkaline  waters  must  be  referred  to  the  same 
action  ;  for  these  waters  can  be  drunk  in  larger  quantity  without  dis- 
tressing the  stomach,  than  the  hard  waters.  They  must  be  used  freely 
and  for  many  months,  to  accomplish  curative  results. 

The  applications  of  water  in  surgical  practice  are  numerous  and  im- 
portant. As  a  dressing  for  wounds,  contusions,  and  inflamed  parts,  it 
is  in  universal  use.  The  author  is  convinced  that  the  cold-water  treat- 
ment of  wounds  is  often  overdone,  the  circulation  in  the  wounded  part 
being  too  much  depressed,  whence  repair  is  slow,  or  sloughing  is  in- 
duced. The  hot-water  dressing,  or  the  immersion  of  the  affected  part 
in  hot  water  (95°  to  100°  Fahr.),  as  proposed  and  practiced  by  Prof. 
F.  H.  Hamilton,  of  New  York,  is  a  method  which  promises  most  suc- 
cessful results : 

"  The  phenomena  usually  observed  in  cases  of  recent  lacerated  or  incised 
wounds,  when  submerged,  are  a  sense  of  comfort,  yet  not  absolute  relief  from 
pain;  on  the  second  or  third  day  the  parts  adjacent  are  swollen  but  not  much 
reddened ;  the  integument  generally  assumes  a  white  and  sodden  appearance, 
and  with  only  slight  tenderness.  On  the  fifth,  sixth,  or  seventh  day  the  swelling 
is  greater  than  usually  accompanies  other  plans  of  treatment,  and,  with  the  in- 
experienced, is  likely  to  excite  alarm ;  but  it  is  found  not  to  be  attended  with 
increased  tenderness,  and  it  pits  under  pressure,  showing  that  it  is  a  condition 
of  oedema  chiefly.  At  this  time  the  granulations  are  generally  covered  with 
lymph,  or  some  exudate  of  a  whitish  color,  and  which  might  easily  be  mistaken 
for  a  diphtheritic  deposit.  At  the  end  of  fourteen  days  or  thereabouts  (the 
period  at  which,  in  most  cases,  we  substitute  fomentation  for  submersion)  the 
limb  is  still  cedematous,  the  granulations  are  abundant,  sometimes  presenting  t» 
fresh  red  appearance,  and  at  others  covered  with  the  white  exudate." 

Prof.  Hamilton  further  remarks  : 

"No  treatment  hitherto  adopted,  under  our  observation,  has  been  attended 
with  equally  favorable  results.  Under  this  plan  the  area  of  acute  inflammation 
is  exceedingly  limited ;  erysipelatous  inflammation  has  been  uniformly  arrested 
or  restrained  when  it  has  actually  commenced,  and  it  has  never  originated  after 
submersion  ;  gangrene  has  in  no  instance  extended  beyond  the  parts  originally 
injured,  and,  when  progressing,  it  has  in  most  cases  been  speedily  arrested  (in 
gangrene,  hot  water,  or  water  at  a  temperature  of  from  100°  to  110°  Fahr.,  is 
to  be  preferred).  Septicaemia  and  pyjemia  have  not  ensued  in  any  case  in  which 
submersion  has  been  practiced  from  the  first  day  of  the  accident.  Purulent 
infiltrations  and  consecutive  abscesses  have  been  infrequent,  and  always  limited 


90  RESTORATIVE   AGENTS. 

to  the  neighborhood  of  the  parts  injured,  and  of  small  extent.  Traumatic  fever, 
usually  present  after  grave  accidents,  when  other  plans  of  treatment  have  been 
pursued,  as  early  as  the  third  or  fourth  day,  has  seldom  been  present  when  this 
plan  has  been  adopted,  and  in  no  case  has  the  fever  been  intense  or  alarming." 

For  the  immersion  of  hand,  foot,  arm,  and  leg,  Hamilton  has  con- 
structed bath-tubs  of  peculiar  shape.  He  advises  this  method  of  treat- 
ment in  contused  or  lacerated  wounds  of  the  extremities.  Simple  in- 
cised wounds  and  amputations  are  unsuited  to  this  plan  of  treatment. 

I  subjoin  the  titles  of  some  of  the  most  recent  and  important  contri- 
butions to  our  knowledge  of  the  actions  and  uses  of  water.  It  is  proper 
to  add  that  I  have  also  consulted  the  works  of  the  followers  of  Priessnitz, 
but  they  are  singularly  deficient  in  accurate  and  scientific  knowledge : 

BRAND,  DR.  ERNST.  Die  Heilung  des  Typhus,  rn.it  einem  Anlumg :  Anweisung  fur  die 
Krankenwdrter  bei  Behandlung  des  Typhus  mil  Badern,  Berlin,  1868,  A.  Hirschwald. 

BRAUN,  DR.  JULIUS.  Systematisches  Lehrbuch  der  Balneotherapie,  dritte  umgearbeitete 
Auflage,  Berlin,  1873,  pp.  714. 

Fox,  DR.  WILSON.  Observalioiis  on  tJie  Treatment  of  Hyperpyrexia,  London  Lancet, 
vol.  ii,  1871,  p.  231,  et  seq. 

HAMILTON,  DR.  FRANK  H.     The  Medical  Record,  New  York,  vol.  ix,  May  15,  1874. 

JURGENSEN,  DR.  THEODOR.  Die  Korperwarme  des  gesunden  Menschen  (Studieri),  Leipzig, 
1873,  p.  28,  et  seq. 

LIEBERMEISTER,  PROF.  DR.  CARL.  Beobachtungen  und  Versuche  uber  die  Anwendung 
des  kalten  Wassers  bei  fieberhaften  Krankheiten,  Leipzig,  1868,  pp.  480. 

IBID.     Ziemsseri's  Cyclopcedia,  American  edition,  vol.  i,  p.  206,  et  seq. 

IBID.     Handbuch  der  Pathologic  und  Therapie  des  Fiebers,  Leipzig,  1875,  p.  598,  et  seq. 

VALENTINER,  DR.  TH.  Handbuch  der  allgemeinen  und  speciellen  Balneotherapie,  George 
Reimer,  1873,  pp.  850. 

HEAT. 

PHYSIOLOGICAL  ACTIONS. — It  is  difficult  to  assign  heat  to  its  proper 
position  in  a  systematic  classification.  As  a  stimulant  to  the  vital  pro- 
cesses, it  pertains  to  the  class  of  agents  promoting  constructive  meta- 
morphosis ;  but,  in  its  influence  on  the  interchanges  of  repair  and  waste, 
the  action  quickly  passes  into  the  stage  of  waste.  As  its  therapeutical 
employment  is  almost  entirely  confined  to  the  range  of  constructive 
metamorphosis,  it  seems  more  appropriate  to  embrace  it  in  this  divis- 
ion of  the  subject. 

The  normal  heat-production  of  the  body  varies  singularly  little  in 
health.  Every  considerable  rise  of  temperature  above,  every  consider- 
able fall  below,  the  normal  of  98'5°  Fahr.,  indicates  the  existence  of 
disease.  The  various  external  causes  of  disturbance  of  the  heat-pro- 
ducing function  of  the  body  do  not,  in  health,  affect  the  normal  stand- 
ard, because  of  the  existence  of  a  regulating  apparatus.  Every  one 
is  familiar  with  the  fact  that  the  human  body  can  be  exposed,  without 
risk,  to  a  temperature  much  above  its  own  standard,  provided  the  heat- 
regulating  function  is  in  a  condition  of  healthy  activity.  If,  however, 
the  transmutation  of  heat  into  another  mode  of  motion  can  not  be 


HEAT.  91 

effected,  then  the  complexus  of  morbid  actions,  called  fever,  is  at  once 
established.  Every  increment  of  heat  added  to  the  body,  unable  to 
transmute  it  into  another  mode  of  motion,  adds  to  the  existing  tem- 
perature. 

Very  important  alterations  take  place  in  a  body,  the  seat  of  a  fe- 
brile process.  Increased  waste,  the  result  of  more  rapid  oxidation, 
occurs  ;  the  excretion  of  urea,  and,  according  to  some  authorities,  of 
carbonic  acid,  is  increased  ;  and  those  important  and  wide-spread  le- 
sions, entitled  parenchymatous  degenerations,  develop  in  various  organs 
of  the  body. 

Modes  of  applying  Heat. — 1.  SOLAR  HEAT. — The  rays  of  the  sun 
may  be  applied  directly  to  the  whole  surface,  or  to  any  part  of  the 
body.  When  the  whole  body  is  exposed  to  the  rays  of  the  summer 
sun,  the  head  and  face  ought  to  be  protected.  The  skin  becomes 
warmer,  the  capillaries  dilate,  an  erythematous  blush  appears,  and  the 
amount  of  blood  in  the  peripheral  vessels  is  increased  above  the  nor- 
mal. The  rays  of  the  sun  in  midsummer,  ranging  from  95°  Fahr.  to 
125°  Fahr.,  produce  considerable  burning  heat,  and  cause  a  superficial 
inflammation  of  the  skin,  which  is  followed  by  desquamation.  When 
the  heat  is  less  powerful,  only  an  agreeable  sensation  of  warmth  may 
be  experienced.  Decidedly  caustic  effects  may  be  produced  by  the 
concentration  of  the  solar  rays  on  a  small  spot  of  integument  by  a 
double-convex  lens — a  burning-glass,  it  has  been  called.  This  may  be 
utilized  as  a  means  of  counter-irritation. 

Besides  the  heat,  the  solar  rays  contain  chemical  or  actinic  rays  ; 
and  hence  it  is  not  improbable  that  chemical  effects  of  a  very  impor- 
tant kind,  or,  it  may  be,  catalytic  effects,  follow  the  application  of  the 
solar  rays  to  a  considerable  portion  of  the  body.  Further,  it  can  not 
be  doubted  that  excitation  of  the  cutaneous  nerves  by  the  heat  and 
chemical  rays  of  the  sun  must  affect  the  condition  of  the  brain  and 
spinal  cord,  and,  through  the  sympathetic  system,  the  nutrition  of 
the  body. 

2.  ARTIFICIAL  HEAT. — There  are  various1  modes  of  applying  arti- 
ficial heat.  It  may  be  dry  or  moist. 

MOIST  HEAT. —  The  Vapor-Bath, — It  consists  simply  in  the  appli- 
cation of  the  vapor  of  water  to  the  surface  of  the  body.  Sufficient  at- 
tention, for  the  limits  of  this  work,  has  been  bestowed  on  this  subject 
in  the  article  on  "  Hydrotherapy." 

DEY  HEAT. — To  the  general  surface  of  the  body  dry  heat  may  be 
applied  by  simply  raising  the  temperature  of  the  air  of  the  apartment, 
the  body  being  uncovered.  Local  application  of  dry  heat  may  be 
made  to  any  part  by  means  of  woolen  cloth,  earthen  plates,  sad-irons, 
bags  of  salt,  bricks,  etc.,  heated  to  the  proper  temperature.  The  ef- 
fects of  these  applications  depend  largely  on  the  amount  of  heat  con- 
tained in  these  objects.  They  produce  at  first  the  sensation  of  warmth, 


92  RESTORATIVE   AGENTS. 

redness  of  the  skin,  and  may  cause  vesication,  or  deep-seated  burning 
and  destruction  of  the  tissues. 

The  Turkish  Bath. — This  differs  from  the  Russian  bath,  in  that  it 
consists  of  dry  air  without  the  presence  of  the  vapor  of  water.  The 
human  body  can  exist  in  dry  air  at  a  very  high  temperature,  without 
injury,  for  a  short  period,  provided  it  is  in  a  state  of  health.  The 
temperature  of  the  air  of  the  Turkish  bath  ranges  from  95°  Fahr.  to 
100°  Fahr.,  but  the  highest  point  is  attained  at  the  conclusion  of  the 
process.  There  are  usually  three  apartments,  so  that  the  patient 
passes  from  one  grade  of  temperature  to  another,  and  thus  avoids  the 
unpleasant,  even  dangerous,  effects  of  high  heat  suddenly  applied. 
When  the  temperature  reaches  110°  Fahr.,  already  some  distress  is  ex- 
perienced. As  the  heat  increases,  the  breathing  becomes  short,  hur- 
ried, and  labored  ;  the  action  of  the  heart  is  tumultuous  ;  an  unpleas- 
ant sensation  of  heat  and  irritation,  with  itching,  is  felt  over  the  whole 
body  ;  the  head  has  a  feeling  of  fullness,  with  constriction  of  the  fore- 
head and  ringing  in  the  ears  ;  perspiration  soon  begins,  and,  when  the 
temperature  reaches  the  highest  point,  is  very  profuse. 

It  is  obvious  that  a  decided  impression  is  made  on  the  organism  by 
a  Turkish  bath.  The  first  effect  of  the  heat  is  on  the  sensory  nerves — 
the  impression  of  warmth.  The  peripheral  vessels  dilate,  and,  of  course, 
admit  into  them  a  larger  amount  of  blood,  with  the  effect  to  diminish 
the  amount  of  blood  in  the  internal  organs.  The  temperature  of  the 
blood  rises  with  the  increase  of  heat  ;  the  action  of  the  heart  corre- 
sponds, and  a  state  of  fever  would  be  quickly  induced  if  the  excess 
of  heat  were  not  at  once  disposed  of  by  the  perspiration,  in  which,  ac- 
cording to  the  doctrine  of  the  correlation  of  forces,  it  disappears  as 
motion.  The  circulation  being  more  rapid,  and  the  peripheral  vessels 
containing  more  blood,  a  more  active  metamorphosis  of  tissue  proba- 
bly takes  place.  Elimination  is  more  active  through  the  skin,  but  is 
less  active  through  the  intestinal  canal  and  the  kidneys.  The  acidity 
of  the  urine  is  increased,  and  the  water  and  salts  are  relatively  dimin- 
ished. Remotely,  the  tension  of  the  vascular  system  falls,  absorption 
becomes  more  active,  the  muscular  tonus  declines,  and  the  sensibility 
of  the  nervous  system  and  of  the  special  senses  is  lowered. 

THERAPY. — Warm  applications  possess  a  high  degree  of  utility  in 
the  various  painful  and  inflammatory  affections  of  the  abdominal  or- 
gans. Acute  peritonitis,  local  or  general,  is  probably  more  frequently 
benefited  by  applications  of  ice.  As  a  rule,  the  feelings  of  the  patient 
furnish  the  guide  to  the  selection  of  the  temperature.  In  the  ab- 
sence of  any  specific  indication  from  the  feelings  of  the  patient, 
the  following  rule  may  be  adhered  to  :  If  the  case  be  one  of  pain 
without  fever  or  inflammation,  warm  or  hot  applications  ;  if  inflamma- 
tory, cold.  Those  materials  which  retain  heat  and  moisture  longest 
are  to  be  preferred  j  for  example,  the  material  known  as  spongio- 


AIR.  93 

piline,  poultices  of  flaxseed-meal,  flannels  wrung  out  in  hot  water  and 
covered  with  oiled-silk,  etc.  When  the  weight  of  the  application  is 
objected  to,  a  light  material,  like  a  bag  of  hops  dipped  in  hot  water, 
may  be  applied.  In  affections  of  the  pelvic  viscera,  the  same  modes 
of  application  can  be  resorted  to,  under  the  same  conditions. 

Heat,  especially  dry  heat,  is  a  very  important  remedy  in  sudden 
and  alarming  depression  of  the  vital  powers,  with  feebleness  of  the 
heart's  action  and  coldness  of  the  surface.  Active  haemorrhage,  of 
course,  contraindicates  its  employment.  Feeble  infants,  born  at  term 
or  prematurely,  are  often  saved  by  the  application  of  dry  heat — the 
highest  temperature  which  can  be  borne  without  blistering  being  ne- 
cessary. The  methodus  medendi  is  simple  enough  :  the  heating  of 
the  blood  in  the  superficies  of  the  body  increases  the  movement  of 
both  heart  and  lungs.  High  heat,  especially  if  long  continued,  is  de- 
cidedly contraindicated  in  cases  of  fatty  and  fibroid  degeneration  of  the 
heart,  in  cases  of  carditis,  considerable  obstruction  of  the  orifices,  etc. 

Hot-air  baths,  and  hot  applications  of  any  kind,  may  be  dangerous 
in  old  subjects,  and  in  those  persons  of  middle  age  who  present  the 
evidences  of  degenerated  vessels.  Not  unfrequently,  attacks  of  mi- 
graine, cases  of  ordinary  neuralgia  of  the  fifth,  tic-douloureux  of  mild 
form,  etc.,  are  relieved  by  hot,  dry  applications  made  over  the  course 
and  peripheral  distribution  of  the  affected  nerves.  Stupor  and  coma, 
due  to  urcemia,  or  to  narcotic  medicines,  may  be  relieved  by  dry  heat 
applied  to  the  neck.  The  alternate  use  of  cold  and  heat  is  generally 
more  efficient.  In  neuralgia  of  the  larger  nerves,  dry  heat  is  pallia- 
tive. In  irritable  spine,  the  so-called  spinal  irritation,  dry  heat  is  an 
efficient  remedy.  In  these  cases  solar  heat  is  especially  serviceable — 
the  sun's  rays  falling  on  the  spine,  or,  what  is  better,  the  rays  concen- 
trated by  a  burning-glass  on  various  points  on  the  spine. 

Probably  the  most  generally  useful  application  of  dry  heat  is  in 
the  treatment  of  chronic  rheumatism  and  in  general  dropsy.  In  the 
treatment  of  these  maladies,  elimination  is  the  object  to  be  accom- 
plished: in  the  one  case,  of  certain  excrementitious  substances,  notably 
of  uric  acid  ;  and  in  the  other,  of  water  by  the  skin. 

The  Turkish  bath  has  an  unquestionably  good  effect  in  constitu- 
tional syphilis.  Here  there  are  two  objects  to  be  accomplished — to 
promote  the  action  of  the  mercurial  medicines  and  of  the  ptisans,  and 
to  secure  elimination  through  the  skin.  In  the  same  way  the  Turkish 
bath  is  highly  useful  in  plumbic,  mercurial,  and  paludal  cachezice. 
Our  French  colleagues  maintain  the  superior  value  of  sulphur-vapor 
baths  in  the  cachexiae  produced  by  the  mineral  poisons. 

AIR. 

The  Atmosphere. — As  a  therapeutical  agent,  only,  is  air  to  be  con- 
sidered here.  Nevertheless,  various  hygienical  relations  of  the  subject 
are  also  therapeutical,  and  must  therefore  be  included. 


94  RESTORATIVE   AGENTS. 

COMPOSITIOX. — The  atmosphere  is  a  mechanical  mixture  of  oxygen, 
nitrogen,  and  we  should  also  add  carbonic  acid,  and  the  vapor  of  water. 
In  round  numbers  there  are  21  parts  of  oxygen,  79  parts  of  nitrogen 
by  volume,  and  '033  per  cent  of  carbonic  acid.  The  essential  constit- 
uents— oxygen  and  nitrogen — are  quite  uniform  in  proportion  in  all 
parts  of  the  world,  but  the  carbonic  acid  and  vapor  of  water  vary  con- 
siderably, owing  to  local  causes.  Contrary  to  the  generally  received 
opinions,  the  quantity  of  carbonic  acid  is  greater  at  the  tops  of  the 
highest  mountains  than  on  the  plains,  and  the  oxygen  less.  The 
amount  of  moisture  is  determined  chiefly  by  temperature,  and  when 
the  air  can  contain  no  more,  it  is  said  to  be  saturated.  A  trace  of  am- 
monia also  is  present  in  the  air,  and  a  minute  quantity  of  active  oxy- 
gen or  ozone. 

When  a  beam  of  electric  light  is  made  to  traverse  the  atmosphere, 
minute  particles,  previously  invisible  to  the  eye,  and  some  even  extra- 
microscopic,  come  into  view.  The  lowest  forms  of  life — microzymes, 
bacteria,  etc. — are  found  in  great  numbers  ;  in  cities,  particles  of  car- 
bon, lime,  and  other  earthy  matters,  fibers  of  cotton  and  woolen  cloth, 
leather,  ordure  of  animals,  etc.  ;  in  the  country,  pollen  of  plants,  and 
particles  of  vegetable  tissues  ;  in  hospital  wards,  pus-cells  and  other 
matters  derived  from  the  persons,  wounds  and  discharges,  bedding, 
and  utensils  of  the  sick.  We  owe  our  present  knowledge  of  these 
accidental  constituents  of  the  air  chiefly  to  the  researches  of  Prof. 
Tyndall. 

Various  gaseous  matters  are  also  accidentally  present  in  the  air, 
varying  in  different  localities  in  consequence  of  local  telluric  condi- 
tions, and  certain  trades  and  manufactures.  As  respects  the  first,  there 
are  carbonic  acid  and  carbonic  oxide,  sulphureted  and  phosphureted 
compounds  of  hydrogen,  marsh  miasm,  etc.  Under  the  second  may 
be  included  sewer-gas,  gaseous  emanations  from  decomposing  animal 
matter,  from  chemical  works  of  various  kinds,  etc. 

PHYSIOLOGICAL  EFFECTS. — 1.  Pure  Air. — When  air  is  breathed  in 
the  process  of  respiration,  the  oxygen  passes  into  the  blood,  and  car- 
bonic acid,  the  vapor  of  water,  a  trace  of  ammonia,  and  some  organic 
matter,  pass  out.  The  blood  which  leaves  the  lungs  is  changed  in 
color,  from  the  dark,  purplish  hue  of  venous,  to  the  scarlet  of  arterial 
blood  ;  it  has  gained  oxygen,  and  lost  carbonic  acid  and  water.  The 
cause  of  the  diffusion  of  gases  in  the  lungs  is  chiefly  the  difference  in 
tension  of  the  gases  in  the  blood  and  in  the  atmosphere — the  tension 
becoming  equal  in  the  process  of  respiration  (Hermann). 

In  the  tissues  where  oxidation  processes  are  taking  place,  there  is, 
also,  a  respiration  process  going  on,  consisting  in  the  formation  and 
excretion  of  carbonic  acid. 

2.  Impure  Air. — So  essential  to  life  is  the  supply  of  oxygen  to 
warm-blooded  animals,  that  they  can  not  be  deprived  of  it,  even  for  a 


AIR.  95 

very  short  time,  without  danger  to  life.  As  pure  oxygen  can  not  be 
inhaled  for  any  considerable  period  without  injury,  admixture  with 
some  "  indifferent  gas  "  becomes  necessary.  Thus  nitrogen  is  utilized 
in  the  formation  of  atmospheric  air.  The  other  indifferent  gases  are 
hydrogen  and  light  carbureted  hydrogen,  or  marsh  gas  :  when  mixed 
with  oxygen,  they  can  be  breathed  with  impunity  ;  when  inhaled 
alone,  they  cause  dyspnoea  and  asphyxia. 

Certain  other  gases  are  entitled  "  irrespirable,"  because,  owing  to 
the  chemical  actions  instantaneously  set  up,  they  can  not  be  inhaled. 
Some  of  these  irrespirable  gases  are  acid — as  carbonic,  muriatic,  hypo- 
nitrous,  sulphurous,  etc.  ;  others  form  acids  by  combination  with  oxy- 
gen, as  nitric  oxide,  etc.  ;  others  are  alkaline,  as  ammonia ;  others  es- 
tablish an  ozonizing  action,  as  chlorine,  bromine,  etc. 

Other  gases  are  comprehended  in  a  group  as  "  poisonous,"  of 
which  there  are  three  classes.  The  first  class  contains  those  which 
seize  and  combine  with  the  oxygen  of  the  blood,  decomposing  hemo- 
globin. They  are  hence  called  "reducing  gases,"  of  which  sulphu- 
reted  hydrogen,  phosphureted  hydrogen,  etc.,  are  examples.  The 
gases  of  the  second  class  displace  the  oxygen  and  enter  into  combina- 
tion with  the  hemoglobin.  Carbonic  oxide  and  nitric  oxide  are  ex- 
amples of  these  displacing  gases.  The  third  class  contains  the  gases 
used  for  the  production  of  anesthesia. 

In  the  process  of  respiration,  the  air  loses  its  oxygen,  nitrogen  is 
relatively  partly  increased,  carbonic  acid  accumulates,  and  certain  ill- 
defined  "  organic  matters  "  appear.  This  vitiated  air  exerts  a  most  in- 
jurious influence,  and  soon  becomes  unfit  to  sustain  life.  The  amount 
of  carbonic  acid  which  can  be  breathed  without  injury  has  not  been 
definitely  ascertained,  but  is  greater  than  is  commonly  supposed. 
According  to  Pettenkofer  and  Voit,  10  per  1,000  volumes  produce  no 
discomfort.  When,  in  a  crowded  apartment,  headache,  vertigo,  and 
feeble  circulation  are  apparently  caused  by  the  quantity  of  carbonic 
acid  present,  these  results  are  in  part  due  to  the  lessened  supply  of 
oxygen,  and  to  the  action  of  nitrogen  and  organic  matters. 

The  foul  air  from  cesspools  and  sewers  affects  the  health  of  man 
in  two  modes  :  by  the  direct  action  of  the  gases  of  decomposition, 
and  indirectly  by  acting  as  carriers  of  the  germs  of  disease.  As  re- 
spects the  former,  its  injurious  influence  has  probably  been  exagger- 
ated ;  for  the  original  observation  of  Parent-Duchatelet,  that  workmen 
engaged  in  cleaning  the  sewers  of  Paris  suffered  from  no  diseases  due 
to  their  occupation,  has  been  abundantly  confirmed  in  the  subsequent 
experience  of  the  French  officials.  It  is  probable,  also,  that  certain 
persons  possess  a  high  degree  of  susceptibility  to  the  action  of  sewer- 
gas,  and  are  affected  by  comparatively  minute  quantities.  When 
sewer-gas  is  admitted  to  private  houses,  and  is  breathed  by  such  sus- 
ceptible persons,  they  decline  in  health,  become  easily  fatigued3  lose 


96  RESTORATIVE   AGENTS. 

appetite  and  suffer  with  nausea  and  diarrhoea,  waste,  and  have  an 
earthy,  sallow  complexion.  If  the  gas  is  more  concentrated,  they 
experience  more  acute  symptoms,  and  have  attacks  of  a  choleriform 
character.  Of  course,  asphyxia  is  produced  when  the  gas  is  so  con- 
centrated as  to  displace  oxygen  entirely,  as  is  the  case  sometimes  in 
old  drains  and  privy-vaults,  the  air  of  which,  as  is  well  known,  may 
extinguish  life  speedily. 

Sewer-gas,  examined  microscopically,  is  found  to  be  loaded  with 
minute  particles,  the  lowest  forms  of  life,  etc.,  and  hence  it  is  in  a  high 
degree  probable  that  the  germs  of  fevers,  dysentery,  cholera,  diph- 
theria, etc.,  may  in  a  similar  manner  be  conveyed  by  it. 

Effects  of  Compressed  Air. — Our  knowledge  of  this  subject  is  de- 
rived in  part  from  observations  made  on  workmen  engaged  in  under- 
ground avocations  requiring  them  to  labor  under  greatly  increased 
barometric  pressure  ;  in  part  from  observations  made  on  patients  un- 
dergoing the  compressed-air  treatment ;  and  in  part  from  experimental 
researches  on  animals. 

Not  to  enter  too  far  into  details  out  of  place  here,  it  suffices  to 
state  that  the  inhalation  of  compressed  air  lessens  the  respiratory 
movements  and  the  number  of  heart-beats,  and  increases  the  arterial 
tension.  The  effect  of  this  change  in  the  conditions  of  the  circulation 
is  to  diminish  the  amount  of  blood  in  the  veins  and  auricles,  and  to 
increase  it  relatively  in  the  ventricles  (Sanderson).  On  ophthalmo- 
scopic  examination  of  the  fundus  oculi  it  has  been  ascertained  (Von 
Vivenot)  that  the  blood-vessels  of  the  retina  diminished  in  size  with 
the  increase  in  the  pressure.  Compressed  air  does  not  appear  to  in- 
fluence materially  the  production  of  carbonic  acid,  but  it  does  the 
absorption  of  oxygen  (Von  Liebig).  The  changes  induced  in  the 
phenomena  of  life  under  high  barometric  pressure  have  been  carefully 
studied  by  Paul  Bert,  who  seems  to  have  established  that  the  evil 
effects  of  such  pressure  are  largely  due  to  the  formation  of  bubbles 
of  gas  in  the  blood.  He  finds  that  nitrogen  is  dissolved  in  the  blood 
during  the  time  of  high  pressure,  and  returns  to  the  gaseous  state 
when  the  pressure  ceases.  He  further  ascertained  that  the  bubbles  of 
gas  obstructed  the  circulation  at  various  points,  especially  in  the  lum- 
bar portion  of  the  spinal  cord,  causing  paraplegia.  When  the  ac- 
cumulation of  gas  was  sufficient  in  amount,  the  pulmonary  circulation 
was  obstructed  and  the  heart  paralyzed  by  the  sudden  distention. 
MM.  Blanchard  et  Regnard  have  studied  the  changes  taking  place 
in  the  spinal  cord  under  the  action  of  nitrogen.  Numerous  haemor- 
rhagic  foci,  and  evidences  of  parenchymatous  myelitis,  were  discovered 
in  the  entire  cord.  The  myelitis  presented  the  usual  characteristics  : 
hypertrophy  and  varicosity  of  the  axis  cylinder,  and  granular  change 
at  various  points,  but  least  pronounced  in  the  lumbar  portion  of  the 
cord,  and  most  decided  in  the  dorsal  region. 


AIR.  97 

AIR  AS  A  THERAPEUTICAL  AGENT. — As  a  general  rule,  the  sick 
require  more  air-space  than  the  healthy.  The  mere  cubic  dimensions 
are  much  less  important  than  the  amount  of  oxygen  available  for  res- 
piration ;  but  as  the  sick  are  more  readily  affected  by  draughts  than 
the  healthy,  it  follows  that  the  sick  require  more  cubic  space,  and  less 
frequent  renewal  of  the  air.  It  seems  generally  conceded  that  2,000 
cubic  feet  of  air-space  per  patient  is  necessary  in  hospitals  and  in  the 
sick-room  to  supply  the  needed  amount  of  oxygen,  although  a  less 
space  may  be  better  if  provided  with  the  means  of  frequent  changes 
of  air  without  sudden  variations  of  temperature  and  strong  currents. 
A  large  cubic  space  of  stagnant  air  will  be  inadequate  to  the  require- 
ments of  the  sick.  Even  when  so  large  an  amount  of  air  as  3,700  cu- 
bic feet  per  hour  for  each  patient  has  been  supplied  to  a  hospital  ward, 
the  air  in  it  has  had  a  distinctly  "  stuffy  "  and  offensive  smell.  Every- 
body is  familiar  with  the  fact  that  the  sick  and  wounded  do  better  in 
tents  and  in  the  open  air,  than  in  the  best  constructed  military  hos- 
pitals. 

If,  as  has  been  affirmed  by  the  highest  sanitary  authorities,  1,000 
cubic  feet  of  air-space  is  necessary  to  a  healthy  adult,  it  is  clear  that 
the  sick  require  not  less  than  we  have  named,  2,000  ;  for  the  renewal 
of  the  air  in  the  case  of  the  latter  must  be  less  rapid.  As  the  means 
for  the  renewal  of  the  air  in  the  sick-chamber  in  private  houses  consist 
of  doors,  windows,  and  fireplaces — or  natural  ventilation — the  supply 
to  the  patient  is  variable.  To  insure  the  best  results  under  these  cir- 
cumstances, the  bed  should  be  so  placed  as  to  be  without  stagnant 
corners  and  recesses,  and  yet  not  within  the  range  of  currents  or 
draughts.  When  the  air  is  still,  movements  may  be  produced  by 
burning  a  lamp  in  the  chimney.  In  cold  weather  the  fire  in  the  fire- 
place induces  a  strong  upward  current  in  the  chimney,  the  air  coming 
from  all  the  crevices.  It  would  be  quite  beyond  the  subject-matter 
of  this  treatise  to  consider  the  various  mechanical  contrivances  which 
have  been  proposed,  and  are  now  used,  to  secure  proper  ventilation  in 
public  institutions  and  hospitals ;  but  it  may  be  useful  to  mention 
those  devices  by  which  natural  ventilation  in  the  sick-chamber  may 
be  promoted. 

Where  there  are  opposite  windows,  cross-draughts  may  be  prevent- 
ed by  the  following  expedients  :  1,  by  giving  an  upward  slope  to  the 
window  so  that  the  current  of  fresh  air  is  deflected  toward  the  ceiling  ; 
2,  by  having  some  of  the  window-panes  doubled,  the  outer  one  having 
a  space  at  the  bottom  of  the  pane,  and  the  inner  one  at  the  top;  3,  by 
fastening  a  block  to  the  upper  sash  which  prevents  closing.  If  there 
are  windows  at  one  side  only,  the  room  may  be  efficiently  ventilated 
by  vertical  tubes  carried  up  the  walls  from  some  distance  (a  few  feet) 
and  communicating  with  the  external  air. 

In  the  fevers,  exanthemata,  diphtheria,  dysentery,  etc.,  an  abun- 


98  RESTORATIVE  AGENTS. 

dant  supply  of  air  is  a  measure  of  the  highest  utility.  The  result  in  a 
doubtful  case  may  be  determined  by  the  amount  of  oxygen  received 
by  the  patient.  Furthermore,  free  admission  and  exit  of  air  is  the 
most  efficient  means  of  destroying  disease-germs,  and  their  retention 
in  a  stagnant  atmosphere  intensifies  their  virulence.  In  febrile  affec« 
tions,  the  apprehension  of  "  taking  cold  "  may  be  allayed  by  the  assur- 
ance that  the  condition  of  fever  is  preventive.  Draughts,  however, 
should  be  avoided  in  measles  and  in  all  affections  of  the  breathing 
organs. 

There  are  two  conditions  in  diseases  of  the  respiratory  organs,  in 
which  an  abundant  supply  of  air  is  essential  :  inflammatory  affections 
in  which  the  breathing  space  is  encroached  upon  so  that  the  oxygena- 
tion  of  the  blood  is  hindered  ;  and  chronic  maladies,  as  emphysema, 
asthma,  etc.,  in  which  labored  breathing  is  a  consequence  in  part  of 
mechanical  defects.  Considerable  diminution  in  the  supply  of  air  has 
a  powerful  influence  in  the  production  of  consumption.  The  statistics 
on  this  point  collected  by  the  English  Sanitary  Commission  seem  con- 
clusive, and,  since  their  recommendation  of  increased  cubic  air-space  in 
the  barracks,  the  number  of  cases  of  phthisis  has  materially  diminished. 
In  the  treatment  of  this  disease,  a  suitable  supply  of  air  becomes 
even  more  imperative.  The  subjects  of  this  disease  should  occupy 
apartments,  whenever  practicable,  provided  with  ample  windows  and 
fireplace,  and  frequent  renewal  of  the  air  day  and  night  should  be 
secured  by  some  of  the  contrivances  now  used  for  this  purpose  and  al- 
ready referred  to.  Whenever,  by  reason  of  fever  or  debility,  exercise  * 
in  the  open  air  can  not  be  taken,  the  patient,  suitably  clad  and  pro- 
tected in  severe  weather,  may  sit  in  an  apartment  with  all  the  win- 
dows and  doors  open,  a  part  of  each  day. 

Maladies  characterized  by  a  deficiency  in  the  oxidation  processes 
throughout  the  body  require  increased  supply  of  air  under  all  the  cir- 
cumstances of  life.  The  most  important  of  these  are  diabetes,  gout, 
rheumatism,  obesity,  excess  in  the  production  of  lithates,  etc.  The 
good  effects  of  open-air  exercise  in  these  disorders  result  chiefly  from 
the  increased  consumption  of  oxygen.  Anaemia,  chlorosis,  convales- 
cence from  acute  diseases,  and  chronic  wasting  maladies,  also  require 
increased  consumption  of  air  :  the  oxygen  is  even  more  important  than 
the  iron  which  is  given  so  profusely  in  these  cases  ;  indeed,  without 
additional  oxygen,  the  assimilation  of  the  iron  can  hardly  be  accom- 
plished. 

THERAPEUTICAL  APPLICATIONS  OF  COMPRESSED  AIR  are  effected 
by  two  modes  :  by  placing  the  patient  in  a  chamber  in  which  the  air 
has  been  condensed  by  an  air-pumping  engine  ;  and  by  having  the 
patient  breathe,  through  a  mask  closely  fitting  the  mouth  and  nose,  air 
compressed  in  a  portable  reservoir.  The  latter  method  only  is  ordi- 
narily available.  Without  entering  into  minute  details,  it  will  suffice 


AIR.  99 

to  say  that  the  former  method  consists  of  an  air-tight  chamber  eight 
feet  high  and  seven  feet  wide,  in  which  three  patients  can  sit  comfort- 
ably. The  air  is  compressed  gradually  to  one  and  a  half  atmospheres 
— a  pressure  of  twenty-two  pounds  to  the  square  inch — and  the  pa- 
tient remains  in  the  chamber  about  an  hour  and  a  half.  One  of  the 
first  and  most  complete  arrangements  of  this  kind  was  erected  under 
the  supervision  of  Dr.  Liebig  (not  the  chemist)  at  Reichenhall,  Bava- 
ria ;  and  he  has  since  communicated  the  results  of  his  large  experience 
to  the  Aerztliches  Intelligent- Blatt  of  Munich.  The  portable  apparatus 
now  most  used  is  that  of  Waldenburg  (der  transportable pneumatische 
Apparat}.  This  consists  of  an  outer  cylinder  containing  some  water, 
and  an  inverted  inner  cylinder  containing  air,  which  fits  into  the  outer 
one.  Obviously  the  air  within  may  be  condensed  or  rarefied  by  low- 
ering or  raising  the  inner  cylinder,  which  is  easily  effected  by  applying 
weights.  A  mercurial  manometer  indicates  the  degree  of  condensa- 
tion, and  a  water-gauge  the  height  of  the  water.  With  the  air-cham- 
ber a  flexible  tube,  having  an  oro-nasal  mask  attached,  communicates. 
With  this  apparatus  the  patient  breathes  either  condensed  or  rarefied 
air  at  the  will  of  the  operator.  The  author  has  had  arranged  for  his 
own  use  a  pneumatic  apparatus  which  can  be  employed  for  inhalation 
of  compressed  or  rarefied  air,  and  for  the  atomization  of  liquids.  It  is 
only  available  in  cities  where  a  sufficient  water-pressure  can  be  ob- 
tained. It  consists  of  a  brass  cylinder  strongly  made,  and  containing 
at  the  top  a  stop-cock  and  pipe  for  the  admission  of  water,  and  at  the 
bottom  a  stop-cock  for  drawing  off  the  water.  At  the  top,  also,  there 
is  a  stop-cock  and  pipe  for  the  attachment  of  the  flexible  tube  and 
oro-nasal  mask,  and  a  gauge  for  registering  the  pressure.  The  admis- 
sion of  water  effects  the  compression  of  the  air  ;  its  removal — all  the 
stop-cocks  being  closed — effects  the  rarefaction.  Precisely  the  same 
results  can  be  attained  as  in  the  more  complicated  arrangement  of 
Waldenburg.  Furthermore  the  author's  apparatus  can  be  employed  as 
an  atomizer,  using  compressed  air  or  steam. 

The  applications  of  compressed  air  are  numerous  and  important. 
The  results  are  chemical  and  mechanical.  The  chemical  effects  are 
due  to  the  increased  supply  of  oxygen  ;  the  mechanical,  to  the  distri- 
bution of  the  blood-pressure.  In  anaemia,  chlorosis,  amenorrhoza,  in 
the  neuralgias,,  especially  of  the  fifth  nerve,  headache,  epistaxis,  in 
gout,  diabetes,  obesity,  etc.,  very  excellent  results  are  obtained  by  the 
use  of  compressed  air — which  means  the  increased  consumption  of 
oxygen.  To  achieve  all  that  is  possible  to  effect  in  these  cases,  the 
treatment  must  be  continued  for  a  considerable  time. 

It  is,  however,  in  certain  cardiac  and  pulmonary  affections  that  the 
pneumatic  treatment  is  especially  commended.  Acute  catarrh,  nasal, 
faucial,  bronchial,  if  early  applied  ;  chronic  bronchitis,  with  or  with- 
out emphysema,  capillary  bronchitis,  atelectasis,  asthma,  dilatation  of 
9 


100  RESTORATIVE  AGENTS. 

the  right  cavities,  and  fullness  of  the  venous  with  ischsemia  of  the  ar- 
terial system,  are  conditions  in  which  the  compressed  air  is  signally 
beneficial.  Probably  in  emphysema,  more  than  in  any  other  malady, 
has  the  relief  afforded  by  this  treatment  been  most  conspicuous  ;  for 
this  is  a  disease  which  has  hitherto  offered  few  results  to  therapeutical 
skill.  "  Die  Exspiration  in  verdiinnter  Luft  ist  das  specifische  mecha- 
nische  Antidot  des  Emphysems,"  is  the  dogmatic  statement  of  Walden- 
burg — "  Expiration  into  rarefied  air  is  the  specific  mechanical  antidote 
to  the  emphysematous  affections." 

The  rules  for  the  inspiration  and  expiration  of  rarefied  and  con- 
densed air  respectively  may  be  formulated  as  follows  : 

As  inspiration  of  condensed  air  increases  the  intra-thoracic  air- 
pressure,  it  impedes  the  flow  of  blood  to  the  right  auricle,  and  lessens 
somewhat  the  pulse-rate,  and  is  accordingly  indicated  in  cases  of  dysp- 
noea having  a  mechanical  origin,  in  incipient  phthisis,  in  asthma,  bron- 
chitis, and  in  insufficiency  of  the  mitral. 

As  inspiration  of  rarefied  air  has  the  opposite  effects  to  those  of 
condensed  air,  its  use  is  indicated  in  the  few  cases  in  which  increased 
inspiratory  power  is  desirable,  as  in  contracted  thorax,  the  result  of 
effusion. 

Expiration  into  condensed  air  increases  the  expiratory  power  when 
deficient,  and  expiration  into  rarefied  air  is  indicated  in  emphysema 
and  chronic  bronchitis. 

HOT  AIR. — Since  it  has  been  shown  by  Pasteur  that  the  vinous  fer- 
mentation is  arrested  by  raising  to  the  temperature  of  160°  Fahr.  the" 
bottles  containing  new  wine,  this  fact  has  been  extensively  applied, 
and  is  called  Pasteurism.  Recently  the  breathing  of  hot  air  has  been 
brought  forward  as  a  remedy  for  phthisis,  and  the  results  of  the  prac- 
tice have  been  good.  The  air,  washed,  is  heated  by  a  Bunsen's  burner, 
and  then  breathed  by  the  patient  for  a  time  which  is  determined  by 
the  condition.  A  heat  of  200°  Fahr.  is  the  initial  temperature,  and 
this  is  raised  up  to  300°,  even  400°,  and  the  time  occupied  from  a  half 
to  two  hours,  several  times  each  day. 

MASSAGE. 

DEFINITION.  —  The  term  massage  is  probably  derived  from  the 
Arab  word  mass,  which  signifies  "  to  knead."  The  French  word  mas- 
sage is  equivalent  to  the  term  shampooing,  and  is  applied  to  a  process 
of  rubbing,  friction,  and  percussion  of  the  body.  Masseur  is  a  male 
rubber,  and  masseuse  a  female  rubber — that  is,  persons  who  make  a 
business  of  massage. 

METHOD. — Massage  by  friction  consists  in  rubbing,  rolling  under 
the  fingers,  and  gently  pinching  the  skin,  and  rubbing,  tapping,  knead- 
ing, and  exercising  the  muscles  and  joints.  Beginning  at  an  extrem- 
ity, the  foot  for  example,  the  skin  is  taken  up  between  the  thumb  and 


MASSAGE.  101 

fingers  and  rolled  and  pressed  ;  then  the  muscular  masses  are  well 
grasped,  rolled  and  pressed  and  kneaded,  and  rapidly  tapped  a  quick 
succession  of  light  blows  ;  and  then  each  articulation  is  in  turn  put 
through  all  of  its  motions.  Even  the  muscles  of  the  neck  and  the  in- 
terossei  may  be  subjected  to  the  same  treatment,  with  a  little  address 
and  painstaking.  In  fact,  no  part  of  the  body  should  be  omitted  ex- 
cept the  face. 

Massage  by  percussion  alone  consists  in  applying  to  various  parts 
of  the  body  a  very  rapid  succession  of  short  blows,  not  forcible  enough 
to  cause  pain.  The  blows  or  taps  may  be  made  with  a  wooden  spatula, 
with  the  fingers  as  arranged  for  percussion,  or  with  the  lateral  margin 
of  the  hand  fully  extended. 

Dr.  Mortimer  Granville  has  accomplished  notable  results  in  the 
treatment  of  neuralgia  by  rapid  percussion  over  the  trajectory  of  the 
nerves  affected.  He  has  devised  a  small  instrument  for  this  purpose, 
called  percuteur.  The  curative  results  of  this  delicate  percussion  are 
attributed  by  Granville  to  a  modification  in  the  nerve-molecules. 

PHYSIOLOGICAL  EFFECTS. — The  good  effects  of  massage  are  popu- 
larly ascribed  to  electrical  or  supernatural  agency.  That  electrical 
currents  are  induced  by  massage  is  true,  but  the  curative  effects  are 
attributable  to  other  agencies. 

The  effects  of  massage  are  :  1,  local ;  2,  systemic. 

1.  The  masseur  or  rubber  puts  forth  more  or  less  muscular  power, 
which  at  the  points  of  contact  or  friction  develops  or  is  transformed 
into  another  mode  of  motion — heat.     The  action  thus  induced  in  the 
constituent  tissues  of  the  parts  operated  on,  also  serves  to  elevate  the 
temperature.     The  vessels  dilate  and  an  increased  quantity  of  blood 
enters  them,  and  the  motion  of  the  blood-current  is  accelerated.     The 
immediate  effect  of  these  changes  is  to  promote  the  nutritive  energy 
of  the  tissues  subjected  to  friction.     This  result  is  seen  in  the  im- 
proved color,  warmth,  and  volume  of  the  parts. 

2.  A  general  rise  of  temperature,  equal  in  most  instances  to  one 
degree,  has  been  observed  to  take  place  quite  uniformly  (Mitchell). 
The  body  increases  in  weight ;  all  the  organic  functions  are  performed 
with  more  energy,  and  power  is  gained  in  every  way.     Massage  in  its 
several  forms  exercises  peculiar  effects  on  the  nervous  system,  which 
should  not  be  overlooked.     "When  an  inflamed  part  which  can  be  ma- 
nipulated, a  joint  for  example,  is  rubbed  with  excessive  gentleness, 
the  sensibility,  which  was  at  first  so  acute  that  every  touch  gave  pain, 
rapidly  subsides,  until,  after  an  hour  of  friction,  it  may  be  handled 
with  some  roughness,  without  evoking  painful  sensations.     When  the 
local  condition  is  that  of  pain  merely,  it  is  remarkable  how  the  acutest 
suffering  is  alleviated  by  persistent  friction  of  a  gentle  kind.     Again, 
the  state  of  spasm  of  a  muscle  is  relieved  and  relaxation  induced  by 
persevering  rubbing  of  the  affected  muscle.     Results  such  as  these  are 


102  RESTORATIVE   AGENTS. 

explicable  only  on  the  theory  that  the  gentle  titillation  of  the  cutane- 
ous branches  of  the  nerves  (end-organs)  has  so  far  lowered  their  irri- 
tability that  they  cease  to  receive  and  transmit  painful  impressions. 
The  rapid  and  long-continued  transference  to  the  centers  of  conscious 
impressions  of  the  gentle  titillation  of  the  end-organs  allays  the  irri- 
tability of  the  center,  so  that,  if  pain  be  transmitted,  it  excites  no  re. 
action,  and  therefore  is  not  realized. 

THERAPY. — Obstinate  waJcefulness  and  nocturnal  restlessness  may 
often  be  relieved  by  massage  of  pressure  or  percussion.  Very  gentle 
and  long-continued  friction  of  the  extremities,  especially  of  the  lower 
extremities,  is  necessary,  or  corresponding  tapping.  Simple  headache, 
even  severe  paroxysms  of  neuralgia,  and  the  spasms  of  tic  douloureux, 
are  often  most  surprisingly  relieved  by,  at  first,  exceedingly  delicate 
frictions  of  the  end-organs  of  the  fifth — the  skin  of  the  face,  forehead, 
neck,  and  the  scalp — and  subsequently  stronger  rubbing  of  the  same 
parts.  The  same  method  has  been  effective  in  hemicrania,  migraine, 
and  spinal  pain  (Westerlund,  Graham,  Putnam,  and  others).  Next  to 
electricity,  massage  is  the  most  useful  remedy  we  possess  in  the  treat- 
ment of  infantile  paralysis  and  other  wasting  palsies,  after  the  acute 
symptoms  have  subsided.  In  hemiplegia  and  other  forms  of  paralysis 
due  to  intra-cranial  lesions,  the  indications  for  the  treatment  by  mas- 
sage are  a  lowered  state  of  the  nutrition  of  the  paralyzed  parts,  cold- 
ness and  blueness  of  the  skin,  wasting  and  contracted  muscles,  ulcer- 
ations,  etc.  In  progressive  muscular  atrophy,  much  more  may  be 
accomplished  by  persistent  frictions  and  kneadings  of  the  wasting* 
muscles.  The  treatment  should  be  begun  early,  and  the  first  indica- 
tions— pain,  fibrillary  trembling,  weakness,  etc. — require  the  massage, 
without  waiting  for  obvious  wasting.  Of  course,  any  treatment  is 
useless  when  the  wasting  has  proceeded  so  far  that  no  muscular  ele- 
ments remain. 

Probably  massage  has  accomplished  more  conspicuously  good  re- 
sults in  chronic  joint  affections,  synomtis,  contractions  and  deformities, 
and  thickening  from  inflammatory  deposits  (Berghmann  and  Helle- 
day,  Billroth,  Mosengeil,  and  others).  It  is  in  this  class  of  cases  that 
healers,  natural  bone-setters,  and  other  empirics  sometimes  achieve 
surprising  success  in  the  face  of  failures  by  regular  surgeons.  The 
author  therefore  especially  urges  on  young  surgeons  and  physicians 
the  extraordinary  utility  of  massage  in  this  group  of  cases,  and  the 
great  results  which  can  be  achieved  by  it,  when  sections  of  muscles, 
tendons,  and  cicatrices  may  appear  to  be  imperatively  demanded.  In 
many  cases  patient  and  long-continued  use  of  the  method  may  be  re- 
quired. 

In  the  hands  of  Weir  Mitchell,  massage  has  proved  of  surprising 
benefit  in  cases  of  the  so-called  spinal  irritation,  with  its  protean 
manifestations  in  the  nervous,  muscular,  digestive,  and  sexual  systems. 


MASSAGE.  103 

He  uses  it  as  a  means  of  promoting  the  nutrition  of  the  body  generally, 
and  of  the  muscular  system  particularly,  while  he  maintains  the  body 
in  a  condition  of  nearly  absolute  rest. 

As  the  results  obtained  have  been  surprisingly  great,  it  were  better 
to  indicate  with  some  particularity  the  kind  of  cases  to  which  massage 
seems  best  adapted,  and  we  can  do  no  better  than  employ  the  graphic 
language  of  Mitchell  :  "  It  includes  that  large  group  of  women,  espe- 
cially, said  to  have  nervous  exhaustion,  or  who  are  described  as  having 
spinal  irritation,  if  that  be  the  prominent  symptom.  To  it  I  must  add 
cases  in  which,  besides  wasting  and  anaemia,  emotional  manifestations 
predominate,  and  which  are  then  called  hysterical,  whether  or  not  they 
exhibit  ovarian  or  uterine  disorders.  Nothing  is  more  common  in 
practice  than  to  see  a  young  woman  who  falls  below  the  health- 
standard,  loses  color  and  plumpness,  is  tired  all  the  time,  by-and-by 
has  a  tender  spine,  and  soon  or  late  enacts  the  whole  varied  drama  of 
hysteria.  .  .  .  But  no  matter  how  it  comes  about,  the  woman  grows 
pale  and  thin,  eats  little,  or,  if  she  eats,  does  not  profit  by  it.  Every- 
thing wearies  her — to  sew,  to  write,  to  read,  to  walk — and  by-and-by 
the  sofa  or  the  bed  is  her  only  comfort." 

"  In  the  treatment  of  these,  massage  plays  an  important  part.  Rest, 
electrical  excitation  and  exercise  of  the  muscular  system,  systematic 
feeding,  are  employed  in  conjunction  with  massage." 

How  far  the  results  in  the  treatment  by  massage  are  affected  by 
psychical  impression  has  not  been  ascertained.  The  separation  of 
these  patients  from  home  influences  and  associations,  the  confinement 
to  bed,  and  the  novel  treatment,  combine  to  affect  the  imagination 
profoundly,  and  to  arouse  hope  and  expectation  to  the  highest  point. 
In  the  class  of  cases  described  by  Mitchell,  these  mental  influences 
are  powerful  factors  both  in  causing  and  curing  morbid  mental  states. 
In  illustration  may  be  quoted  Davy's  celebrated  case  of  paralysis  cured 
by  the  mere  application  of  the  thermometer,  and  the  remarkable  re- 
coveries which  occurred  under  the  religious  ministrations  and  prayers 
of  Prince  Hohenlohe. 

The  extraordinary  effects  produced  by  the  application  of  certain 
metals  in  hysterical  subjects  (Burq's  Metallotherapy)  may  also  be 
quoted  in  illustration.  The  results  obtained  by  Charcot  from  metallo- 
therapy  have  been  even  more  remarkable  than  the  cures  effected  by 
Mitchell  with  massage. 

THE  MUSCLE-BEATEE. — Massage  has  its  ill  effects,  and  is  now,  like 
the  "  rest-cure,"  much  overdone.  Besides  the  expense  and  inconven- 
iences of  the  treatment,  it  is  used  injudiciously  in  cases  of  debility,  and 
in  convalescence,  when  the  material  produced  is  not  in  excess  of  the 
needs. 

The  muscle-beater  may  well  be  substituted  for  massage  in  many 
cases.  It  is  composed  of  a  wooden  handle  of  size  convenient  to  bQ 


104  RESTORATIVE   AGENTS. 

grasped,  sixteen  to  eighteen  inches  in  length,  and  at  the  end  are  placed 
two  elastic  balls  of  vulcanized  caoutchouc,  having  a  diameter  of  two  and 
a  half  to  three  inches.  Each  ball  has  a  small  hole  in  it  to  permit  the 
entrance  and  exit  of  air.  With  this  instrument  blows  of  varying  force 
and  frequency  can  be  made  over  the  body  as  a  whole,  or  to  any  part. 

DIGESTION-FERMENTS. 

Pepsin. — Pepsina  velpepsinum  /  pepsina  porci  ;  pepsine,  FT.  ;  Ver- 
dauungsstoff,  Ger. 

DEFINITION. — A  proteolytic  ferment  or  enzyme  obtained  from  the 
glandular  layer  of  the  fresh  stomach  of  the  pig.  There  are  two  pro- 
cesses worthy  of  mention  for  obtaining  the  ferment :  Scheffer's,  and 
Prof.  Lionel  S.  Beale's.  By  Scheffer's  process  the  mucous  membrane 
is  digested  in  a  solution  of  muriatic  acid,  and  the  pepsin  precipitated 
with  chloride  of  sodium.  Beale  directs  that  the  mucous  membrane  be 
first  cleansed  and  then  scraped  strongly  with  an  ivory  knife,  so  as  to 
remove  the  contents  of  the  gastric  glands.  The  pepsin  is  contained 
in  the  very  viscid  mucous  which  is  thus  removed.  When  spread  on 
clean  glass  in  a  very  thin  layer,  it  is  dried  at  a  temperature  not  to  ex- 
ceed 100°  Fahr.,  and  in  the  vapor  of  hot  water  or  over  sulphuric  acid. 

PREPARATIONS. — Pepsinum  Saccharatum. — Pepsin,  10  grm.,  and 
sugar  of  milk,  90  grm.  "  One  part  of  saccharated  pepsin  dissolved  in 
500  parts  of  water  acidulated  with  7'5  parts  of  hydrochloric  acid 
should  digest  at  least  50  parts  of  hard-boiled  egg-albumen  in  five  or 
six  hours,  at  a  temperature  of  100°  to  104°  Fahr."  Dose,  3j— 31? 

Liquor  Pepsini. — Solution  of  pepsin  is  composed  of  saccharated 
pepsin  in  solution  in  water  and  glycerin,  and  acidulated  with  hydro- 
chloric acid.  Dose  :  a  teaspoonf ul  ter  in  die,  usually  after  meals.  The 
wine  of  pepsin  is  an  unscientific  preparation,  and  should  not  be  pre- 
scribed. Boudault's  (really  Corvisart's)  compound  nutritive  powder, 
consisting  of  pepsin,  starch,  and  lactic  acid,  is  an  exceedingly  uncertain 
preparation,  and  is  often  totally  inert.  Only  those  preparations  of 
pepsin  should  be  used,  made  by  the  processes  above  described,  espe- 
cially those  of  E.  Scheffer,  of  Louisville,  Ky.  The  saccharated  pepsin 
and  the  glycerole  are  practically  unchangeable. 

INGLUVIN  is  a  proprietary  preparation,  said  to  be  made  of  the 
gizzard  of  the  domestic  chicken  by  drying  and  pulverization.  Dose, 
gr.  v — 3j.  Ingluvin  has  the  remarkable  property  of  arresting  cer- 
tain kinds  of  vomiting — notably  the  vomiting  of  pregnancy.  It  is  a 
stomachic  tonic,  and  relieves  indigestion,  flatulence,  and  dyspepsia. 

Recent  investigations  have  shown  that  ingluvin  owes  its  curative 
effects,  not  to  any  ferment  corresponding  to  pepsin,  but  to  a  peculiar  bit- 
ter principle.  This  result  is  the  more  satisfactory,  since  such  an  organ 
as  the  gizzard  could  hardly  furnish  the  necessary  quantity  of  a  digestive 
ferment  to  effect  the  results  now  known  to  be  produced  by  ingluvin. 


DIGESTION-FERMENTS.  105 

Under  ordinary  circumstances,  and  when  the  object  of  its  adminis- 
tration is  to  promote  the  digestive  function,  it  should  be  taken  after 
meals.  When  the  object  is  to  arrest  the  vomiting  of  pregnancy,  it 
should  be  given  before  meals. 

But  only  the  successful  use  of  this  agent  and  the  apparent  sincer- 
ity of  the  composition  as  given  to  the  public  would  seem  to  justify  its 
mention  here  ;  but  no  doubt  need  be  felt  as  to  the  propriety  of  using  a 
patented  preparation  if  there  is  no  substitute  of  equal  value. 

PANCREATIN.  PANCREATIC  EMULSION.  LIQUOR  PANCREATICUS. — 
Pancreatin  is  a  mixture  of  the  enzymes  naturally  existing  in  the  pan- 
creas of  warm-blooded  animals,  usually  obtained  from  the  fresh  pan- 
creas of  the  hog  (Sus  scrofa,  Linne.  Class,  Mammalia  /  order,  Pachy- 
dermatd). 

Pancreatin  occurs  in  transparent,  brittle,  yellowish  scales,  or  a 
yellowish  or  yellowish-white  or  grayish  powder,  odorless,  or  having  a 
faint,  peculiar,  not  unpleasant  odor,  and  a  somewhat  meat-like  taste. 
It  is  slowly  and  almost  completely  insoluble  in  water,  insoluble  in 
alcohol.  It  digests  albuminoids,  converts  starch  into  sugar  in  pres- 
ence of  alkalies  ;  prolonged  contact  with  acids  renders  it  inert.  In 
the  presence  of  an  alkali  it  has  the  power  to  convert  proteids  into  pep- 
tones, to  emulsionize  fats,  etc.  As  acids  destroy  pancreatin,  it  follows 
that  the  liquor  pancreaticus  should  not  be  given  while  stomach  diges- 
tion is  going  on,  but  when  the  chyme  has  entered  the  intestine,  in 
about  three  hours  after  the  taking  of  food  (Roberts). 

In  cases  of  very  weak  digestion,  Roberts  suggests  the  employment 
of  "  peptonized  "  foods — i.  e.,  foods  that  have  been  acted  on  by  pan- 
creatin and  the  proteids  converted  into  peptones.  The  following 
formulae  proposed  by  Roberts  will  be  found  useful  in  some  conditions 
of  disease  : 

"Peptonized  Milk. — A  pint  of  milk  is  diluted  with  one  fourth 
water,  and  heated  to  140°  Fahr.  Two  or  three  teaspoonfuls  of  liquor 
pancreaticus,  and  ten  to  twenty  grains  of  bicarbonate  of  soda,  are 
then  mixed  therewith.  The  mixture  is  then  poured  into  a  covered 
jug,  and  the  jug  is  placed  in  a  warm  situation  under  a  'cozy'  in  order 
to  keep  up  the  heat.  At  the  end  of  an  hour  or  hour  and  a  half,  the 
product  is  boiled  for  two  or  three  minutes.  It  can  then  be  used  like 
ordinary  milk." 

"Peptonized  Gruel. — Gruel  may  be  prepared  from  any  of  the  nu- 
merous farinaceous  articles  which  are  in  common  use — wheaten  flour, 
corn-meal,  oatmeal,  arrow-root,  sago,  pearl-barley,  pea-flour.  The 
gruel  should  be  very  well  boiled,  and  made  thick  and  strong.  It  is 
then  poured  into  a  covered  jug  and  allowed  to  cool  to  a  temperature 
of  about  140°  Fahr.  Liquor  pancreaticus  is  then  added  in  the  propor- 
tion of  a  tablespoonful  to  the  pint  of  gruel,  and  the  jug  be  kept  warm 
under  a  '  cozy '  as  before.  At  the  end  of  a  couple  of  hours  the  prod- 


106  RESTORATIVE  AGENTS. 

uct  is  boiled  and  finally  strained."  In  this  process  the  starch  is  con- 
verted into  sugar,  and  the  albuminoid  matters  are  peptonized,  whence 
the  gruel  assumes  a  thin,  watery  consistence.  Peptonized  gruel  is 
administered  with  peptonized  milk. 

"  Peptonized  milk-gruel  is  prepared  as  follows  :  Gruel  is  made 
in  the  usual  way,  thick  and  strong  ;  to  this  while  boiling  is  added  an 
equal  measure  of  milk.  To  each  pint  of  the  mixture  add  two  or  three 
teaspoonfuls  of  liquor  pancreaticus  and  twenty  grains  of  bicarbonate 
of  sodium.  It  is  kept  warm  for  a  couple  of  hours,  then  boiled  for  a 
few  minutes  and  strained." 

SYNERGISTS. — Lactic  and  chlorhydric  (muriatic),  acetic,  citric,  and 
malic  acids,  promote  the  digestive  activity  of  pepsin. 

PHYSIOLOGICAL  EFFECTS. — Ten  grains  of  the  saccharated  pepsin, 
prepared  by  the  process  of  Scheffer,  will  dissolve  120  grains  of  coagu- 
lated albumen  in  four  to  six  hours,  at  a  temperature  of  100°  Fahr. 
Pepsin  is  an  essential  constituent  of  the  gastric  juice,  and  possesses  the 
property,  especially  in  the  presence  of  lactic  and  chlorhydric  acids,  of 
digesting  the  nitrogenous  constituents  of  the  food  (casein,  albumen, 
fibrin,  etc.),  and  converting  them  into  peptones. 

THERAPY. — Pepsin  is,  of  course,  indicated  in  stomach-disorders 
characterized  by  a  deficiency  of  this  essential  principle.  As  Fenwick 
has  shown,  the  amount  of  pepsin  secreted  by  the  gastric  glands  un- 
dergoes great  diminution  in  various  morbid  states,  as  in  cancer,  dia- 
betes, typhoid  fever,  and  heart-disease.  In  convalescence  from  fever, 
therefore,  pepsin  is  indicated,  and  in  the  incurable  morbid  states,  men-« 
tioned  above,  it  serves  a  useful  purpose  in  maintaining  the  function  of 
digestion.  Fox  "  bears  strong  testimony  in  favor  of  pepsin  "  (p.  74) 
in  cases  of  atonic  dyspepsia  and  "  irritative  states  of  the  mucous  mem- 
brane." He  prefers  to  administer  it  with  chlorhydric  acid.  In  the 
atonic  dyspepsia  of  phthisis  pepsin  is  highly  beneficial,  especially 
when  given  in  connection  with  pancreatic  emulsion.  In  other  forms 
of  dyspepsia,  accompanied  by  imperfect  solution  of  the  fats  and  the 
formation  of  fat-acids,  the  addition  of  pancreatic  solution  greatly  in- 
creases the  activity  of  pepsin  (Long). 

In  the  apepsia  of  infants  (Barthez),  especially  occurring  in  those 
artificially  fed,  great  benefit  is  derived  from  the  use  of  pepsin.  Dr. 
Cummins  has  seen  many  apparently  hopeless  cases  recover  under  its 
use,  and  he  regards  it  as  so  valuable  that  he  never  recommends  a  wet- 
nurse,  but  relies  on  artificial  food,  the  digestion  of  which  is  aided  by 
the  administration  of  pepsin.  Corvisart  used  his  nutritive  powder  (the 
so-called  Boudault's  pepsin)  with  happy  effects  in  the  same  cases  ;  and 
Barthez,  who  applied  the  term  apepsia  to  this  inability  of  infants  to 
digest  their  proper  aliment,  has  been  equally  successful  in  the  same 
mode  of  treatment.  The  saccharated  pepsin  should  be  administered  in 
these  cases  in  doses  of  ten  to  thirty  grains  immediately  after  the  child 


DIGESTION-FERMENTS.  107 

has  taken  its  milk  or  other  food,  or  thirty  minims  of  the  glycerole  of 
pepsin  at  the  same  time.  It  is  better,  according  to  M.  Barthez,  to  give 
pepsin  without  acid  to  infants  (Trousseau  et  Pidoux). 

Pepsin  is  one  of  the  remedies  which  has  been  used  with  success  in  the 
vomiting  of  pregnancy.  The  heaviness  and  torpor  which  are  felt  during 
the  progress  of  digestion  in  some  subjects,  and  also  the  gastralgia  which 
is  produced  in  this  way,  may  be  relieved  by  its  timely  administration. 

According  to  Hollman,  the  use  of  pepsin  is  attended  with  beneficial 
results  in  anaemia,  chlorosis,  atrophy,  and  allied  states,  due,  no  doubt, 
to  the  better  preparation  of  the  peptones  for  absorption  into  the  blood. 

In  chronic  ulcer  of  the  stomach  and  in  cancer  of  this  organ,  pepsin, 
by  facilitating  digestion,  will  diminish  the  distress  of  the  patient,  and 
will  contribute  to  the  cure  of  ulcer  and  prolong  life  in  cases  of  cancer. 

Very  great  success  has  been  attained  in  the  treatment  of  diarrhoea 
in  infants  by  pepsin.  The  form  of  diarrhoea  amenable  to  this  remedy 
is  due  really  to  an  atonic  state  of  the  intestinal  mucous  membrane. 
Every  motion  contains  half-digested  food.  Soon  after  taking  milk 
or  other  food,  the  child  becomes  uneasy  and  a  discharge  takes  place. 
Frequently  undigested  food  is  vomited  as  well.  If  this  condition  of 
things  continues  for  any  considerable  time,  the  child  emaciates,  and 
the  skin  wrinkles  and  becomes  dry  and  harsh.  The  motions  will  be 
quickly  changed  in  character,  and  the  nutrition  of  the  child  improved, 
by  giving  pepsin  immediately  after  each  supply  of  food.  Facts  in 
illustration  of  this  statement  have  been  published  by  Corvisart,  Bar- 
thez, Rilliet,  Trousseau  et  Pidoux,  Ellis,  of  Dublin,  Davidson,  of  Liv- 
erpool, Hawley,  of  Brooklyn,  and  others. 

In  cases  of  entire  inability  of  the  stomach  to  digest  food,  or  when 
surgical  operations  or  accidental  injuries  prevent  the  introduction  of 
aliments  into  this  viscus,  pepsin  is  added  to  the  nutritive  enemata 
in  order  to  insure  the  preparation  of  peptones  for  absorption.  Mr. 
Malcolm  Morris  reports  the  cure  of  an  obstinate  case  of  eczema  by 
the  administration  of  papain.  It  was  due  to  indigestion,  it  is  prob- 
able. 

Carica  Papaya. — A  member  of  the  Passaflorinece,.  It  resembles 
the  Cucurbitacece  in  the  form  of  its  fruit,  and  by  some  authorities  it  is 
placed  in  a  separate  class — the  Papayacece. 

COMPOSITION. — The  young  fruit  when  incised  furnishes  an  abun- 
dance of  milky  fluid,  which  is  slightly  bitter  to  the  taste,  and  it  coagu- 
lates on  exposure  to  the  air,  separating  into  an  albuminous  clot  and  a 
transparent  liquid  resembling  in  this  process  the  coagulation  of  blood. 

The  juice  contains  a  digestive  ferment  which  is  called  papain, 
sometimes  papayotin.  It  is  an  albuminous  substance,  white,  amor- 
phous, soluble  in  water,  but  insoluble  in  alcohol  and  ether.  The  dose 
of  papain  ranges  from  5  to  30  grains. 

From  the  leaves  of  the  plant  an  alkaloid  has  been  obtained,  called 


108  RESTORATIVE   AGENTS. 

by  its  discoverer,  Yon  Greshoff,  carpaine.  This  substance  has  the 
usual  properties  of  an  alkaloid— combines  with  acids  to  form  salts, 
and  produces  distinct  physiological  reactions.  The  dose  of  carpaine 
by  hypodermatic  injection  is  %  to  ^  of  a  grain,  and  by  the  stomach 
twice  these  quantities. 

Thus  far  carpaine  has  been  merely  the  subject  of  experimental  in- 
vestigation, and  we  need  occupy  but  little  space  with  an  account  of 
its  physiological  properties,  the  knowledge  of  which  we  owe  to  Van 
Ryn  and  C.  L.  Rtimke.  According  to  these  investigators,  who  agree 
for  the  most  part  in  their  conclusions,  carpaine  is  a  cardiac  remedy. 
It  lowers  the  blood  pressure,  but  increases  the  pulse  rate  but  slightly. 
When  the  action  of  the  heart  is  arrested  by  muscarin,  it  does  not,  like 
atropine,  cause  it  to  resume  its  movement  when  applied  directly.  It 
ultimately  paralyzes  respiration  and  circulation,  but  not  by  an  impres- 
sion made  on  the  vagus.  Its  effects  are  really  expended  on  the  centers 
of  respiration  and  circulation.  It  does  not  act  on  the  peripheral  nerves 
or  on  the  muscles  ;  it  does  not  cause  fibrillary  trembling  or  tetanus. 

Further  investigations  and  clinical  observations  are  necessary  to 
determine  the  real  place  of  carpaine  as  a  remedy. 

THE  ACTIONS  AND  USES  OF  PAPAIN. — It  is  as  a  solvent  of  albu- 
minous substances,  as  a  digestive,  that  papain  comes  into  considera- 
tion. As  compared  with  pepsin  its  range  is  far  wider.  While  pep- 
sin is  active  only  in  acid  solutions,  papain  is  active  in  neutral  or 
alkaline,  and  in  slightly  acid  solutions  (Finkler,  Hirsch,  Sittmann,  and 
others).  Papain  is  also  more  effective  and  lasting  as  a  solvent  of 
albuminous  matters  than  pepsin.  Strongly  acid  and  strongly  alkaline 
solutions  are  rather  inimical  to  the  digestive  function  of  papain, 
although  it  still  preserves  some  degree  of  activity  under  these  condi- 
tions ;  but  in  neutral  and  feebly  alkaline  solutions  it  is  at  its  best 
working  power.  Too  great  extent  of  dilution  impairs  its  effect ;  on 
the  other  hand,  a  certain  degree  of  concentration  favors  its  action. 
From  these  data  it  is  obvious  that  papain  is  more  useful  as  a  digestive 
ferment  for  all  the  conditions  present  than  is  pepsin,  although  the  lat- 
ter has  greater  energy  in  the  presence  of  dilute  or  strongly  acid 
solutions. 

For  promoting  stomach  digestion,  in  the  state  of  apepsia,  papain 
may  be  utilized  in  place  of  pepsin.  Sittmann  finds  papain  to  have 
remarkable  power  to  dissolve  albumin,  f  of  a  grain  of  this  substance 
bringing  about  the  solution  of  150  grains  of  albumin  in  the  course  of 
two  hours.  In  acute  gastritis,  he  found  8  grains,  taken  after  meals, 
relieve  the  pain  and  in  a  few  days  effect  a  cure.  It  has  proved 
equally  beneficial  in  gastric  ulcer  and  chronic  gastric  catarrh  by  the 
same  authority.  The  author  has  found  it  useful  in  that  troublesome 
disorder,  membranous  enteritis.  In  the  treatment  of  this  disease, 
doses  of  10  to  20  grains  given  after  meals,  at  a  time  when  stomach 


DIGESTION-FERMENTS.  109 

digestion  is  ended,  are  highly  effective.  For  lumbricoid  worms  it  has 
proved  active  in  securing  their  expulsion.  Cases  of  tcenia  have  been 
reported  cured,  and  the  author  has  met  with  one  in  which  daily  exhi- 
bitions of  papain  after  meals  seemed  to  be  the  effective  agent  in  secur- 
ing its  discharge. 

In  intestinal  indigestion  due  to  insufficient  production  of  pancre- 
atic juice  and  consequent  imperfect  digestion  of  fats  and  formation  of 
peptones,  papain  is  useful  in  a  high  degree.  When  catarrhal  jaundice 
succeeds  to  duodenitis,  it  is  one  of  the  best  remedies  to  bring  about  a 
return  to  the  normal  state.  In  all  cases  of  intestinal  disorder,  and 
when  coincident  affections  of  the  pancreas  occur,  papain  should  be 
given  in  full  doses,  an  hour  or  two  after  meals,  and  with  a  moderate 
quantity  of  sodium  bicarbonate  to  neutralize  any  acid  present. 

One  of  the  most  important  applications  of  papain  is  in  the  treat- 
ment of  false  membrane,  chiefly  the  false  membrane  of  diphtheria. 
Bouchut  was  the  first  to  conceive  the  idea  that  papain,  having  an  ex- 
traordinary digestive  power  of  albumin  and  fibrin,  must  act  as  a  solv- 
ent of  a  croupous  exudation,  and  he  found  it  true  on  actual  trial. 
Jacobi,  of  New  York,  has  been  one  of  the  most  conspicuous  advocates 
of  this  practice.  He  reports  several  cases  in  which  the  solvent  action 
of  papain  was  pronounced.  The  solution  employed  by  him  had  the 
strength  of  1  to  8,  or  1  part  of  papayotin  to  4  each  of  water  and 
glycerin,  applied  freely  by  a  mop  or  in  spray.  Probably  a  much 
stronger  solution  would  be  more  effective.  Papain  has  also  been  used 
successfully  as  a  vermifuge — against  the  round  worm  and  tsenia.  It 
has  been  supposed  to  act  as  a  digestive,  attacking  the  soft  albuminous 
material  of  which  these  parasites  are  composed  ;  but,  in  the  case  of 
the  tape  worm,  certainly  the  action  seems  to  be  stupefying,  the  worm 
being  expelled  in  its  entirety.  Considerable  doses  must  be  given  night 
and  morning  until  the  expulsion  of  the  worm  takes  place.  The  author 
found  this  method  successful,  aided  by  a  brisk  cathartic,  when  the 
passage  of  numerous  segments  indicated  an  uneasy  state  of  the  para- 
site. The  dose  ranges  from  10  to  30  grains  for  this  purpose.  There 
is  reason  to  believe  that  much  of  the  papain  of  commerce  is  not  genu- 
ine, or,  if  genuine,  much  diluted.  Care  should  be  exercised  to  procure 
only  genuine  material  in  prescribing. 

Authorities  referred  to  : 

BoucnuT  ET  WURZ.  Sur  le  Ferment.  Digestif  du  Carica  Papaya.  Annuaire  de 
Therap.  for  1881. 

TINKLER,  DR.  Comparative  Experiments  between  Papoid  and  Pepsin.  Therapeutic 
Gazette,  1887,  p.  518. 

HIRSCH,  DR.  A.  Ueber  Papain  und  Seiner  Werth  ah  Digestivum.  Therapeutische 
Afonatshefte,  December,  1894. 

ROBERTS,  DR.  WILLIAM.     Lumleian  Lectures,  April  and  May,  1880. 

SITTMANN,  DR.  Ueber  Papain  bei  Erkrankungen  des  Magens.  Munch,  med.  Woch- 
enschrift,  1893.  Quoted  by  Hirsch,  supra. 


110  RESTORATIVE   AGENTS. 

ACIDS. 

Acidum  Lacticum. — Lactic  acid  j  acide  lactique,  FT.  ;  Jfilchsdurel 
Ger. 

PROPERTIES. — It  is  an  acid,  sirupy  liquid,  which  contains  75  per 
cent  of  absolute  lactic  acid,  and  has  a  pale  wine-color.  Specific 
gravity,  1'212.  It  mixes  in  all  proportions  with  water,  alcohol,  and 
ether. 

INCOMPATIBLES  AND  ANTAGONISTS.  —  Alkalies  and  the  mineral 
salts. 

SYNERGISTS. — Pepsin,  sodium  chloride,  vegetable  acids,  chlorhydric 
acid,  etc. 

Dose. — Fifteen  minims  to  3  ss  in  water  before  or  after  meals,  ac- 
cording to  the  conditions  present. 

PHYSIOLOGICAL  ACTION. — As  lactic  acid  is  a  frequent  constituent  of 
the  gastric  juice,  it  has  undoubtedly  an  important  function  in  connec- 
tion with  digestion.  Used  medicinally,  it  promotes  the  appetite  and 
facilitates  digestion.  In  large  doses  (  3  j)  it  gives  rise  to  epigastric 
pain,  flatulence,  and  loss  of  appetite.  As  lactic  acid  is  one  of  a  series 
of  homologous  acids,  containing  butylactic,  valerolactic,  and  leucic 
acids,  it  is  not  improbable  that  some  of  these  may  result  from  its  oxi- 
dation when  administered  in  excess.  It  probably  combines  with  bases 
and  forms  lactates,  for  it  displaces  not  only  the  volatile  but  some  of 
the  mineral  acids  from  their  combinations.  Chemical  investigations 
have  indeed  confirmed  this,  for,  besides  free  lactic  acid,  lactates  have 
been  found  in  the  gastric  juice.  It  is  not  known  definitely  whether 
free  lactic  acid  occurs  in  the  blood  in  the  healthy  state,  but  it  certainly 
does  in  some  morbid  conditions.  According  to  Lehmann,  lactates  are 
rapidly  converted  into  carbonates  in  the  blood.  Free  lactic  acid,  as 
was  long  ago  shown  by  Berzelius,  is  found  in  muscular  fluid,  and  has 
also  been  detected  in  the  spleen  by  Scherer.  Although  it  is  not  always 
a  constituent  of  normal  urine,  yet,  when  the  supply  of  lactates  to  the 
blood  is  considerably  beyond  the  oxidizing  power  of  the  blood,  it  has 
been  found  (Lehmann).  Scherer  has  shown  also  that  lactic  acid  is 
present  in  the  exudates  of  puerperal  fever. 

Lactic  acid  has  the  power  to  dissolve  a  considerable  quantity  of 
freshly-precipitated  phosphate  of  lime. 

The  suggestion  made  by  Prout,  of  a  relation  between  an  excess  of 
lactic  acid  in  the  blood  and  rheumatic  inflammation,  received  a  re- 
markable confirmation  in  the  experiments  of  Richardson,  who  produced 
endocardial  inflammation  by  injecting  lactic  acid  into  the  peritoneal 
cavity  of  dogs.  Further  confirmation  of  this  connection  has  been  af- 
forded in  the  attacks  of  acute  rheumatism  which  have  occurred  in  sub- 
jects of  diabetes  treated  by  lactic  acid. 

THERAPY. — Solutions  of  lactic  acid  are  of  great  utility  as  solvents 
of  false  membrane.  Since  the  comparative  demonstration  of  solvents 


LACTIC  ACID.  Ill 

made  by  Bricheteau  and  Adrian,  it  has  been  employed  (successfully  by 
Dr.  Weber,  of  Darmstadt,  and  Dr.  Dureau,  in  croup,  applied  by  means 
of  a  pulverisateur  in  the  strength  of  thirty  to  forty  drops  to  the  ounce 
( Waldenburg),  and  is  also  advocated  by  Morell  Mackenzie  and  Lennox 
Browne.  The  following  is  the  formula  used  by  Mackenzie  at  the  London 
Throat  Hospital :  IJ  Acidi  lactici,  3  iijss ;  aquae  destil.,  §  x.  M.  This 
may  be  used  in  a  spray -producer,  or  be  applied  on  a  mop  to  the  affected 
part.  It  is  unquestionably  an  excellent  solvent  of  the  exudation  of  diph- 
theria, as  the  author  has  frequently  observed.  It  may  be  used  also  as  a 
gargle  when  the  exudation  does  not  extend  beyond  the  tonsils  and  the 
pillars  of  the  fauces.  For  this  purpose  sufficient  acid  may  be  added 
to  water  to  give  a  distinctly  sour  taste.  As  the  application  is  free 
from  danger,  it  may  be  used  as  often  as  every  half-hour.  When  used 
in  the  form  of  spray,  care  must  be  had  to  prevent  the  acid  hurting 
the  eyes. 

Chiefly  in  atonic  dyspepsia  is  lactic  acid  employed.  In  this  con- 
dition it  is,  so  to  speak,  a  physiological  remedy,  being  a  constituent 
of  the  gastric  juice  ;  therefore  it  is  supplied  artificially,  because  the 
stomach  is  unequal  to  the  task  of  producing  it.  Generally,  it  is  ad- 
visable to  combine  pepsin  with  it  thus  :  ]J  Liq.  pepsinse,  3  xij  ;  acidi 
lactici,  3  iv.  M.  A  teaspoonful  three  times  a  day  after  meals  is  a 
proper  dose  for  an  adult.  In  the  apepsia  of  infants,  characterized  by 
the  presence  of  undigested  aliment  in  the  discharges,  this  combination 
is  an  excellent  remedy.  If  a  marked  degree  of  acidity  exists,  the  acid 
should  be  omitted,  or  given  before  the  milk,  when  it  may  prevent  the  ex- 
cessive production  of  acid.  In  irritative  dyspepsia,  when  the  pain  and 
suffering  are  due  to  slow  and  imperfect  digestion,  lactic  acid  will  often 
give  great  relief,  either  alone  or  combined  with  pepsin.  Cases  of  acid- 
ity and  heartburn  are  often  quickly  relieved  by  lactic  acid  given  before 
meals.  When  the  presence  of  an  excess  of  the  phosphates,  uric  acid, 
and  the  urates,  and  of  oxalate  of  lime,  in  the  urine,  is  due  to  imperfect 
digestion  and  faulty  assimilation,  as  is  frequently  the  case,  lactic  acid 
is  serviceable.  Dr.  Deecke  advocates  the  use  of  lactic  acid  in  chronic 
cystitis,  as  a  means  of  arresting  the  ammoniacal  decomposition  of  the 
urine,  a  condition  in  which  he  holds  it  to  be  very  effective. 

Lactic  acid  has  been  used  with  varying  success  in  the  treatment  of 
diabetes.  The  object  to  be  gained  is  the  prevention  of  sugar  formation 
from  the  starchy  and  other  elements  of  the  food.  Dr.  Foster  reports 
some  cases  apparently  decidedly  benefited,  and  Dr.  Ogle  gives  an  ac- 
count of  two  cases  in  which  no  good  results  were  attained.  Cases  have 
been  lately  reported  in  which  the  patients  were  improved  by  the  use  of 
lactic  acid,  but,  on  the  whole,  the  utility  of  this  agent  in  diabetes  must 
be  held  to  be  as  yet  subjudice,  besides  the  danger  of  setting  up  an 
endocarditis,  or  other  changes  in  the  intima  of  the  vessels,  that  might 
be  even  more  serious  than  the  malady  for  which  prescribed. 


112  RESTORATIVE  AGENTS. 

Authorities  referred  to  above  : 

BRICHETEAU,  DR.  FELIX.     Bulletin  General  dc  Therapeutique,  vol.  Ixxiv,  p.  72. 

BCTLER,  DK.  N.  L.  Treatment  of  Croup  by  Lactic-Acid  Spray.  The  Practitioner^ 
vol.  vii.  p.  189. 

DCREAU,  DR.     Bulletin  General  de  Therapeutique,  vol.  Ixxxiii,  p.  45. 

JAFFE,  DR.  Die  Diphtheric.  Schmidt1  S  Jahrbucher  der  gesammten  Medicin,  vol.  cxlix, 
p.  321. 

OGLE,  DR.  JOHN  W.,  and  DR.  BALTHAZER  FOSTER.     British  Medical  Journal. 

LEHMANN,  PROF.  DR.  C.  G.  Physiological  Chemistry,  American  edition,  vol.  i,  p. 
85,  et  seq 

MACKENZIE,  DR.  MORELL.  The  Pharmacopoeia  of  the  Hospital  for  Diseases  of  the 
Tfiroat,  London,  1872. 

XOTHXAGEL,  H.     Handbuch  der  Arzneimittellehre,  Berlin,  1870,  p.  376. 

RANKE,  PROF.  DR.  J.  Grundzuge  der  Physiologic  dcs  Menschen,  zweite  Auflage,  Leip- 
zig, 1872,  p.  248. 

WALDENBCRG,  DR.  L.  Die  locale  Behandlung  der  Krankheiten  der  Athmungsorgart, 
Berlin,  1872,  p.  403. 

Mineral  Acids.  —  Acidum  Sulphuricum.  —  Sulphuric  acid.  "  A 
liquid  composed  of  not  less  than  92*5  per  cent  of  absolute  sulphuric 
acid.  A  colorless,  oily  liquid,  inodorous,  and  having  strong  acid  and 
corrosive  qualities.  The  specific  gravity  of  sulphuric  acid  should  be 
not  less  than  1'835.  It  is  miscible  in  all  proportions  with  water  and 
alcohol,  with  the  evolution  of  heat." 

The  official  preparations  into  which  sulphuric  acid  enters  are  aci- 
dum  sulphuricum  aromaticum  and  acidum  sulphuricum  dilutum. 

Acidum  Sulphuricum  Dilutum. — Diluted  sulphuric  acid.  "Sul- 
phuric acid,  100  grm. ;  distilled  water,  825  grm.  This  contains  10  per 
cent  of  the  official  sulphuric  acid,  and  has  the  specific  gravity  of  1*070 
nearly."  Dose,  v^  v — m,  xxx,  and  should  be  well  diluted  with  water 
when  administered. 

Acidum  Sulphuricum  Aromaticum. — Aromatic  sulphuric  acid,  or 
elixir  of  vitriol.  "  Sulphuric  acid,  100  c.  c. ;  tincture  of  ginger,  50 
c.  c.  ;  oil  of  cinnamon,  1  c.  c.  ;  and  sufficient  alcohol  to  make  1,000  c.  c. 
The  specific  gravity  should  be  0'955.  Dose,  niv —  3  j,  well  diluted 
with  water. 

Acidum  Hydrochloricum. — Hydrochloric  acid,  muriatic  acid.  "  A 
liquid  composed  of  31 -9  per  cent  of  absolute  hydrochloric  acid  and 
68*1  per  cent  of  water.  It  should  have  a  specific  gravity  of  1*163. 
It  is  a  fuming,  colorless  liquid,  of  a  pungent,  suffocating  odor,  and 
an  intensely  acid  taste  and  reaction."  The  official  preparations  into 
which  hydrochloric  acid  enters  are  acidum  hydrochloricum  dilutum, 
acidum  nitrohydrochloricum,  and  acidum  nitrohydrochloricum  dilutum. 

Acidum  Hydrochloricum  Dilutum. — Diluted  hydrochloric  acid. 
"  Hydrochloric  acid,  100  grm.  ;  distilled  water,  219  grm.  This  mix- 
ture contains  10  per  cent  of  absolute  hydrochloric  acid,  and  has  a 
specific  gravity  of  1'050. 

Acidum  Nitricum. — Nitric  acid.     "  A  colorless,  fuming,  very  caus- 


MINERAL   ACIDS.  113 

tic  and  corrosive  liquid,  of  a  peculiar,  somewhat  suffocating  odor,  and 
a  strongly  acid  reaction.  Specific  gravity,  1*414.  It  is  composed  of  68 
per  cent  by  weight  of  absolute  nitric  acid,  and  32  per  cent  of  water. 

Acidum  Nitricum  Dilutum. — Diluted  nitric  acid.  Nitric  acid, 
100  grm.  ;  distilled  water,  580  grm.  Dose,  TH,  ij — TTI  x,  in  sufficient 
water. 

Acidum  Nitrohydrochloricum.  —  Nitrohydrochloric  acid,  also 
known  as  aqua  regia.  Nitric  acid,  180  c.  c.  ;  hydrochloric  acid,  820 
c.  c.  Dose,  Tfj,  ij — TH,  x,  well  diluted. 

Acidum  Nitrohydrochloricum  Dilutum.  —  Diluted  nitrohydro- 
chloric  acid.  Nitric  acid,  40  c.  c.  ;  hydrochloric  acid,  180  c.  c.  ;  dis- 
tilled water,  780  c.  c.  A  colorless,  faintly  yellow  liquid,  odorless,  or 
having  a  faint  odor  of  chlorine,  and  a  very  acid  taste  and  reaction. 
Dose,  ni  v — TTI  xx,  in  sufficient  water. 

Acidum  Phosphoricum. — Phosphoric  acid.  A  liquid  composed  of 
not  less  than  85  per  cent  of  absolute  orthophosphoric  acid,  and  not 
.more  than  15  per  cent  of  water.  Specific  gravity,  1*710.  Dose,  m,  j 
— til  x,  well  diluted. 

Acidum  Phosphoricum  Dilutum. — Phosphoric  acid,  100  grm.  ;  dis- 
tilled water,  750  grm.  Dose,  TTI  v — til  xx,  in  sufficient  water. 

Acidum  Hypophosphorosum  Dilutum. — Diluted  hypophosphorous 
acid.  Consists  of  10  per  cent  by  weight  of  absolute  hypophosphorous 
acid  and  90  per  cent  of  water. 

ANTAGONISTS  AND  INCOMPATIBLES.  — Alkalies  and  their  carbon- 
ates, salts  of  lime  and  lead. 

PHYSIOLOGICAL  ACTIONS. — By  assisting  digestion  and  by  correcting 
an  abnormal  condition  of  the  alimentary  mucous  membrane,  acids 
directly  contribute  to  the  blood-forming  process,  and  indirectly,  through 
the  blood,  to  the  construction  of  tissue,  and  the  bettering,  in  general, 
of  the  bodily  condition. 

The  mineral  acids  grouped  above  agree  in  the  general  qualities 
of  their  actions,  but  differ  in  some  particulars.  They  attack  the 
living  tissues  with  great  energy,  abstract  the  water,  and  combine 
with  the  potash,  soda,  and  lime  bases.  In  virtue  of  this  affinity  for 
water  and  this  power  of  combination  with  bases,  they  cause  destruc- 
tion of  tissue  and  are  called  escharotics.  Some  of  them  are  more 
powerful  than  others  :  thus,  sulphuric  and  phosphoric  acids  pen- 
etrate more  deeply  than  the  others.  Nitric  acid  stains  the  skin  yel- 
low ;  sulphuric  acid  carbonizes  or  blackens.  Hence  in  cases  of  acci- 
dent, or  when  these  acids  are  used  with  criminal  intent,  it  is  very  ob- 
vious at  a  glance  which  has  been  taken  or  given  :  nitric  acid  making  a 
yellow  stain  of  the  face,  lips,  and  mouth,  and  sulphuric  carbonizing 
or  blackening  those  parts.  In  the  stomach  they  produce  the  same  ef- 
fects. When  concentrated,  they  destroy  the  mucous  membrane  of  the 
mouth,  epiglottis,  oesophagus,  and  stomach.  The  systemic  effects  are 


114  RESTORATIVE    AGENTS. 

those  of  the  irritant  and  corrosive  poisons.  The  appropriate  rem- 
edies are  chemical  and  mechanical  :  alkalies,  magnesia,  soda,  lime, 
soap,  to  neutralize  the  acid  ;  and  eggs,  milk,  oil,  etc.,  to  protect  me- 
chanically the  tissues.  The  depression  of  the  powers  of  life  which 
immediately  follows  the  ingestion  of  a  mineral  acid  should  be  treated 
by  opium,  nutrient  and  stimulating  enemata,  and  the  intra-venous  in- 
jection of  ammonia. 

The  mineral  acids,  when  administered  in  medicinal  doses,  must  on 
reaching  the  stomach  act  in  accordance  with  their  chemical  position. 
They  will  combine  with  the  bases  and  form  salts.  Hydrochloric,  and 
to  a  less  degree  phosphoric,  aid  digestion,  acting  as  synergists  to  pep- 
sin, and  contribute  to  the  formation  of  peptones.  Sulphuric  unites  with 
bases  to  form  insoluble  sulphates,  and  precipitates  the  albuminous  sub- 
stances from  their  solution  in  the  gastric  juices  ;  hence  this  acid, 
although  for  a  brief  period  it  improves,  soon  disorders  digestion.  It 
is  true  of  all  the  mineral  acids  that  their  long-continued  use  diminishes 
the  production  of  acid  gastric  juice,  and  in  this  way  after  a  time  they 
cause  the  very  troubles  for  the  relief  of  which  they  were  originally 
administered.  An  acid  solution  on  one  side  of  an  animal  membrane, 
and  an  alkaline  solution  on  the  other,  is  the  condition  most  favorable 
to  osmosis.  Hence  the  introduction  of  an  acid  into  the  stomach  with 
sufficient  frequency  and  in  sufficient  quantity  must  impair  the  produc- 
tion of  acid  gastric  juice.  In  practice  this  is  found  to  be  the  case. 
The  mineral  acids  are  among  the  most  diffusible  substances  known, 
and  of  these  hydrochloric  stands  at  the  head.  So  much  of  these  acids. 
as  does  not  enter  into  combination  in  the  stomach  diffuses  quickly  into 
the  blood,  and  the  salts  which  they  form  by  combination  with  bases 
follow  the  laws  of  diffusion  according  to  their  class.  The  acids,  es- 
pecially the  hydrochloric,  and  next  nitric,  diminish  the  alkalinity  of 
the  blood,  and  in  this  way  accomplish  all  that  they  are  capable  of 
doing  as  systemic  remedies. 

THERAPY. — Not  much  need  be  said  of  the  use  of  the  mineral  acids 
in  affections  of  the  mouth  and  throat.  Formerly  they  were  much  em- 
ployed in  the  treatment  of  mercurial  and  other  forms  of  stomatitis, 
diphtheria,  aphthae,  gangrene,  etc. 

In  using  mineral  acids  in  affections  of  the  mouth,  it  should  not  be 
forgotten  that  they  attack  the  enamel  of  the  teeth.  First,  the  animal 
matter  adherent  to  the  teeth  is  dissolved  off,  when  the  teeth  are  said  to 
be  "  set  on  edge."  The  acid  should  be  applied  to  the  affected  surface 
only,  and  the  mouth  should  afterward  be  washed  out  with  an  alkaline 
lotion.  Pure  hydrochloric  acid  may  be  applied  with  a  camel's-hair  brush 
or  on  a  bit  of  soft  pine-wood  to  the  gums  in  cases  of  sloughing  from 
mercurial  stomatitis,  and  to  the  ulcers  of  stomatitis  materna,  to  syphi- 
litic mucous  patches,  and  to  those  painful  ulcers  of  the  mouth  which 
occur  periodically  in  some  subjects  affected  with  a  peculiar  form  of  in- 


MINERAL   ACIDS.  115 

digestion.  In  the  case  of  ulcers  having  their  origin  in  stomach-dis. 
order,  the  internal  use  of  hydrochloric,  nitric,  or  iiitro-hydrochloric 
acid,  is  often  extremely  beneficial. 

The  local  use  of  hydrochloric  acid  in  diphtheria,  so  strongly  urged 
by  Bretonneau,  is  now  rarely  employed,  for  it  is  well  known  that  the 
diphtheritic  exudation  will  rapidly  extend  over  an  inflamed  surface  pro- 
duced by  the  application  of  the  acid,  and  the  destruction  of  the  exu- 
dation at  one  part  does  not  prevent  its  extension  and  renewed  forma- 
tion. 

Any  of  the  mineral  acids  administered  by  the  stomach  should  be 
well  diluted,  and  to  prevent  injury  to  the  teeth  should  be  taken  through 
a  glass  tube  or  a  straw.  The  mouth  should  also  be  rinsed  out  after 
swallowing  the  acid. 

The  mineral  acids  are  highly  useful  in  certain  stomach-diseases.  In 
atonic  dyspepsia  hydrochloric  acid  should  be  given  after  meals,  or  better, 
lactic  acid.  It  is  highly  probable  that  hydrochloric  acid  is  produced 
during  digestion  by  the  reaction  between  chloride  of  sodium  and  lactic 
acid.  A  combination  of  the  acid  with  pepsin,  as  already  suggested,  is 
preferable  in  these  cases  of  atonic  dyspepsia.  When,  in  consequence 
of  faulty  digestion,  acetic,  lactic,  and  butyric  acids  are  produced  in  the 
stomach  from  the  starchy,  saccharine,  and  fatty  constituents  of  the  food, 
the  acids  given  after  meals  add  to  the  distress  of  the  patient. 

To  prevent  the  excessive  formation  of  acid,  whether  due  to  the  ac- 
tion of  the  gastric  glands,  or  to  abnormal  fermentation  of  the  starchy, 
saccharine,  and  fatty  elements  of  the  food,  mineral  acids  are  used  with 
decided  advantage,  but  they  must  be  administered  before  meals.  For 
this  purpose,  hydrochloric  or  phosphoric  acid  is  to  be  preferred.  The 
excessive  production  of  acid  is  manifested  by  acid  eructations,  pyrosis, 
heartburn,  and  ulcerative  stomatitis. 

Indigestion  characterized  by  eructations  of  offensive  gas,  a  sal- 
low complexion,  by  the  appearance  of  oxalate-of-lime  crystals  in  the 
urine,  accompanied  by  mental  despondency,  is  relieved  by  nitro- 
muriatic  acid ;  better  by  nitric,  when  the  symptoms  of  lithsemia  are 
predominant. 

The  experience  of  English  physicians  practicing  in  India  has  been 
favorable  to  the  use  of  nitro-muriatic  acid  in  chronic  hepatic  affections, 
and  in  dysentery  and  dropsy  of  hepatic  origin.  Acute  diseases  of  the 
liver,  and  such  chronic  affections  as  cirrhosis  and  waxy  degeneration, 
are  not  as  a  rule  benefited  by  the  mineral  acids.  Mucous  duodenitis 
and  catarrh  of  the  gall-ducts  accompanied  by  jaundice,  and  jaundice 
of  malarial  origin,  are  forms  of  hepatic  disease  in  which  nitro-muri- 
atic acid  is  serviceable.  With  the  internal  use  of  the  acid  should  be 
conjoined  the  local  use  to  the  right  hypochondrium  of  the  acid-bath. 
Three  ounces  of  nitro-muriatic  acid  to  a  gallon  of  water  is  a  suitable 
strength  for  the  topical  use  in  this  way.  The  feet  may  be  placed  in  the 
10 


116  RESTORATIVE  AGENTS. 

bath,  and  the  legs,  arms,  and  abdomen  may  be  alternately  sponged, 
when  the  skin  is  torpid  and  its  secretion  defective.  The  temperature 
of  the  bath  should  be  about  96°  Fahr.  (Martin).  Another  mode  of 
making  topical  application  of  the  acid  bath  is  as  follows  :  "  Let  a  flan- 
nel roller  of  ten  or  twelve  inches  wide,  and  sufficient  to  encircle  the 
body  twice,  be  soaked  in  the  fluid  and  then  wrung  so  as  to  remain  only 
damp.  Apply  this  instantly  to  the  body,  covering  it  with  a  piece  of 
oiled-silk  to  avoid  damping  the  dress.  It  should  be  worn  constantly, 
but  should  be  changed,  soaked,  and  wrung,  morning  and  evening" 
(Squire).  This  is  a  very  effective  local  application  in  the  hepatic  dis- 
orders mentioned  above  as  amenable  to  treatment  by  the  mineral  acids, 
and  is  serviceable  in  the  first  stage  of  cirrhosis.  Dr.  Scott,  of  Bom- 
bay, ascribes  to  the  acid  bath  the  power  to  relieve  the  pain  of  hepatic 
colic,  by  causing  the  expulsion  of  the  impacted  calculus. 

The  mineral  acids  are  very  effective  remedies  in  the  treatment  of 
summer  and  colliquative  diarrhoea.  Crapulous  diarrhoea  and  dysen- 
tery are  not  benefited  by  them.  The  indications  for  their  use  are  these: 
painless,  watery  evacuations,  of  a  light  color,  alkaline  in  reaction. 
Hope's  mixture,  which  contains  nitrous  acid,  has  long  been  used  with 
success  in  such  cases.  The  formula  is  as  follows:  I£  Acidi  nitrosi,  3  j ; 
tincturse  opii,  gtt.  xl ;  aqua?  camphorae,  f  viij.  S. :  One  fourth  to  be 
taken  every  three  or  four  hours.  A  mixture  of  this  kind  may  readily  be 
extemporized,  in  which  the  relative  proportion  of  the  acid  and  opium 
may  be  arranged  according  to  the  indications  of  the  case.  Sulphuric 
acid  is  more  decidedly  astringent  than  nitric  and  muriatic,  and  is* 
therefore,  as  a  rule,  to  be  preferred  in  diarrhoea.  Bence  Jones  places 
them  as  regards  their  actions  thus:  Hydrochloric  more  promotes  diges- 
tion; nitric  acid,  secretion;  and  sulphuric,  astringency.  Nitric  and  nitro- 
hydrochloric  are,  according  to  this  view,  better  suited  to  stomach  and 
hepatic  disorders  characterized  by  deficient  secretion,  and  sulphuric  is 
more  appropriate  for  the  relief  of  a  relaxed  state  of  the  mucous  mem- 
brane. A  combination  of  aromatic  sulphuric  acid  with  opium  is  one  of 
the  most  effective  remedies  we  possess  in  the  treatment  of  summer  diar- 
rhoea and  cholera.  Sulphuric  acid  may  also  be  used  with  advantage  in 
the  treatment  of  dysentery,  in  combination  with  sulphate  of  magnesia. 
IJ  Magnesii  sulphat.,  f  j;  acidi  sulphur,  dil.,  3  ij;  morphinse  sulph.,  gr.  j; 
aquae,  f  iv.  M.  S. :  A  tablespoonf ul  every  three  or  four  hours.  After  the 
action  of  a  saline  laxative,  Hope's  mixture,  or  an  extemporized  prescrip- 
tion of  a  similar  kind,  may  be  used.  When  the  mineral  acids  do  not 
quickly  improve  the  discharges  and  lessen  their  frequency,  and  when 
they  increase  the  tormina  and  tenesmus,  they  should  be  suspended.  In 
the  treatment  of  cholera,  dilute  or  aromatic  sulphuric  acid  may  be  given 
frequently,  well  diluted,  in  full  doses.  Opium  can  be  added  at  such 
intervals  as  may  be  indicated.  MacCormac  has  found  the  acid  to  be  a 
most  valuable  prophylactic  against  cholera  attacks.  It  should  be  ad- 


MINERAL  ACIDS.  117 

ministered  with  promptness  when  the  preliminary  diarrhcea  is  threat- 
ened. 

Mineral  acids,  especially  the  muriatic,  are  very  serviceable  in  fevers. 
They  were  formerly  classed  as  refrigerants,  or  cooling  medicines,  and 
were  supposed  to  allay  thirst  and  to  diminish  fever.  Although  these 
notions  are  no  longer  entertained,  the  acids  are  known  to  render  an  im- 
portant service  in  fevers.  They  increase  secretion  of  the  mucous  mem- 
brane, and  thus  relieve  the  dryness  of  the  tongue  and  fauces.  As  in 
fevers  the  gastric  juice  is  deficient  in  acids,  digestion  is  materially  aided 
by  their  administration.  In  typhoid  fever,  the  acids  restrain  somewhat 
the  exhausting  diarrhoea,  increase  the  digestive  power,  remove  or 
diminish  the  dryness  of  the  tongue,  and,  it  may  be,  destroy  the  mi- 
crobes, which  constitute  the  poison  of  typhoid,  or  which  produce  it 
under  circumstances  favorable  to  their  development.  Hydrochloric 
acid  is  preferable  in  the  treatment  of  fevers.  It  may  often  be  advan- 
tageously administered  in  beef -juice. 

In  scarlet  fever,  hydrochloric  acid  is  frequently  combined  with 
chlorate  of  potassa  (producing  euchlorine),  but  it  is  better  adminis- 
tered alone  in  this  disease.  Besides  the  internal  administration  of 
the  acid,  it  is  often  mixed  with  water  and  used  as  a  gargle,  or  mixed 
with  honey  and  applied  with  a  brush  to  the  throat.  One  part  of  acid 
to  five  parts  of  honey  or  ten  of  water  is  a  strong  enough  solution  for 
this  purpose.  In  the  other  eruptive  fevers,  hydrochloric  acid  is  serv- 
iceable to  allay  thirst,  to  increase  digestion,  and  to  obviate  the  tend- 
ency to  adynamia  in  these  diseases.  To  children,  the  dilute  hydro- 
chloric acid  may  be  readily  administered  in  lemonade  or  in  sirup  of 
lemons. 

There  is  no  doubt  of  the  value  of  the  acids,  especially  the  nitro- 
muriatic,  in  the  treatment  of  constitutional  syphilis.  This  remedy  is 
not  to  be  compared  in  efficiency  with  mercury  and  iodide  of  po- 
tassium, but  in  chronic  cases  saturated,  so  to  speak,  with  these  ap- 
proved remedies,  in  which  syphilitic  patches  persistently  reappear 
in  the  mouth,  nitro-muriatic  acid  often  renders  important  service.  It 
is  undoubtedly  true  that  constitutional  syphilis  has  been  treated 
successfully  by  the  acids  alone,  but  a  very  rigidly  abstemious  dietary 
has  been  enforced  in  these  cases.  It  has  already  been  shown  that 
the  denutrition  method  is  of  itself  sufficient  in  some  cases  to  relieve 
the  organism  of  constitutional  infection.  How  much  of  the  result 
is  to  be  ascribed  to  the  remedy,  and  how  much  to  denutrition,  is  not 
clear. 

Nitric  acid  has  been  used  with  success  in  the  treatment  of  inter- 
mittent fever  by  Hammond,  Bailey,  and  others.  In  order  to  obtain  a 
curative  effect,  it  is  necessary  to  give  the  acid  in  full  doses  every  four 
or  six  hours.  This  acid  is  of  great  service,  also,  after  an  arrest  of  the 
paroxysms  of  intermittent  by  quinine,  to  remove  the  hepatic  congestion 


HQ  RESTORATIVE   AGENTS. 

and  the  changes  in  the  glandular  apparatus  of  the  intestines  induced 
by  the  fever-movement.  It  may  be  advantageously  combined  with 
the  bitters,  or  used  instead  of  the  aromatic  sulphuric  acid  in  the  prep- 
aration of  the  official  infusum  cinchonceflavce. 

The  mineral  acids  have  long  been  used  with  more  or  less  advan- 
tage in  the  treatment  of  phthisis.  Their  utility  obviously  depends 
on  the  fact  that  they  supply  to  the  digestive  fluids  a  material  in 
which  they  are  deficient  in  this  disease.  As  Fenwick  has  shown, 
both  pepsin  and  acid  occur  in  quantity  much  less  than  normal  in 
the  gastric  juice  of  phthisical  subjects.  The  acid  best  suited  for  the 
treatment  of  the  indigestion  of  phthisis  is  the  official  acidum  mu- 
riaticum  dilutum. 

Nitric  acid  is  one  of  the  numerous  remedies  used  in  whooping-cough. 
It  is  frequently  successful  in  shortening  the  duration  of  the  disease  and 
moderating  its  violence  ;  but  it  acts  much  more  beneficially  after  the 
subsidence  of  the  catarrhal  stage.  It  should  be  given  well  diluted 
in  sweetened  water.  Chronic  bronchitis  and  hoarseness  produced  by 
singing  and  by  simple  acute  catarrh  are  relieved  by  ten-minim  doses 
of  dilute  nitric  acid. 

The  mineral  acids,  especially  the  hydrochloric,  have  lately  been 
proposed  as  remedies  for  acute  rheumatism.  The  unquestionable  util- 
ity of  the  tincture  of  the  chloride  of  iron  in  rheumatism  lends  support 
to  this  practice.  It  is  highly  probable  that  the  mineral  acids  check 
the  formation  of  lactic  acid  in  the  blood.  Whatever  may  be  the  na- 
ture of  the  action,  good  results  from  the  treatment  have  been  reported 
(Dr.  J.  James  Ridge). 

Some  of  the  accidents  due  to  lead  are  prevented,  and  relieved  when 
they  occur,  by  sulphuric  acid.  Sulphuric-acid  lemonade  is  used  by 
workmen  in  lead-factories  to  prevent  lead-poisoning.  This  is  supposed 
to  act  by  forming  the  insoluble  sulphate  of  lead.  Dilute  sulphuric 
acid  is  also  effective  in  the  treatment  of  lead-colic.  The  constipation 
due  to  lead  is  relieved  by  a  combination  of  sulphuric  acid  and  sulphate 
of  magnesia,  and  the  lead-cachexia  is  much  benefited  by  a  prescrip- 
tion of  sulphate  of  quinine,  sulphate  of  iron,  and  dilute  sulphuric  acid. 
The  effects  of  lead  on  the  nervous  system  are  not  removed  by  sul- 
phuric acid. 

Sulphuric  acid  is  sometimes  very  effective  in  uterine  haemorrhage. 
It  has  seemed  to  the  author  to  be  more  useful  in  the  case  of  haemor- 
rhage due  to  fibroid  or  polypus  than  the  flow  arising  from  other  causes. 
Although  sometimes  prescribed  for  pulmonary  haemorrhage,  it  is  not 
equal  to  other  remedies.  In  intestinal  haemorrhage  sulphuric  acid  acts 
directly  in  part,  and  is  therefore  serviceable.  In  purpura  it  sometimes 
acts  happily. 

The  aromatic  sulphuric  acid  has  long  been  used  to  check  profuse 
treating,  especially  the  sweating  of  phthisis.  It  is  certainly  service- 


MINERAL   ACIDS.  119 

able  in  this  condition,  but  objectionable  because  of  the  ill  effects  of 
the  acid  on  the  function  of  digestion.  If  used  at  all,  it  should  not  in 
any  case  be  long  continued. 

Nitric  and  nitro-hydrochloric  acids  have  also  been  used  with  ad- 
vantage in  such  diseases  of  the  skin  as  lepra,  impetigo,  acne,  erythema 
nodosum  •  and  sulphuric,  internally  and  locally,  is  said  to  be  very 
effective  in  lichen,  prurigo,  and  itching  conditions  in  general. 

In  certain  morbid  states  of  the  urine,  as  the  phosphatic  diathesis, 
oxaluria,  alkalinity  of  the  urine  from  disease  of  the  urinary  mucous 
membrane,  and  phosphatic  calculus,  the  mineral  acids  render  important 
service.  In  chronic  cystitis  and  phosphatic  deposits,  a  very  weak  solu- 
tion of  nitric  acid  (gtt.  j —  f  j)  may  be  injected  with  advantage.  In 
using  such  injections  it  is  to  be  remembered  that  the  bladder  is  ex- 
tremely intolerant,  and  hence  they  should  be  permitted  to  escape  im- 
mediately. When  uric  acid  is  in  excess  in  the  urine  from  faulty  diges- 
tion and  assimilation,  nitric  acid  is  often  of  great  service  :  the  excess 
of  uric  acid  disappears  because  the  foods  are  more  perfectly  prepared 
for  admission  into  the  blood. 

LOCAL  OE  TOPICAL  USES  OF  THE  MINERAL  ACIDS. — Some  allusions 
have  been  made  to  the  local  application  of  muriatic  acid  in  diseases  of 
the  throat  and  of  the  acid  bath  in  hepatic  affections.  It  will  not  be 
necesary  to  recapitulate  on  these  points. 

Nitric  acid  is  one  of  the  most  efficient  escharotics  for  the  destruc- 
tion of  specific  or  unhealthy  ulcers.  It  is  the  most  frequently  used 
caustic  for  the  destruction  of  chancroid,  sloughing  or  phagedenic 
chancre.  A  glass  rod  or  bit  of  pine  is  dipped  into  the  acid  and  ap- 
plied, care  being  taken  to  penetrate  to  all  the  sinuosities  of  the  sore. 
The  surrounding  healthy  tissue  may  be  protected  from  injury  by  the 
previous  application  of  oil,  and,  when  the  acid  has  sufficiently  pene- 
trated, its  further  action  may  be  arrested  by  some  alkaline  wash,  A 
water-dressing,  or  spirit  and  water,  or  dilute  tincture  of  benzoin,  or 
some  similar  application,  may  be  afterward  applied  to  the  sore.  Ordi- 
nary indurated  chancre  does  not  require  escharotic  applications.  Hos- 
pital gangrene,  or  a  gangrenous  condition  of  wounds,  injuries,  or 
ulcers,  is  similarly  treated  with  advantage,  and  probably  no  form  of 
caustic  is  more  desirable  than  nitric  acid  for  these  purposes.  Ordinary 
torpid  and  ill-conditioned  ulcers  are  improved  and  put  in  the  way  of 
healing  by  frequent  washing  with  a  weak  lotion  of  nitric  acid  (  §  j — 
Oj).  The  same  solution  will  remove  mucous  patches  and  condylomata, 
and  will  often  check  the  bleeding  from  haemorrhoids. 

Nitric  acid  is  one  of  the  means  employed  for  the  removal  of  haem- 
orrhoids. It  is  not  effective,  however,  against  all  forms.  Large 
hemorrhoids  are  much  better  treated  by  the  ligature,  galvano-caustic 
loop,  or  carbolic-acid  injections.  The  so-called  "  strawberry-pile,"  a 
small  haemorrhoid  of  red  color,  which  consists  of  a  congeries  of  arte- 


120  RESTORATIVE   AGENTS. 

rial  twigs  and  which  bleeds  freely,  can  be  effectually  destroyed  by 
nitric  acid.  The  pile  should  be  exposed,  usually  through  a  speculum, 
and  the  strong  nitric  acid  be  applied  on  a  pine  stick  freely,  followed 
by  an  abundant  application  of  olive-oil  to  prevent  the  extension  of  the 
escharotic  action  to  the  surrounding  parts.  Small,  superficial  nmwi 
are  treated  successfully  in  the  same  way. 

Sulphuric  acid  penetrates  more  deeply  than  nitric,  and  its  escha- 
rotic  action  is  not  so  easily  limited  ;  hence,  it  is  not  so  frequently  em- 
ployed for  the  destruction  of  sloughing  and  ill-conditioned  ulcers.  It 
is  sometimes  used  in  the  form  of  Ricord's  paste  to  chancres,  sloughing 
or  phagedenic.  The  paste  is  made  by  the  addition  of  sufficient  char- 
coal to  strong  sulphuric  acid  to  give  it  the  proper  consistence.  This 
is  spread  on  a  piece  of  muslin  of  a  size  equal  to  the  sore,  and  is  allowed 
to  remain  on  until  an  eschar  is  produced,  when  an  ordinary  poultice 
may  be  applied. 

A  favorite  liniment  of  Sir  Benjamin  Brodie  for  counter-irritation 
of  diseased  joints  is  made  by  the  addition  of  sulphuric  acid  to  olive-oil 
(  3  j  of  the  acid,  ^  iv  of  olive-oil). 

A  general  bath  in,  or  sponging  the  body  with,  a  solution  of  nitro- 
muriatic  acid — one  ounce  to  a  gallon — is  very  serviceable  in  the  case 
of  cachectic  children  who  present  these  symptoms  :  a  dry  and  wrinkled 
skin,  sallow  complexion,  capricious  appetite  with  a  taste  for  dirt-eat- 
ing, and  whitish,  pasty  motions.  Applying  to  the  surface  of  the  body 
an  acid  solution,  must  affect  the  constitution  of  the  blood,  for  an  acid 
solution  on  one  side  of  an  animal  membrane  and  an  alkaline  fluid  on 
the  other  are  the  conditions  most  favorable  to  diffusion. 

Lately,  Dr.  Lombe  Atthill,  of  Dublin,  has  called  attention  to  the 
"  use  of  nitric  acid  in  the  treatment  of  uterine  disease."  He  applies 
the  fuming  nitric  acid  to  the  interior  of  the  uterine  cavity  after  pre- 
vious dilatation  with  sponge  or  laminaria  tents.  In  order  to  protect  the 
cervix  and  cervical  canal  he  introduces  an  intra-uterine  speculum  with 
expansive  blades.  The  cavity  is  first  mopped  out  and  dried  with  cot- 
ton ;  then  a  probe,  wrapped  with  cotton,  is  dipped  in  fuming  nitric 
acid  and  applied  thoroughly  to  the  mucous  membrane.  This  practice 
is  very  effective  in  the  treatment  of  intra-mural  fibroids  and  fungous 
granulations,  to  restrain  haemorrhage,  and  after  the  removal  of  polypi. 
He  almost  invariably  employs  nitric  acid  in  the  treatment  of  granular 
cervicitis  and  endo-cervicitis,  "  with  the  best  results."  When  decided 
tenderness  of  the  uterus  exists,  he  advises  that  this  be  first  removed  by 
suitable  measures. 

Authorities  referred  to  above  : 

ATTHILL,  DR.  LOMBE.     Obstetrical  Journal  of  Great  Britain  and  Ireland,  June,  1873. 
BRETONNKAU.     Den  Inflammations  Spiciales  du  Tissu  Muqueux,  at  en  particulier  de  la 
Diphtheritc,  Paris,  1826,  p.  242,  et  seq. 

Fox,  DR.  WILSON.     TJie  Diseases  of  the  Stomach,  Macnullan  &  Co.,  1872,  p.  140. 


OILS  AND   FATS.  121 

GUBLER,  DR.  ADOLPH.  Commentaires  Therapeutigues  du  Codex  Medicamentarius,  Paris, 
1868,  p.  464. 

MACKENZIE,  DR.  HORELL.     Pharmacopoeia  of  the  Throat  Hospital,  p.  35. 

MARTIN,  SIR  RANALD.     Ismdon  Lancet,  December  9,  1865. 

NOTHNAGEL,  DR.  HERMANN.  Handbuck  der  Arzneimittellehre,  Berlin,  1870,  p.  378, 
ct  seq. 

RIDGE,  DR.  J.  JAMES.     The  Medical  Times  and  Gazette,  vol.  ii,  1871. 

RINGER,  DR.  SIDNEY.     A  Handbook  of  Therapeutics,  third  edition,  p.  97,  et  seq. 

SQUIRE.     Companion  to  the  British  Pharmacopoeia,  1871,  p.  12. 

OILS  AND  FATS. 

Adeps. — Lard.  Saindoux,  Fr. ;  Schweineschmalz,  Ger. — Below  the 
temperature  of  86°  Fahr.  a  soft  solid. 

Adeps  Benzoinatus. — Benzoinated  lard.  Lard,  1,000  grm.  ;  ben- 
zoin, 20  grm. 

Adeps  Lance  Hydrosus. — Hydrous  wool-fat.  The  purified  fat  of 
the  wool  of  the  sheep  ( Ovis  aries,  Linne")  mixed  with  not  more  than  30 
per  cent  of  water. 

Sevum. — Suet.  Suif  de  mouton,  Fr. ;  Schopsentalg,  Ger.  The 
prepared  suet  of  Ovis  aries. 

Oleum  Amygdalae  expressum. — Almond-oil.  Huile  d'amandes, 
Fr.  ;  Mandelndl,  Ger.  The  fixed  oil  obtained  from  the  kernel  of  the 
fruit  of  the  Amygdalus  communis. 

Oleum  Theobromatis.  —  Cacao-butter.  Beurre  de  cacao,  Fr.  ; 
Cacaobutter,  Ger.  The  concrete  oil  of  the  kernels  of  the  fruit  of 
Theobroma  cacao. 

Oleum  Olivce. — Olive  or  sweet  oil.  Huile  d'olive,  Fr.  ;  Olivenol, 
Ger.  The  fixed  oil  obtained  from  the  fruit  of  Olea  Europma. 

Oleum  Gossypii  Seminis. — Cotton-seed  oil.  A  fixed  oil  expressed 
from  the  seed  of  Gossypium  herbaceum,  and  subsequently  purified. 

COMPOSITION. — Lard  is  composed  of  38  per  cent  of  stearin  and 
margarin  and  62  per  cent  of  olein,  and  olive-oil  of  72  per  cent  of  olein 
and  28  per  cent  of  margarin.  The  more  solid  fats,  as  suet,  contain 
much  stearin.  These  neutral  fats  are,  chemically,  combinations  of  an 
acid  (stearic,  palmitic,  margaric,  oleic)  with  a  base,  glycerin. 

Petrolatum — [Vaseline  ;  cosmoline]. — A  semi-solid  substance,  con- 
sisting of  hydrocarbons,  chiefly  of  the  marsh-gas  series.  A  yellowish, 
or  yellow,  fat-like  mass,  transparent  in  thin  layers,  completely  amor- 
phous, tasteless,  and  odorless  ;  insoluble  in  water,  scarcely  soluble  in 
alcohol,  but  readily  soluble  in  ether,  chloroform,  oil  of  turpentine,  etc. 

Oleum  morrhuce. — Cod-liver  oil.  Huile  de  morite,  Fr. ;  Leber- 
thran,  Ger.  A  fixed  oil  obtained  from  the  fresh  livers  of  Gadus  mor- 
rhua,  or  of  other  species  of  Gadus. 

COMPOSITION. — Cod-liver  oil  contains  a  peculiar  principle,  gaduin, 
and  yields,  by  distillation  with  ammonia,  propylamin.  It  also  differs 
from  the  fats  and  oils  above  described  in  containing  various  biliary 


joo  RESTORATIVE   AGENTS. 

principles  and  traces  of  iodine,  bromine,  phosphorus,  sulphuric  and 
phosphoric  acids,  lime,  magnesia,  soda,  and  iron.  It  agrees  with  the 
other  oils  in  being  composed  for  the  most  part  of  olein  and  margarin. 
It  is  the  latter  constituent  which  gives  the  white  cloudiness  of  cod-liver 
oil  in  cold  weather,  and  which  is,  by  the  "  British  Pharmacopoeia,"  di- 
rected to  be  separated  by  artificial  cooling.  According  to  Winkler, 
cod-liver  oil  does  not  yield  glycerin,  but  oxide  of  propyl,  when  saponi- 
fied. There  are  three  varieties  of  oil,  due,  not  to  differences  in  com- 
position, but  to  modes  of  preparation  :  the  pale,  the  light-brown,  and 
the  dark  oil.  The  pale  oil  is  freest  from  the  products  of  decomposi- 
tion and  empyreuma,  is  the  best  for  internal  administration,  and  is  the 
official  preparation. 

In  order  to  obtain  more  positive  therapeutical  results,  certain  medici- 
nal substances  are  frequently  added  artificially  to  the  cod-liver  oils  of 
commerce.  Iodine,  bromine,  phosphorus,  and  iron,  are  thus  added.  Not 
only  are  such  compounds  bad,  chemically  considered,  but  the  addition 
of  such  ingredients  gives  great  opportunities  for  sophistication,  and  im- 
pure brown  and  other  fish-oils  may  be  substituted  for  the  pure  cod-liver 
oil.  Besides,  these  combinations  possess  no  therapeutical  advantage. 

It  has  been  supposed  that  any  oil  or  fat,  even  glycerin,  may  be 
used  in  place  of  cod-liver  oil,  and  cream  has  been  prescribed  in  this 
belief.  Linseed-oil  has  been  considered  to  have  some  special  efficacy  in 
wasting  diseases,  more  particularly  in  phthisis,  because  of  the  large 
amount  of  vegetable  albumen  which  it  contains.  These  notions  are 
erroneous.  Cod-liver  oil  has  special  therapeutical  virtues  because  it 
contains  gadiiin,  propylamin,  the  constituents  of  bile,  iodine,  phos- 
phorus, bromine,  etc.,  in  addition  to  the  ordinary  ingredients  of  an 
animal  fat. 

PHYSIOLOGICAL  ACTIONS. — An  oil  or  fat  applied  by  friction  to  the 
epidermis  will  disappear,  and,  as  a  positive  gain  may  thus  accrue,  it  is 
reasonable  to  suppose  that  not  only  absorption,  but  assimilation,  also, 
has  taken  place. 

Fat  plays  an  important  part  in  the  metamorphosis  of  animal  fluids. 
As  was  long  since  shown  by  Lehmann,  a  small  quantity  of  fat  is  essen- 
tial to  the  digestion  of  nitrogenous  articles  of  food.  Cod-liver  oil,  as 
well  as  other  oils,  when  taken  in  the  proper  quantity,  has  the  power  to 
facilitate  gastric  digestion,  and  therefore  promotes  the  appetite.  Oil 
is  a  very  important  material  in  intestinal  digestion — constitutes  the 
molecular  basis  of  the  chyle,  which  consists  chiefly  of  finely-divided 
fatty  matter,  each  globule  of  fat  being  surrounded  by  a  thin  layer  of 
albumen.  The  fat  taken  in  with  the  food  undergoes  the  emulsionizing 
process,  chiefly  in  the  small  intestine,  and  by  the  aid  of  the  pancreatic 
and  biliary  secretions.  Cod-liver  oil  is,  above  all  other  fats,  adapted 
to  form  the  molecular  basis  of  the  chyle.  All  fats  do  not  penetrate 
into  the  veins  and  lacteals  with  the  same  facility,  and  the  presence  of 


OILS   AND   FATS.  123 

certain  substances  is  necessary  to  the  process.  Fats  are  not  crystal- 
loidal  but  colloidal  substances,  and  have,  therefore,  but  a  feeble  power 
of  osmosis  ;  but,  notwithstanding  this  fact,  the  blood  of  the  portal 
vein  is  much  richer  in  fat  than  the  blood  of  the  arteries  and  systemic 
veins.  The  diffusion  of  fats  is  accomplished  by  the  action  of  the  bile. 
It  was  long  since  shown,  by  Wistinghausen,  that  in  capillary  tubes 
moistened  by  bile,  oil  will  rise  much  higher  than  in  tubes  not  so  moist- 
ened, or  when  moistened  with  water  or  a  saline  solution.  He  also 
showed  that  oil  will  pass  through  membrane  saturated  with  bile  much 
more  readily  than  through  similar  membrane  saturated  with  water. 
It  has  been  ascertained  that,  in  dogs  with  biliary  fistulae,  the  amount 
of  fat  in  the  chyle  is  much  below  the  normal,  and  in  the  fasces  much 
greater  than  normal  (Day).  Hence  it  must  be  concluded  that  the 
presence  of  bile  is  necessary  to  the  absorption  of  fats,  and  that  cod- 
liver  oil  must  be  peculiarly  adapted  to  form  the  molecular  basis  of  the 
chyle.  It  is  for  these  reasons  that,  during  a  course  of  cod-liver  oil, 
the  body-weight  is  increased,  the  red  blood-globules  become  more  nu- 
merous, and  a  greater  amount  of  fat  is  deposited  in  the  tissues.  It 
promotes  the  constructive  metamorphosis.  The  important  rdle  per- 
formed by  the  oils  and  fats  in  the  organism  is  shown  by  a  variety  of 
considerations.  Wherever  tissue-changes,  physiological  or  pathologi- 
cal, are  taking  place,  fat  accumulates  and  enters  largely  into  the  for- 
mation of  the  resulting  products.  Newly-formed  plasma  contains 
much  free  fat,  and  all  plastic  exudations  more  than  the  non-plastic 
(Lehmann).  Fat  is  the  most  abundant  constituent  of  pus. 

Food  is  intended  ultimately  for  two  objects  :  first,  to  build  up  the 
tissues  in  the  growing  state  and  to  reconstruct  the  tissues  wasted  by 
use  ;  second,  to  supply  force,  nervous,  muscular,  and  digestive,  to  the 
different  parts  of  the  organism  requiring  it.  The  part  performed  by 
the  fats  is  important  as  regards  both  objects.  As  already  stated,  they 
are  essential  to  the  construction  of  tissue  ;  modern  researches  have 
shown  that  they  have  a  necessary  office  in  the  evolution  of  force.  The 
well-known  experiment  of  Fick  and  Wislicenus  demonstrated  that,  on 
a  diet  of  hydrocarbons,  great  muscular  effort  can  be  undergone  with 
but  little  destruction  of  muscular  tissue,  and  without  increased  urea- 
discharge.  Turkish  porters,  who  are  remarkable  for  their  great  mus- 
cular strength  and  endurance,  live  on  a  diet  composed  of  fat  and  rice. 
The  acrobats  of  Japan,  who  live  on  a  similar  diet,  grow  to  an  enormous 
size,  and  accomplish  feats  of  strength  and  agility  to  which  the  athletes 
of  Western  nations  are  hardly  equal. 

If  a  muscle  is  made  to  contract  under  a  bell-jar,  an  extraordinary 
evolution  of  carbonic-acid  gas  takes  place,  just  as  in  violent  muscular 
exercise  the  amount  of  carbonic-acid  gas  exhaled  from  the  luners  is 

o  o 

increased. 

THERAPY. — Oils  and  fats  are  used  by  inunction  in  the  treatment  of 


J24  RESTORATIYE   AGENTS. 

the  scaly  skin-diseases.  A  warm  bath,  if  not  contraindicated,  may  well 
precede  the  inunctions,  and  adeps  benzoinatus,  or  suet,  be  then  thor- 
oughly rubbed  in. 

Inunctions  of  oil  or  fat  promote  constructive  metamorphosis  in  such 
chronic  wasting  diseases  as  phthisis,  scrofula,  chronic  dysentery,  etc. 
The  best  oil  for  this  purpose  is  cod-liver  oil,  but,  as  it  stains  the  skin  yel- 
low and  has  a  disagreeable  odor,  it  is  often  strongly  objected  to.  Lard 
or  suet  benzoinated  can  be  used,  or  may  be  perfumed  to  the  taste  of 
the  patient.  The  best  time  for  practicing  the  inunctions  is  just  before 
retiring.  A  warm  bath  should  first  be  taken,  and  then  from  one  to  two 
ounces  may  be  rubbed  into  the  skin.  A  thick  night-garment  should 
be  put  on  to  promote  absorption  and  to  prevent  injury  to  the  bedding. 
Sadly-nourished  infants,  rickety,  or  scrofulous,  or  suffering  from 
chronic  intestinal  disorders,  who  have  a  dry  and  scaly  skin,  are  often 
materially  benefited  by  the  tepid  or  warm  bath,  followed  by  inunc- 
tions of  lard,  suet,  or  almond-oil.  Chlorotic  girls,  with  or  without  dis- 
orders of  menstruation,  are  improved  in  condition  by  the  same  means. 
Spare  icomen,  who  wish  to  gain  flesh  and  roundness  of  form,  may  have 
their  wish  gratified  by  warm  baths  and  inunctions  of  oil.  The  im- 
provement which  results  from  this  practice  is  partly  due  to  the  gen- 
eral gain  in  bodily  nutrition. 

Rubeola,  scarlatina,  roseola,  erysipelas,  and  other  febrile  diseases, 
are  benefited  by  oil  inunctions.  These  applications  are  grateful  to  the 
patient ;  they  allay  the  burning  heat  of  the  skin,  and  in  this  way  dimin- 
ish restlessness  and  excitement.  Inunctions  of  oil  reduce  the  tempera- 
ture, but  the  decline  in  fever-heat  is  in  part  the  result  of  the  calmative 
influence  which  these  applications  have  over  one  of  the  chief  sources  of 
distress.  Inunctions  of  oil  have  a  special  utility  in  the  desquamative 
stage  of  scarlet  fever.  It  is  the  author's  observation  that  inunctions  of 
oil  are  serviceable  in  fevers  generally,  when  there  is  much  heat  of  skin 
and  high  temperature,  with  restlessness.  Cocoa-butter  is  the  most  ele- 
gant of  these  preparations  for  external  use,  but  lard  benzoinated  is  the 
best.  In  the  infectious  diseases,  a  little  carbolic  acid  may  be  added 
to  the  inunction  oil  or  fat,  with  the  view  of  destroying  disease-germs. 
Those  who  experience  frequent  catarrhal  attacks,  and  take  cold  on 
slight  exposure,  may  have  their  susceptibility  diminished  by  a  daily 
application  of  oil  to  the  whole  surface  of  the  body. 

In  many  maladies,  the  patients  experience  a  notable  distaste  for 
fatty  food  in  any  form.  This  is  especially  the  case  with  scrofulous 
and  phthisical  subjects,  and,  as  fat  in  some  form  is  necessary  to  di- 
gestion, assimilation,  and  heat-producing,  it  is  obvious  that  by  the  use 
of  cod-liver  oil  an  essential  element  of  nutrition  may  be  supplied  in  the 
best  form.  In  cases  in  which  there  exists  a  condition  of  faulty  as- 
similation of  fats,  cod-liver  oil,  by  reason  of  the  fact  that  it  contains 
in  intimate  association  the  bile  elements,  is  especially  adapted  to  form 


OILS  AND   FATS.  125 

the  molecular  basis  of  the  chyle.  In  scrofula,  rickets,  and  other  dis- 
orders of  the  nutritive  functions  belonging  to  this  group,  cod-liver  oil 
is  the  best  agent  for  promoting  constructive  metamorphosis. 

After  scarlet  fever  in  many  children,  especially  in  those  with  stru- 
mous  diathesis,  there  occur  discharges  from  the  nose  and  ears,  feeble 
digestion,  and  general  emaciation.  These  sequelae  of  scarlet  fever  are 
best  removed  by  the  internal  use  of  cod-liver  oil. 

As  a  remedy  in  phthisis,  cod-liver  oil  holds  the  first  place,  but  it  is 
not  adapted  to  all  forms  and  all  stages  of  that  disease.  It  is  especially 
a  remedy  for  the  chronic  forms  of  phthisis— -fibroid  lung  and  chronic 
tuberculosis — and  is  not  serviceable  in  caseous  pneumonia  and  acute 
phthisis.  It  is  more  useful  in  the  chronic  forms  of  phthisis  because 
these  afford  the  time  and  opportunity  to  reconstruct  the  tissues  of  the 
body — to  build  up  the  tissues  from  the  molecular  basis  of  the  chyle. 
Cod-liver  oil  is  not  well  borne  when  there  is  much  fever,  and  can  not 
be  well  assimilated  when  the  stomach  has  undergone  the  alterations 
which  belong  to  acute  inflammatory  affections.  This  remedy  is  too 
often  prescribed  without  any  reference  to  the  condition  of  the  pa- 
tient's digestive  functions.  The  power  of  the  stomach  and  intestines 
to  digest  fat  is  limited,  and,  if  the  quantity  which  can  be  disposed  of 
is  exceeded,  the  patient  is  incommoded.  Rarely  is  it  proper  to  pre- 
scribe more  than  a  teaspoonful  three  times  a  day,  and  few  patients 
can  digest  a  tablespoonful.  As  the  secretion  of  gastric  juice,  bile,  and 
pancreatic  juice,  takes  place  most  abundantly  during  the  digestion  of 
food,  the  time  for  the  administration  of  oil  in  phthisical  cases  is  after 
eating.  When  it  is  not  well  borne,  the  digestion  and  assimilation  of 
the  oil  may  be  aided  by  combining  it  with  liquor  potassae,  lime-water, 
the  compound  tincture  of  gentian,  tincture  of  nux  vomica,  or  strychnine, 
or  other  correctives  according  to  the  indications  in  individual  cases. 
When  the  oil  is  not  well  digested — although  stomach  disorder  may 
not  have  occurred — and  it  is  seen  to  float  on  the  stools,  it  may  be  com- 
bined with  ether,  since  Bernard  has  demonstrated  that  ether  increases 
the  production  of  pancreatic  fluid. 

If  continued  for  a  sufficient  length  of  time,  cod-liver  oil  is  of  the 
greatest  service  in  chronic  bronchitis  and  emphysema.  It  should  be 
given  in  the  same  way  and  under  the  same  conditions  as  in  phthisis. 

Chronic  rheumatism  and  rheumatic  arthritis,  maladies  for  the  re- 
lief of  which  cod-liver  oil  was  first  prescribed,  when  occurring  under 
bad  hygienic  influences  in  cachectic  subjects,  may  be  much  relieved 
by  this  agent.  In  addition  to  the  internal  use  of  the  oil,  it  may  be 
applied  with  advantage  locally  to  the  affected  joints.  This  combined 
use  of  the  oil,  systemically  and  by  local  inunction,  is  to  be  commended 
in  the  so-called  rheumatic  gout  with  deposits  about  the  joints.  On  the 
same  principle,  cod-liver  oil  is  beneficial  in  cases  of  strumous  syno- 
vitis,  caries,  and  necrosis  of  bone  dependent  on  a  constitutional  state. 


JOQ  RESTORATIVE  AGENTS. 

It  does  not  have,  it  must  be  admitted,  any  direct  influence  over  these 
morbid  processes  ;  but  it  enters  most  usefully  into  constructive  tissue- 
metamorphosis. 

As  a  reconstituent,  cod-liver  oil  is  a  very  useful  remedy  in  certain 
chronic  affections  of  the  brain  and  nervous  system.  One  of  the  most 
common  conditions  with  which  we  have  to  deal  in  middle  and  ad- 
vanced life,  and  also  one  of  the  most  important  as  regards  the  integ- 
rity of  the  brain,  is  atheroma  of  the  arteries.  This  condition  is  rep- 
resented by  increased  hardness  of  the  radial  pulse,  the  arcus  senilis, 
irregular  action  of  the  heart,  giddiness,  vertigo,  partial  loss  of  vision, 
and  failure  of  the  memory  and  other  intellectual  faculties.  Used  to 
obviate  these  degenerative  changes,  and  to  prevent  failure  in  the  nu- 
trition of  the  brain,  we  have  in  cod-liver  oil  a  remedy  of  real  value. 
It  should  be  given  in  small  quantity,  and  continued  for  a  long  time. 
As  a  phosphorized  fat  plays  an  important  part  in  the  structure  and 
functions  of  the  cerebral  tissues,  we  may  imitate  the  processes  of  Na- 
ture and  administer  the  phosphates,  the  hypophosphites,  or  the  lacto- 
phosphate  of  lime,  in  combination  with  cod-liver  oil.  The  author  has 
seen  excellent  results  from  such  a  combined  use  of  these  agents.  Dr. 
Anstie  much  insists  on  the  use  of  fats,  especially  cod-liver  oil,  as  a 
part  of  the  diet  of  those  suffering  from  neuralgia,  paralysis  agitans, 
epilepsy,  mercurial  tremor,  and  chorea.  Dr.  Radcliffe  had  previously 
pointed  out  the  utility  of  fats  and  oils  in  the  same  affections,  and  all 
practical  physicians  familiar  with  the  subject  are  now  pretty  well 
agreed  as  to  the  value  of  this  practice.  The  special  indications  for 
cod-liver  oil  in  these  affections  are  faulty  assimilation  and  a  low  con- 
dition of  the  nutritive  functions.  Fats  and  oils  are,  of  course,  contra- 
indicated  in  these  nervous  disorders  when  they  occur  in  plethoric  and 
overfed  subjects,  but  such  a  state  of  things  is  exceptional. 

In  diseases  of  the  skin  of  strumous  origin,  cod-liver  oil  is,  as  Dr. 
Tilbury  Fox  remarks,  "  our  sheet-anchor."  Among  these  diseases  are 
lupus,  ecthyma,  psoriasis,  scleroderma,  etc.  The  constitutional  state 
requiring  cod-liver  oil  is  a  lowered  condition  of  the  assimilative  func- 
tions dependent  on  the  strumous  cachexia.  The  local  use  of  the  oil  is 
certainly  advantageous  in  these  cases.  Dr.  Hughes  Bennett  strongly 
recommends  the  free  application  of  the  oil  to  favus  and  eczema  im- 
petiginodes. 

The  condition  of  debility  and  faulty  assimilation  which  results 
from  the  prolonged  treatment  of  syphilis  with  mercury  and  iodine  is 
frequently  remarkably  improved  by  cod-liver  oil.  The  syphilodermata, 
when  occurring  in  cachectic  subjects,  are  benefited  by  a  persistent  use 
of  the  same  remedy.  With  the  internal  use  of  the  oil  may  be  con- 
joined inunctions.  These  are  especially  beneficial  in  the  squamae  of 
syphilitic  origin. 

MODE  OF  ADMINISTRATION  OF  Coo-LivEE  OIL. — As  cod-liver  oil  is 


OILS   AND   FATS.  127 

extremely  repugnant  to  many  patients,  it  is  desirable  to  prescribe 
it  in  as  agreeable  a  form  as  possible.  It  can  easily  be  taken  in  gela- 
tin capsules  containing  20  to  40  minims  of  oil  and  a  minim  or  two 
of  guaiacol.  Quickly  stirred  up  in  a  hot  whisky-punch,  it  may  be 
swallowed  without  appreciation  of  the  taste  of  the  oil.  It  may  be 
taken  on  beer,  the  oil  covered  with  the  foam,  and  carefully  pre- 
vented touching  the  glass.  A  wine-glass  may  be  thoroughly  mois- 
tened with  ale  or  beer,  and  the  dose  of  oil  just  enveloped  in  the 
beer,  when  it  may  be  tossed  into  the  throat  without  perceiving  the 
taste  of  the  oil ;  or  the  oil  may  be  taken  in  sufficient  lemon-juice 
in  the  same  way.  It  may  also  be  taken  in  black  coffee.  A  very 
good  disguise  is  that  of  Carlo  Paresi,  by  which  it  is  made  to  have 
the  odor  and  taste  of  coffee.  To  400  parts  of  cod-liver  oil  are 
added  10  parts  of  animal  charcoal  and  20  parts  of  ground  roasted 
coffee.  The  mixture  is  digested  in  a  water-bath  at  a  temperature 
of  50°  to  60°  C.,  and  after  standing  three  days  is  filtered  and  put 
in  well-stoppered  bottles.  It  is  said  that  10  drops  of  chloroform  to 
100  grammes  of  the  oil  will  render  it  palatable.  One  part  of  essential 
oil  of  eucalyptus  to  100  parts  of  pale  oil  makes  a  mixture  in  which  the 
odor  and  taste  of  the  oil  are  entirely  extinguished.  Two  drachms  of 
cod-liver  oil  may  be  mixed  with  a  drachm  each  of  compound  spirits  of 
lavender  and  brandy.  Emulsions  of  cod-liver  oil  are  now  prepared 
with  glycerin  and  yolks  of  eggs,  and  suitably  flavored.  The  various 
emulsions  with  lime  are  also  much  prescribed.  Cod-liver  oil  saponified 
by  lime  has  been  brought  forward  by  Prof.  Van  den  Court,  of  Brus- 
sels, as  a  remedy  of  especial  efficacy  in  phthisis.  Lastly,  cod-liver  oil 
has  been  used  instead  of  lard  or  butter  in  the  preparation  of  rolls, 
which  are  readily  eaten  by  children.  The  addition  of  ether  to  cod- 
liver  oil  promotes  its  digestion.  Bernard  long  ago  made  the  observa- 
tion that  ether  stimulates  the  pancreas  and  increases  its  secretion,  thus 
contributing  to  the  emulsionizing  of  the  fats.  The  combination  of  ether 
and  cod-liver  oil  has  been  especially  urged  by  Dr.  B.  Foster.  The 
committee  of  the  New  York  Therapeutical  Society  report  that  the  ad- 
dition of  fifteen  minims  of  ether  to  each  half-ounce  of  oil  enables  the 
patient  to  take  it,  if  it  had  previously  disagreed. 

Authorities  referred  to  : 

ANSTIE,  DR.  FRANCIS  E.  Neuralgia  and  the  Diseases  that  resemble  it,  Macmillan  &  Co., 
London,  1871. 

BENNETT,  DR.  J.  HUGHES.  Oleum  Jccoris  Asclli  as  a  Tlwrapeutic  Agent  in  Certain 
Forms  of  Gout,  Rheumatism,  and  Scrofula,  London,  1841. 

DAT,  Du.  GEORGE  E.  Chemistry  in  its  Relation  to  Physiology  and  Medicine,  London, 
1860,  p.  174. 

FLINT,  DR.  AUSTIN,  JR.     TJie  Physiology  of  Man,  vol.  ii,  p.  372,  New  York,  1873. 

GUBLER,  DR.  ADOLPH.     Commcntaires  Therapeutlques,  etc.,  Paris,  1868,  p.  156. 

LEHMANN,  PROF.  C.  G.  Physiological  Chemistry,  Philadelphia,  1855,  vol.  i,  p.  221, 
et  seq. 


128  RESTORATIVE   AGENTS. 

NOTHNAGEL,  DR.  HERMANN.     Handbuch  der  Arzneimiliel,  Berlin,  1870,  p.  661,  et  seq. 
RAXKE,  PROF.  DR.  JOHANNES.     Grundziige  der  Physiologic  des  Menschen,  Leipzig,  1872, 

p.  289. 

RINGER,  DR.  SIDNEY.     Handbook  of  Therapeutics,  p.  247. 

SIMON,  DR.  FRANZ.     Animal  Chemistry,  Syd.  Soc.,  vol.  i,  p.  206. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Mati&re  Medicate,  huitieme  Edi- 
tion, vol.  i,  p.  304. 

WILLIAMS,  DR.  J.  C.  B.  and  DR.  THEODORE.     Consumption. 

PHOSPHORUS   AND   SOME   OF  ITS  COMPOUNDS. 

Phosphorus. — Phosphore,  Fr.  ;  Phosphor,  Ger.  A  translucent, 
nearly  colorless  solid,  resembling  wax,  without  taste,  but  having  a  pe- 
culiar smell.  Its  specific  gravity  is  1-8. 

Oleum  Phosphoratum. — Phosphorated  oil.  Prepared  by  dissolv- 
ing phosphorus  in  ether  and  almond-oil.  One  part  of  phosphorus  to 
100  parts  of  the  menstruum.  Dose,  mi — TTIV. 

PiluloB  Phosphori. — Phosphorus  pills.  Each  pill  contains  about 
Y^  grain.  Phosphorus  is  dissolved  in  chloroform,  and  then  mixed 
with  powdered  althea  and  acacia,  glycerin,  and  water.  The  pills  are 
coated  with  balsam  of  tolu. 

Spiritus  Phosphori.— Spirit  of  phosphorus.  Prepared  by  dissolv- 
ing phosphorus  in  absolute  alcohol — 1'2  grammes  of  phosphorus  and 
sufficient  alcohol  to  make  up  to  1,000  c.  c.  This  alcoholic  solution 
is  utilized  in  preparing  the  elixir  of  phosphorus. 

JZlixir  Phosphori. — Elixir  of  phosphorus.  Prepared  by  mixing 
the  spirit  of  phosphorus  210  c.  c.  with  glycerin  550  c.  c.  and  a  suffi- 
cient quantity  of  aromatic  elixir  (U.  S.  P.)  to  make  up  to  1,000  c.  c. 

Each  cubic  centimeter  of  elixir  of  phosphorus  represents  about 
one  fourth  milligramme,  0'0025  grain,  of  phosphorus. 

Pills  of  phosphorus  may  be  extemporaneously  made  by  mixing 
the  bisulphide  of  carbon  solution  with  some  inert  powder.  The  evap- 
oration of  the  bisulphide  leaves  the  phosphorus  in  a  finely-divided 
state  intimately  incorporated  with  the  powder. 

Zinci  Phosphidum. — Zinc  phosphide.  Dose,  one  twentieth  to 
one  tenth  of  a  grain.  It  is  best  administered  in  pill-form  made  with 
conserve  of  roses. 

SYNKRGISTS. — Oils  and  fats  favor  the  absorption  of  phosphorus, 
and  should  never,  therefore,  be  employed  in  cases  of  poisoning 
by  this  agent.  Arsenic,  and  in  a  feeble  degree  sulphur,  are  syner- 
gistic. 

ANTAGONISTS. — The  chief  chemical  antidotes  to  phosphorus  are 
hydrated  magnesia,  lime-water,  powdered  charcoal,  and  sulphate  of 
copper.  To  this  list  must  be  added  turpentine  of  a  certain  kind. 
Phosphorus  is  now  frequently  taken  in  the  form  of  matches,  the  par- 
ticles of  which  do  not  readily  dissolve  in  the  stomach  and  intestinal 
juices.  When  pure  phosphorus,  in  the  sticks  or  cylinders  in  which  it 


PHOSPHORUS.  129 

occurs  in  commerce,  is  swallowed,  large  masses  may  remain  imbedded 
in  the  folds  of  mucous  membrane,  or,  escaping  solution,  descend  with 
the  other  contents  of  the  canal.  Considerable  time  may  thus  elapse 
from  the  ingestion  of  the  poison  until  its  action  begins.  Emetics, 
therefore,  assume  a  high  degree  of  importance,  and  the  most  service- 
able emetic  is  sulphate  of  copper,  which  is  at  the  same  time  a  chemical 
antidote  (Eulenburg  and  Guttmann).  Bamberger  has  shown  that 
phosphorus  reduces  sulphate  of  copper  to  the  metallic  state,  the  first 
step  in  the  process  being  the  formation  of  phosphide  of  copper,  and 
that  the  masses  of  phosphorus  are  surrounded  by  a  layer  of  copper, 
preventing  its  evaporation.  He  therefore  advises  that  an  emetic  dose 
of  sulphate  of  copper  be  first  administered.  Emesis  may  be  facilitated 
by  giving  hydrated  magnesia,  diffused  in  a  quantity  of  tepid  water/ 
As  catharsis  is  next  in  importance,  the  bowels  should  be  thoroughly 
evacuated.  After  the  emetic  dose  of  sulphate  of  copper  has  acted 
efficiently,  this  antidote  should  be  given  in  small  doses  as  frequently 
as  possible — about  one  twelfth  of  a  grain  every  twenty  minutes.  As 
the  irritability  of  the  stomach  may  prevent  sufficient  retention  of  the 
sulphate,  the  carbon-ate  of  copper  has  been  proposed  as  a  substitute, 
although  Eulenburg  and  Landois,  in  their  experiments  on  animals,  have 
been  unable,  by  the  exhibition  of  the  latter,  to  prevent  death  in  cases 
of  phosphorus-poisoning. 

Before  the  action  of  potassium  permanganate  was  ascertained,  tur- 
pentine was  the  most  important  antidote.  Letheby  was  the  first  to  note 
that  the  vapor  of  turpentine  prevented  the  toxic  action  of  the  vapor 
of  phosphorus,  and  that  workmen  employed  in  the  match-factory  at 
Stafford,  who  were  protected  by  vials  of  turpentine  worn  about  the 
neck,  escaped  necrosis  of  the  maxillary  bones  and  other  deleterious 
effects.  Dr.  P.  C.  Andant  next  published  cases  indicating  the  anti- 
dotal power  of  turpentine,  and  M.  Personne  submitted  the  subject  to 
experimental  demonstration  and  confirmed  the  observations  of  Andant. 
As  turpentine  destroys  the  luminosity  in  the  dark  and  arrests  the  es- 
cape of  the  vapor  of  phosphorus,  M.  Personne  infers  that  it  acts  simi- 
larly as  an  antidote,  that  is,  prevents  the  combustion  of  phosphorus  in 
the  blood  and  the  consequent  consumption  of  the  oxygen.  The  author 
has  collected  forty-six  cases  of  poisoning  by  phosphorus,  in  which  tur- 
pentine was  employed  as  the  antidote,  and  of  this  number  but  four 
were  unsuccessful  (Kohler,  Sorbets,  Laboulbene,  Schimpff,  Lichten- 
stein,  Rommeleare,  Berthold,  etc.).  Rectified  oil  of  turpentine  is  not 
antidotal.  The  acid  French  oil  is  the  preparation  which  has  been 
used  with  success.  The  experiments  of  Vetter  on  animals  fully  con- 
firm the  results  of  clinical  experience,  for  he  found  that,  while  the 
rectified  oil  of  turpentine  had  no  effect,  the  crude,  acid,  French  tur- 
pentine was  very  efficient  as  an  antidote.  The  action  of  the  crude 
turpentine  is  a  process  of  oxidation  and  combination  by  which  phos- 


130  RESTORATIVE   AGENTS. 

phorus  is  converted  into  phosphoro-terebinthinic  acid — a  spermaceti- 
like  substance,  without  poisonous  or  irritating  qualities,  which  is  elim- 
inated by  the  kidneys,  the  urine  having  a  camphoraceous  instead  of 
the  violet  odor  due  to  turpentine  itself.  Although  the  crude  French 
oil  is  to  be  preferred,  it  is  probable  that  our  common  oil  of  turpentine, 
exposed  to  the  air,  will  develop  antidotal  power,  by  absorbing  and 
ozonizing  oxygen.  The  vapor  of  turpentine  acts  in  the  same  manner 
on  the  vapor  of  phosphorus.  Permanganate  of  potassium  has  lately 
been  proved  to  have  complete  antidotal  power.  To  accomplish  this 
result,  the  antidote  must  be  administered  before  absorption  has  taken 
place.  The  stomach  should  be  evacuated  with  copper  sulphate  in 
solution,  and  then  the  stomach  should  be  irrigated  with  a  solution  of 
the  permanganate. 

To  sum  up  :  In  the  treatment  of  poisoning  by  phosphorus,  in  any 
of  the  forms  in  which  it  is  introduced  into  the  stomach,  an  emetic 
of  sulphate  of  copper  should  be  promptly  employed,  and  the  bowels 
should  be  moved  by  hydrated  magnesia.  When  the  stomach  is  emp- 
tied, small  doses  of  sulphate  of  copper  may  be  administered,  and  tur- 
pentine given  ;  or  a  solution  of  permanganate  of  potassium  may  be  used. 
To  counteract  the  cardiac  and  general  systemic  depression,  opium  will 
become  necessary.  If  phosphorus  has  entered  the  blood  despite  the 
use  of  the  appropriate  antidotes,  and  much  injury  to  its  corpuscular 
elements  has  resulted,  transfusion  can  be  employed  with  considerable 
confidence,  since  Jiirgensen  has  succeeded  in  several  instances  in  sav- 
ing life  by  this  expedient.  Direct  transfusion  of  human  blood,  with 
or  without  previous  withdrawal  of  some  portion  of  the  damaged  blood, 
is  the  proper  procedure. 

PHYSIOLOGICAL  ACTIONS. — The  vapor  of  phosphorus  is  highly  irri- 
tating to  the  conjunctiva  and  to  the  broncho-pulmonary  mucous  mem- 
brane. If  caries  of  the  teeth  exist,  necrosis  of  the  maxillary  bones 
may  be  induced  by  the  vapor  ;  but  it  is  doubtful  whether,  as  has  been 
affirmed,  such  necrosis  may  occur  when  the  teeth  are  perfectly  sound. 
There  is  an  obvious  distinction  between  the  local  effects  of  the  vapor 
of  phosphorus  and  the  disease  of  the  osseous  system,  the  result  of  the 
constitutional  impression  of  this  agent. 

In  ordinary  medicinal  doses,  phosphorus  gives  rise  to  a  sense  of 
warmth  at  the  epigastrium,  but,  if  the  dose  be  large,  decided  heat  and 
even  burning  are  experienced,  and  tenderness  of  the  epigastrium  re- 
mains. Prolonged  administration  of  full  doses  will  excite  considerable 
gastric  disturbance,  and  a  catarrhal  state  of  the  mucous  membrane.  In 
the  process  of  the  oxidation  of  phosphorus,  hydrogen  is  evolved,  which 
in  its  nascent  state  readily  combines  with  a  portion  of  phosphorus, 
forming  phosphide  of  hydrogen,  eructations  of  which  constitute  one  of 
the  disagreeable  features  in  the  administration  of  this  remedy.  The 
action  of  the  heart  becomes  more  frequent,  and  the  cutaneous  circu- 


PHOSPHORUS.  131 

lation,  especially,  more  rapid  ;  the  body  temperature  rises  somewhat ; 
the  mental  activity  and  the  muscular  power  increase  ;  the  menstrual 
flow  grows  more  abundant,  and  in  males  aphrodisiac  effects  are  experi- 
enced, and  the  urine  and  sweat  are  more  abundantly  excreted.  Phos- 
phorus in  small  quantity  promotes  constructive  metamorphosis,  in- 
creases the  activity  of  the  vegetative  organs,  and  is  a  natural  excitant 
of  the  functions  of  animal  life  ;  it  enters  largely  into  the  formation  of 
tissues,  and  is  a  necessary  element  in  the  phosphorized  fat  which  holds 
an  important  position  in  the  composition  of  the  cerebral  matter.  The 
administration  of  phosphorus  increases  the  excretion  of  urinary  phos- 
phates. 

The  effects  of  phosphorus  in  toxic  doses  have  been  elaborately  stud- 
ied, both  in  fatal  cases  of  poisoning,  occurring  in  man,  and  by  experi- 
ments on  animals.  The  form  in  which  it  is  swallowed  affects  the  rate 
at  which  the  action  occurs.  If  taken  in  solution  in  oil,  in  ether,  or  in 
the  paste  used  as  a  vermin-destroyer,  the  toxic  symptoms  appear  more 
promptly  than  if  match-heads  or  ordinary  phosphorus  has  been  swal- 
lowed. An  interval  of  varying  duration  elapses  from  the  ingestion  of 
the  poison  until  disturbance  of  the  stomach  ensues.  This  interval — 
one  to  three  hours — is  occupied  by  the  solution  and  oxidation  of  the 
phosphorus.  Then  epigastric  uneasiness,  nausea,  and  vomiting,  come 
on  ;  first,  the  contents  of  the  stomach,  and  then  mucus  and  bilious  mat- 
ters being  ejected.  The  vomiting,  accompanied  by  considerable  epi- 
gastric pain  and  tenderness,  persists  usually  for  several  days,  when  it 
assumes  a  special  character,  owing  to  the  presence  of  the  so-called 
"coffee-grounds,"  or  " black- vomit."  At  first  the  vomited  matters 
have  a  distinct  odor  of  phosphorus,  and  appear  phosphorescent  in  the 
dark.  After  several  days  of  vomiting  these  symptoms  disappear,  and 
there  may  then  be  more  or  less  haematemesis,  as  well  as  coffee-grounds, 
due  to  erosions  of  the  mucous  membrane  (Wolfe).  The  condition  of 
the  intestines  varies  with  the  presence  or  absence  of  phosphorus  in 
their  contents.  The  stools  may  be  simply  pasty  and  grayish  from  the 
absence  of  bile,  or  they  may  contain  mucus  and  blood,  and  appear 
phosphorescent  in  the  dark.  Accordingly,  as  they  may  or  may  not  be 
irritated,  will  the  symptoms  be  those  of  constipation,  diarrhoea,  or  dys- 
entery. The  very  characteristic  but  not  invariable  symptom — jaundice 
— appears  on  the  second  to  the  fifth  day  after  the  reception  of  the 
poison.  It  is  absent  in  one  fourth  of  the  cases,  and  may  be  absent, 
also,  when  there  is  considerable  fatty  degeneration  of  the  liver  (Wolfe, 
Alter).  It  presents  the  usual  appearance  of  jaundice  as  it  occurs  in 
acute  yellow  atrophy.  It  does  not  attain  the  maximum  at  once,  but 
it  appears  first  as  some  yellowness  of  the  conjunctiva,  the  urine  also 
becoming  dark  and  loaded  with  urates,  at  the  same  time. 

The  chemical  changes  which  phosphorus  undergoes  in  the  stomach, 
and  the  combinations  by  which  it  enters  the  blood,  are  as  yet  not  fully 
11 


132  RESTORATIVE   AGENTS. 

explicable.  That  some  phosphoric  acid  and  phosphide  of  hydrogen 
are  formed  is  certain.  That  the  oil  or  fat  in  the  stomach  will  dissolve 
some  portion  of  the  phosphorus,  and  thus  facilitate  its  diffusion  as 
phosphorus  into  the  blood,  is  highly  probable  (Husemann  and  Marine"). 
Phosphorus  is  also  slightly  soluble  in  water  at  about  100°  Fahr.,  and 
in  organic  fluids,  as  the  bile,  to  a  greater  extent  (Hartmann).  As  in 
the  oxidation  of  phosphorus,  phosphorous  and  phosphoric  acids,  and 
phosphide  of  hydrogen,  are  products,  it  is  certain  that  these  exert  a 
poisonous  influence  to  a  greater  or  less  extent  in  the  stomach  (Lecor- 
che).  A  portion  of  the  agent  taken  undoubtedly  enters  the  blood  as 
phosphorus,  and  the  subsequent  changes  in  tissue-metamorphosis  are 
due  to  its  presence  in  the  blood,  where  it  has  been  detected  by  Bam- 
berger  and  others.  With  the  entrance  of  the  poison  into  the  blood 
the  action  of  the  heart  increases,  and  the  temperature  rises,  the  fever 
having  a  remittent  type  (Mannkopff).  Toward  the  end,  however,  the 
function  of  hoematosis  and  of  tissue-metamorphosis  are  so  depressed 
that  the  body-heat  declines  below  normal.  In  other  cases  there  is  no 
fever  at  all,  or  it  appears  near  the  end.  Very  great  weakness  of  the 
heart's  action  has  usually  been  observed,  and  the  pulse  has  been  much 
accelerated,  although  in  some  instances  it  became  very  slow,  descend- 
ing as  low  as  40.  The  damage  done  to  the  blood  is  shown  in  the 
haemorrhages  which  take  place  from  the  various  mucous  surfaces — from 
the  nose,  stomach,  intestines,  kidneys,  uterus  (menorrhagia  and  me- 
trorrhagia) — and  into  the  areolar  tissue,  in  the  form  of  petechiaj  and 
ccchymoses.  A  hasmorrhagic  diathesis  develops,  so  that  the  bleeding 
from  a  simple  wound,  a  leech-bite,  etc.,  may  become  uncontrollable. 

The  intellect  may  remain  unimpaired,  but  usually  there  are  restless- 
ness, with  coma,  sometimes  noisy  delirium,  anaesthesia  of  the  extremi- 
ties, paresis  of  the  members,  and,  near  the  end,  convulsions  (Hermann). 

The  poison  entering  the  blood  is  eliminated  chiefly  by  the  kidneys. 
The  changes  occurring  in  the  urine  are  of  especial  interest.  No  depart- 
ure from  the  normal  occurs  until  the  alterations  in  the  composition  of 
the  blood,  and  the  general  steatosis,  prepare  the  way.  The  urine  is 
diminished  in  amount,  contains  albumen,  blood,  and  sometimes  fibrin- 
ous  casts.  When  jaundice  comes  on,  its  appearance  is  first  announced 
by  the  presence  of  bile-pigments  and  acids.  Urea  almost  entirely  dis- 
appears toward  the  fatal  termination  ;  leucin  and  ty rosin  are  occa- 
sionally present,  and  a  peptone-like  substance  ;  but  the  peculiarity  most 
distinctive  is  the  large  quantity  of  paralactic  acid,  especially  in  the 
fatal  cases  (Schultzen  and  Riess). 

The  duration  of  the  cases  of  phosphorus-poisoning  is  by  no  means 
uniform.  Although  the  rule  is  that  symptoms  do  not  follow  immedi- 
ately on  the  entrance  of  the  poison  into  the  stomach,  there  are  cases 
in  which  pain,  nausea,  and  vomiting  do  occur  almost  immediately,  and 
the  most  formidable  symptoms  come  on  promptly.  One  case  is  re- 


PHOSPEORUS.  133 

ported  in  which  death  occurred  within  nine  hours,  and  numerous  cases 
have  terminated  in  death  at  the  expiration  of  forty-eight  to  seventy- 
two  hours.  But  usually  the  cases  are  less  acute,  and  death  does  not 
occur  before  the  end  of  the  first,  second,  or  third  week.  It  is  impor- 
tant to  bear  in  mind  that  death  may  take  place  unexpectedly,  before 
the  most  severe  symptoms  manifest  themselves  (Naunyn)  ;  and  that 
the  absence  of  decided  gastric  disturbance  does  not  necessarily  in- 
dicate a  mild  case.  When  recovery  takes  place,  the  improvement  is 
slow,  and  the  duration  more  or  less  protracted.  In  cases  observed  by 
Schultzen,  the  swelling  of  the  liver  could  be  distinguished  at  the  ex- 
piration of  four  weeks,  although  the  jaundice  and  the  haemorrhages 
had  disappeared. 

The  changes  induced  by  phosphorus  are  eminently  characteristic. 
In  the  stomach  are  found  erosions  of  variable  extent,  often  absent ; 
fatty  degeneration  of  the  epithelium  ;  and  a  gastro-adenitis,  first  de- 
scribed by  Virchow,  and  confirmed  by  subsequent  observers,  notably 
by  Bernhardt,  whence  the  membrane  has  a  swollen,  grayish,  or  yellow- 
ish color.  The  same  state  of  the  mucous  membrane  may  exist  in  the 
intestine  as  well.  The  liver  is  much  enlarged  as  a  rule,  but  may  be 
atrophied.  In  five  of  the  sixteen  cases  studied  by  Wolfe  the  liver  was 
atrophied,  but  this  is  probably  a  more  advanced  change,  and  is,  there- 
fore, encountered  in  the  most  protracted  cases.  The  color  of  the  liver 
is  usually  a  pale  yellow,  or  it  may  present  a  deep  yellow,  the  acini  ap- 
pearing enlarged  and  distinct.  The  increased  size  of  the  organ,  and 
the  change  in  its  appearance,  are  due  to  fatty  degeneration  of  the  he- 
patic cells  and  epithelium  (Mannkopff)  ;  but,  according  to  some  other 
authorities,  an  interstitial  hepatitis  is  also  set  up,  which  is  especially 
well  marked  in  chronic  phosphorus-poisoning.  The  jaundice,  it  is 
agreed  generally,  is  due  to  resorption  of  the  bile,  swelling  of  the  bile- 
ducts  and  of  the  orifice  of  the  ductus  communis  preventing  the  en- 
trance of  the  bile  into  the  intestine.  The  presence  of  bile-pigments 
and  acids  in  the  urine  supports  this  view,  but  it  has  also  been  main- 
tained that  the  jaundice  is  hamatogenic  from  dissolution  of  the 
blood. 

The  changes  in  the  composition  of  the  blood  are  numerous  and  im- 
portant :  it  is  fluid,  non-coagulable,  its  corpuscles  altered  in  form,  and 
it  contains  much  fat  (Mehu).  There  are  numerous  ecchymoses,  es- 
pecially under  the  peri-  and  endo-cardium  (noted  in  thirteen  out  of  six- 
teen cases  by  Wolfe),  under  the  capsule  of  the  liver,  and  in  other 
situations.  Besides  the  alterations  in  the  blood,  the  occurrence  of 
ecchymoses  is  favored  by  fatty  degeneration  of  the  small  blood-vessels 
and  capillaries  (Klebs).  The  heart  is  also  the  seat  of  an  acute  fatty 
degeneration,  and  its  tissue  is  soft  and  easily  torn.  The  spleen  is  en- 
larged, and  the  kidneys  are  also  enlarged  and  fatty,  the  renal  epithe- 
lium being  crowded  with  oil-drops. 


234  RESTORATIVE   AGENTS. 

Not  every  case  exhibits  the  wide-spread  changes  above  described. 
If  death  occur  in  a  short  time,  within  nine  hours,  as  has  been  noted, 
not  sufficient  time  will  have  elapsed  to  allow  of  universal  steatosis. 
There  may,  indeed,  be  no  characteristic  morbid  appearances  under  such 
circumstances.  In  other  cases,  the  changes  may  be  limited  to  the  liver. 

Chronic  poisoning  by  phosphorus  presents  some  interesting  features. 
It  occurs  in  those  who  are  exposed  to  the  vapor,  in  workmen  engaged 
in  phosphorus-factories,  and  especially  in  the  workers  in  match-facto- 
ries. Irritation  of  the  bronchial  mucous  membrane,  and  to  a  less  ex- 
tent of  the  gastro-intestinal,  takes  place,  with  the  attendant  symptoms 
of  cough,  loss  of  appetite,  indigestion,  constipation,  failure  of  nutri- 
tion, etc.  The  most  important  change  is  that  occurring  in  the  maxilla, 
more  especially  in  the  inferior  maxilla,  which  is  both  more  severely  and 
more  frequently  diseased.  The  lower  jaw  has  been  repeatedly  re- 
moved for  this  phosphorus  necrosis,  which  begins  in  carious  teeth, 
develops  into  a  periostitis,  and  ends  in  death  of  the  bone.  The  alve- 
olar process  only,  or  a  part  or  the  whole  of  the  bone,  may  be  cast  off. 
Phosphorus  increases  the  production  of  osseous  tissue  ;  the  spongy 
tissue  is  thickened,  and  the  compact  is  rendered  more  dense.  Exten- 
sive osteophytic  formations  take  place  in  animals  fed  on  it,  and  the 
marrow  cavity  of  long  bones  may  be  much  encroached  on,  even  closed, 
by  the  deposit  of  new  osseous  material  (Wegner). 

THERAPY. — The  author  enjoins  on  his  readers  the  necessity  for  cau- 
tion in  the  use  of  phosphorus.  As  this  agent  so  readily  induces  an  acute 
fatty  degeneration,  when  taken  in  poisonous  quantity,  the  propriety  of 
its  administration  in  large  doses  for  long  periods  may  be  questioned. 

Phosphorus  is  indicated  more  especially  in  the  nutritive  failure  of 
the  osseous  and  nervous  structures  of  the  body.  It  is  especially  in 
nutritive  failure  of  the  osseous  and  nervous  tissue  that  phosphorus  is 
required.  The  original  suggestion  by  Wegner  of  its  probable  utility 
in  osteomalacia,  or  softening  of  the  bones,  has  been  acted  on  by  Friese, 
who  found  it  remarkably  beneficial  in  some  obstinate  cases.  It  will 
prove  useful,  also,  when  this  condition  exists  in  rickets.  That  hitherto 
incurable  malady — -progressive  pernicious  anaemia — has  in  some  in- 
stances been  apparently  arrested  by  the  administration  of  phosphorus  ; 
but  it  has  failed  in  others.  The  observations  of  Fox,  Broadbent,  and 
others,  as  to  the  utility  of  phosphorus  in  lymphadenoma,  are  very  en- 
couraging, the  more  especially  as,  hitherto,  remedies  have  had  little 
influence  over  this  intractable  malady. 

The  physiological  action  of  phosphorus  in  small  doses  in  increasing 
mental  activity  finds  a  therapeutical  expression  in  the  use  of  its  prep- 
arations in  cerebral  disorders.  It  is  indicated  in  pathological  states 
dependent  on  anaemia,  and  contraindicated  in  vascular  congestion  and 
excitement.  Cases  of  wakefulness,  dependent  on  cerebral  anaemia  and 
exhaustion,  are  often  remarkably  benefited  by  phosphorus  in  the  form 


PHOSPHORUS.  135 

of  the  pill  or  tincture.  It  does  not  procure  sleep  in  the  way  that 
chloral  and  bromide  of  potassium  do.  By  the  use  of  it  in  suitable 
states  we  supply  to  the  cerebral  substance  a  material  which  it  requires 
for  the  healthy  performance  of  its  functions.  It  acts  most  beneficially 
in  the  cases  of  wakefulness  in  which  the  nutritive  functions  of  the 
body  are  wanting  in  activity.  The  wakefulness  of  the  aged,  accom- 
panied with  muscular  cramps,  feebleness  of  memory,  giddiness,  and 
trembling  of  the  voluntary  muscles  on  exertion,  is  improved  by  the 
preparations  of  phosphorus.  Early  decay  of  the  mental  powers,  asso- 
ciated with  atheromatous  changes  of  the  cerebral  vessels,  and  conse- 
quent impaired  nutrition  of  the  brain,  is  benefited  by  minute  doses  of 
this  agent.  In  these  states,  occurring  in  the  aged,  it  is  better  to  com- 
bine with  the  phosphorus,  or  to  administer  simultaneously,  cod-liver 
oil.  The  author  has  seen  good  results  from  such  a  combination  in 
paralysis  agitans.  Large  doses  of  the  medicine  in  these  disorders  of 
advanced  life  are  improper  and  unsafe.  The  best  results  are  obtained 
from  the  persistent  use  of  minute  doses.  M.  Delpech  has  obtained 
excellent  results  from  the  use  of  phosphorus  in  paralysis.  It  is  ob- 
viously adapted  to  cases  of  chronic  character  in  which  all  acute  symp- 
toms have  subsided.  The  paralytic  symptoms  which  accompany  white 
softening  of  the  brain  (local  and  circumscribed  anaemia)  have  appeared 
to  the  author  to  be  improved  by  the  use  of  the  phosphates,  hypophos- 
phites,  and  lacto-phosphate  of  lime. 

The  preparations  of  phosphorus  are  very  serviceable  in  neuralgia. 
It  is  true  the  late  Dr.  Anstie,  in  his  work  on  neuralgia,  expresses 
the  opinion  that  "  its  utility  is  not  very  extensive  or  reliable."  Rad- 
cliffe,  Bradley,  Broadbent,  Mr.  J.  Ashburton  Thompson,  on  the  other 
hand,  report  cures  in  some  obstinate  cases.  Mr.  Thompson's  experi- 
ence indicates  that  large  doses  are  necessary  to  effect  a  cure.  In  his 
own  words  :  "  I  now  invariably  begin  by  giving  ^  of  a  grain  every 
four  hours,  and  this  I  conclude  to  be  an  average  dose."  The  formula 
given  under  the  title  "  Tinctura  Phosphori "  is  Mr.  Thompson's  ;  each 
drachm  of  it  contains  ^  of  a  grain  of  phosphorus.  With  this  solution 
he  has  treated  successfully  thirteen  cases  of  neuralgia.  Dr.  Broadbent 
has  given  phosphorus  with  advantage  in  "  epileptiform  vertigo,"  neu- 
ralgia, and  "  nervous  breakdown  from  overwork." 

We  have  no  remedy  at  present  more  efficient  in  the  treatment  of  im- 
potence than  phosphorus.  In  the  physiological  state,  priapism  is  one  of 
the  results  of  its  toxic  action.  It  is,  of  course,  adapted  only  to  cases 
functional  in  character,  and  not  to  impotence  from  organic  defect. 

According  to  Dujardin-Beaumetz,  phosphorus  is  useful  in  that  very 
protracted  and  troublesome  disease,  progressive  locomotor  ataxia,  or 
posterior  spinal  sclerosis.  Although  the  author  has  not  observed  any 
instances  of  cure  of  this  affection  by  phosphorus,  he  has  witnessed  in  a 
few  instances  decided  amelioration. 


136  RESTORATIVE   AGENTS. 

Phosphorus  has  lately  been  employed  as  a  substitute  for  arsenic  in 
the  skin-diseases  for  which  the  latter  is  used — notably  acne,  psoriasis, 
lupus.  The  author  has  seen  excellent  results  from  the  use  of  the  com- 
pound sirup  of  the  hypophosphites  in  acne  indurata. 

Authorities  referred  to  in  this  article  : 

ALTER,  W.  Experimentelle  Bcitrage  iiber  die  Ursachen  des  Icterus  bei  Phosphorver- 
giftungen.  Diss.  Breslau.  V.  u.  H.,  vol.  i,  1867. 

ANDANT,  DR.  P.  E.  Bull.  Gen.  de  1'herap.,  tome  Ixxv,  p.  269.  Ibid.,  tome  Ixxvi,  p. 
273. 

ANSTIE,  DR.  F.  E.     Neuralgia  and  its  Counterfeits,  London,  1871. 

BAMBERGER,  H.  VON.  Wurzbl.  med.  Ztschr.,  Band  7,  1.  Full  abstract  in  Virchow  u. 
HirscKs  Jahresbericht  for  1867,  vol.  i. 

BENNETT,  DR.  JAMES  RISDON.     The  Medical  Times  and  Gazette,  vol.  i,  1861,  p.  488. 

BERNHARDT,  M.  Die  Verdnderungen  des  Magens  nach  Phosphorvergiftung.  Virchow^ 
Archiv,  Band  39,  p.  23. 

BERTHOLD,  A.     Arcliiv  der  Heilkunde,  1876,  p.  258. 

BRADLEY,  G.  M.     The  British  Medical  Journal,  October,  1872. 

BROADBENT,  DR.  W.  n.      The  Practitioner,  April,  1873,  p.  230. 

D0SART,  M.     The  Lancet,  vol.  ii,  1870,  p.  122. 

EBSTEIN,  DR.  Archiv  der  Heilkunde.  Quoted  in  Schmidfs  Jahrbucher,  vol.  cxiv, 
p.  283. 

ECLENBURG  AND  LANDOis.  Die  Transfusion  bei  acuten  Phosphorvergift.  Centralblatt 
f.  d.  med.  Wiss.  Virchow  u.  Hirsch's  Jahresbericht,  1867,  vol.  i. 

HARTMANN,  JCL.     Zur  acuten  Phosphorvergift.     Diss.  Dorpat.     Ibid.,  vol.  i,  1867. 

HUSEMANN,  TH.  AND  W.  MARME.     Ibid.,  vol.  i,  1866. 

KOHLER,  H.  Berlin,  klin.  Wochen.,  i,  1870,  p.  6.  Ibid.,  Wiener  Presse,  various  num- 
bers, 1873. 

LABOCLBENE,  DR.  Gaz.  des  Htipitaux,  xlvi,  1879,  p.  361,  and  Gaz.  Hebdom.,  1874, 
xxxiii,  p.  524. 

LECORCHE,  DR.     Archives  de  Physiologic  Norm,  el  Path.,  tome  ii,  1869. 

LEBERT,  H.  AND  WYSS,  0.  Etudes  cliniques  el  experimentales  sur  Fempoisonnement  aigu 
par  le  phosphor.  Archives  General  de  Medicine,  September,  October,  November,  and 
December,  1868. 

MUNK  UND  LEYDEN.     Die  acute  Phosphorvergiftung,  Berlin,  1865.     A.  Hirschwald. 

PERSONNE,  M.     Bulletin  General  de  Therapeutique,  tome  Ixxvi,  p.  353. 

RADCLIFFE,  DR.  C.  B.     T/ie  British  Medical  Journal,  1863,  p.  489. 

RANVIEB,  DR.  L.  Gaz.  Med.  de  Paris,  27,  28,  1867.  Recherches  experimentales  au 
sujet  de  faction  du  phosphor  sur  les  tissus  vivants,  etc. 

ROMHELAERE,  DR.  Du  Traitement  de  Vempoisonnement  par  le  phospfiore.  Bull.  Gen. 
de  Therap.,  vol.  Ixxxii,  p.  145. 

SENFTLEBKN,  DR.     VirchouPs  Archiv,  vol.  xxxvi,  p.  530. 

SCHRACBE,  DR.  OTTO.  Uebersicht  neuer  Mittheilungen  iiber  acute  Phosphorvergiftung. 
Schmidfs  Jahrbucher,  Band  136,  p.  207. 

SORBETS,  DR.     Bull.  Gen.  de  Tlierap.,  vol.  Ixvii,  p.  42. 

THOMPSON,  J.  ASHBURTON.     The  Practitioner,  vol.  ii,  p.  13. 

VETTER,  DR.  A.  Ueber  die  acute  Phosphorvergiftung  und  deren  Bchandlung.  Virchow's 
Archiv,  Band  53,  p.  168. 

VIRCHOW,  R.  Der  Zustand  des  Magens  bei  Phosphorvergiftung.  Virchow's  Archiv, 
Band  31,  p.  399. 

WEGNKR,  DR.  GEORG.  Der  Einfluss  des  Phosphors  auf  den  Organismus.  Ibid.,  Band 
55,  p.  11. 


PHOSPHITES  AND   PHOSPHATES.  137 

WOLFE,  JEAN.  Lisser.  Berolini.  Full  Abstract  in  Virchow  u.  ffirscK't  Jahresberickt, 
Tol.  i,  1868.  An  Account  of  the  Morbid  Appearances  in  Sixteen  Cases  of  Phosphorus- 
Poisoning,  occurring  in  Berlin  from  1861  to  1868. 

PHOSPHITES   AND   PHOSPHATES. 

PREPARATIONS. — Syrupus  Calcii  Lacto-phosphatis. — Sirup  of  the 
lacto-phosphate  of  calcium.  Dose,  a  teaspoonful.  Lactic  acid  has 
the  property  of  dissolving  freshly-precipitated  phosphate  of  lime. 

Compound  Sirup  of  the  Phosphates  (not  official). — Parrish's  chemi- 
cal food.  Each  drachm  contains  two  and  a  half  grains  of  phosphate 
of  iron  and  one  grain  of  phosphate  of  lime. 

Syrupus  Hypophosphitum. — Sirup  of  the  hypophosphites.  Com- 
posed of  hypophosphites  of  calcium,  sodium,  and  potassium.  Dose,  a 
teaspoonful  three  times  a  day. 

Syrupus  Hypophosphitum  cum  Ferro. — Sirup  of  the  hypophos- 
phites with  ferrous  lactate.  Dose,  a  teaspoonful  three  times  a  day. 

Sodii  Phosphas. — Sodium  phosphate.  "Large,  colorless,  trans- 
parent, monoclinic  prisms,  speedily  efflorescing  on  exposure  to  air, 
odorless,  having  a  cooling,  saline,  and  feebly  alkaline  taste,  and  a 
slightly  alkaline  reaction.  Soluble  in  six  parts  of  water  at  60°  Fahr., 
and  in  two  parts  of  boiling  water."  Dose,  one  drachm  to  one  ounce. 

Sodii  Pyrophosphas. — Sodium  pyrophosphate.  "  Colorless,  trans- 
lucent, monoclinic  prisms,  permanent  in  the  air,  odorless,  having  a 
cooling,  saline  taste,  and  a  slightly  alkaline  reaction.  Soluble  in  12 
parts  of  water  at  60°  Fahr.,  and  in  I'l  boiling  water  ;  insoluble  in 
alcohol."  Dose,  half  a  drachm  to  half  an  ounce. 

Calcii  Hypophosphis. — Calcium  hypophosphite.  "  Colorless  or 
white  six-sided  prisms,  or  thin,  flexible  scales,  of  a  pearly  luster, 
permanent  in  dry  air,  odorless,  having  a  nauseous,  bitter  taste  and  a 
neutral  reaction.  Soluble  in  6 '8  parts  of  water  at  60°  Fahr.,  and  in 
six  parts  of  boiling  water."  Dose,  gr.  ij — gr.  x. 

Calcii  Phosphas  Prcecipitatus. — Precipitated  calcium  phosphate. 
"A  light,  white,  amorphous  powder,  permanent  in  the  air,  odorless, 
tasteless,  and  insoluble  in  water  or  alcohol."  Dose,  gr.  ij — gr.  v. 

Sodii  Hypophosphis. — Sodium  hypophosphite.  Small,  colorless 
or  white,  rectangular  prisms,  or  a  white  granular  powder,  having  a 
sweetish,  saline  taste  and  a  neutral  reaction.  Soluble  in  one  part  of 
water.  Dose,  gr.  v — gr.  x. 

PHYSIOLOGICAL  ACTIONS. — In  the  first  edition  of  this  work  the 
phosphates  were  included  in  the  same  section  with  phosphorus.  There 
is  a  strong  argument  in  favor  of  this  arrangement,  based  on  the  chem- 
ical reactions  which  ensue  when  phosphorus  is  introduced  into  the 
stomach.  Phosphorus  has  a  strong  affinity  for  oxygen,  and  compounds 
are  quickly  formed  in  the  stomach.  It  is  probable,  however,  that  some 
phosphorus  enters  the  blood  uncombined.  The  toxic  activity  of  the 


138  RESTORATIVE   AGENTS. 

compounds  of  phosphorus  is  in  inverse  ratio  to  the  amount  of  oxygen 
contained  in  the  combination.  This  fact,  which  would  be  inferred 
a  priori,  has  been  experimentally  proved. 

PHYSIOLOGICAL  ACTIONS  OF  PHOSPHATE  OF  LIME. — There  is  no 
part  of  the  body  which  does  not  contain,  or  does  not  yield  on  incinera- 
tion, phosphate  of  lime.  It  gives  solidity  to  the  osseous  framework  of 
the  body,  and,  when  too  little  is  furnished  during  the  growing  period, 
rickets  and  mollifies  ossium  are  the  result.  The  demand  made  on  the 
system  of  the  mother  for  the  supply  of  this  essential  material  for  the 
growth  of  the  osseous  structure  of  the  foetus  is  so  great  that  her  frac- 
tured bones  unite  with  difficulty.  The  bones  of  animals,  fed  on  food 
deficient  in  phosphate  of  lime,  soften.  All  the  animal  fluids  contain 
this  substance  in  solution  :  thus  it  is  found  in  the  blood,  the  saliva,  the 
gastric  juice,  milk,  urine,  and  in  the  intercellular  fluid  throughout  the 
body.  It  accumulates  wherever  tissue-changes  are  rapidly  taking  place 
(Dusart).  It  is  obviously  very  important  to  the  nutritive  processes  of 
the  body. 

As  phosphate  of  lime  is  to  a  limited  extent  soluble  in  lactic  and 
hydrochloric  acids,  it  is  evident  that,  administered  by  the  stomach, 
diffusion  into  the  blood  must  occur.  Large  amounts  can  not,  however, 
be  disposed  of  in  this  way  ;  hence  small  doses  must  be  as  effective,  in 
the  treatment  of  the  maladies  for  which  it  is  prescribed,  as  large  ones 
— for  all  in  excess  of  the  quantity  soluble  in  the  free  acids  of  the 
stomach  must  pass  off  with  the  faeces  or  form  intestinal  concretions. 

PHYSIOLOGICAL  ACTIONS  OF  PHOSPHATE  OF  SODIUM. — This  salt  is 
soluble  in  water  in  the  proportion  of  four  per  cent.  Hence  it  may  be 
given  in  solution,  and  will  readily  diffuse  through  into  the  blood.  In 
the  dose  of  one  ounce  it  acts  as  a  laxative.  As  it  has  a  saline  taste 
similar  to  common  salt,  it  may  be  given  in  soup  or  other  food.  It  in- 
creases the  alkalinity  of  the  blood,  according  to  Bocker,  by  causing  a 
retention  of  the  chloride  of  sodium.  Phosphate  of  soda  diminishes  the 
excretion  of  urea,  in  part,  it  is  supposed,  by  hindering  the  retrograde 
metamorphosis  of  tissue,  in  part  by  its  interference  with  the  process  of 
digestion.  It  is  a  constituent  of  the  blood  in  the  normal  state,  and  as 
it  possesses  the  remarkable  property  of  increasing  the  quantity  of  car- 
bonic acid  which  can  be  held  in  solution  by  any  liquid,  obviously  we 
have  in  these  facts  an  explanation  of  its  influence  over  the  excretion 
of  urea.  That  it  impairs  digestion  in  large  doses  when  administered 
in  health  may  be  admitted,  but  by  removing  morbid  states  of  the  mu- 
cous membrane  the  digestive  function,  in  suitable  cases,  is  directly 
promoted  by  its  use,  and  the  nutrition  of  the  body  generally,  and  the 
tone  of  the  nervous  system,  improved. 

Therapy. — In  cases  of  the  so-called  bilious  sick-headache,  phosphate 
of  soda  is  a  most  useful  laxative.  A  permanent  cure  of  this  very 
troublesome  malady  may  be  wrought  by  regulation  of  the  diet,  and  by 


PHOSPHITES   AND   PHOSPHATES.  139 

the  long-continued  use  of  this  remedy.  It  is  not  pretended  that  cases 
of  migraine,  due  to  an  affection  of  the  nucleus  of  the  fifth,  may  be  thus 
cured.  A  large  proportion  of  these  cases  are  produced  by  a  catarrhal 
state  of  the  gastro-intestinal  mucous  membrane,  which  the  phosphate 
of  soda  has  the  power  to  remove.  For  the  same  reason,  it  is  a  remedy 
of  the  highest  utility  in  cases  of  jaundice  dependent  on  catarrh  of  the 
bile-ducts,  this  disease  being  secondary  to  the  same  process  in  the  in- 
testinal mucous  membrane.  In  these  affections  the  phosphate  of  soda 
should  be  administered  in  a  drachm  dose  (about  one  teaspoonful)  three 
times  a  day,  or  more  frequently.  Children,  who  are  frequently  sub- 
jects of  this  disorder,  do  not  require  larger  doses  than  ten  grains  to  a 
scruple.  In  preventing  inspissation  of  the  bile  and  crystallization  of 
cholesterin,  and  attacks  of  hepatic  colic,  the  persistent  use  of  the  phos- 
phate of  soda  is  rarely  unsuccessful.  It  is  not  pretended  that  this 
agent  can  relieve  the  attacks  of  hepatic  colic,  and,  indeed,  it  is  useless 
at  these  times.  Many  cases  of  this  disease,  if  not  most  of  them,  origi- 
nate in  a  catarrh  of  the  duodenum,  the  transference  of  the  catarrhal 
state  by  continuity  of  tissue  to  the  gall-bladder,  and  the  formation  of 
a  nucleus  of  mucus  and  bile,  about  which  the  cholesterin  crystallizes. 
Phosphate  of  soda  has  the  property  to  prevent  the  occurrence  of  these 
changes,  and  consequently  to  prevent  attacks  of  hepatic  colic.  The 
author  has  found  one  scruple  to  drachm  doses,  administered  for  several 
months  before  each  meal,  extremely  efficacious  in  a  number  of  cases 
of  this  kind.  The  value  of  Vichy  in  this  and  kindred  affections 
probably  depends  on  the  phosphate  of  soda  contained  in  this  mineral 
water. 

Many  ill-conditioned  children  are  found  to  pass  pasty  and  white 
stools,  showing  the  absence  of  bile,  and  are  pale  and  ill-nourished  not- 
withstanding an  abundant  supply  of  milk  and  a  vigorous  appetite. 
Ten  grains  of  phosphate  of  soda,  dissolved  in  the  milk  and  given 
them  several  times  each  day,  will  often  improve  the  intestinal  di- 
gestion, change  the  appearance  of  the  stools,  and  increase  the  nu- 
trition of  the  body. 

The  phosphates  are  especially  useful  in  diseases  characterized  by 
mal-nutrition.  In  rickets,  mollifies  ossium,  delayed  union  of  fractures, 
early  decay  of  the  teeth  in  children,  caries  and  necrosis  of  bone,  in 
which  the  phosphate  is  needed  to  the  repair  and  growth  of  the  osseous 
structures,  it  may  be  supplied  artificially.  The  phosphate  of  lime 
may  be  administered  alone  in  these  states,  but  is  to  be  preferred  in 
the  form  of  the  sirup  of  the  lacto-phosphate,  or  of  Parrish's  phosphates. 
As  a  large  consumption  of  the  phosphate  of  lime  takes  place  during 
suckling,  the  anmmia  of  the  nursing  mother  may  be  most  advan- 
tageously treated  with  the  lacto-phosphate  of  lime  or  phosphates. 
The  waste  caused  by  suppuration,  carbuncles,  mammary  abscesses  or 
boils,  may  be  best  repaired  by  the  same  means.  The  constitutional 


240  RESTORATIVE  AGENTS. 

cachexia  produced  by  chronic  bronchitis  with  profuse  expectoration, 
leucorrhcea,  and  similar  exhausting  discharges,  may  be  much  improved 
by  the  phosphates,  and  with  the  general  improvement  of  the  bodily 
state  there  usually  takes  place  an  arrest  of  the  local  morbid  process. 

The  explanation  of  the  therapeutical  action  of  the  phosphates  in  the 
diseases  just  mentioned  is  equally  true  of  their  use  in  phthisis.  The 
utility  of  the  hy pophosphites  in  this  disease  is  not  any  greater,  for  it  is 
probably  true  that  these  preparations  undergo  oxidation  in  the  stomach 
and  pass  to  phosphates.  The  compound  sirup  of  the  hypophosphites 
is  an  agreeable  preparation  and  is  readily  taken,  and  certainly  proves 
serviceable  in  the  more  chronic  forms  of  the  disease.  The  lacto-phos- 
phate,  the  phosphates,  and  the  hypophosphites,  are  undoubtedly  useful 
in  chronic  phthisis,  fibroid  lung,  chronic  tuberculosis,  emphysema,  and 
dilated  bronchi,  but  no  advantage  can  be  expected  from  them  in  acute 
tuberculosis  and  caseous  pneumonia,  and  it  has  been  asserted  that  phos- 
phate of  lime — 5  grains  ter  die — has  the  power  to  stop  the  sweats  of 
phthisis.  If  they  improve  the  appetite,  promote  digestion,  and  increase 
the  body-weight,  they  do  good ;  if  they  disagree  with  the  stomach,  they 
do  harm  (Bennett).  Not  unfrequently  the  sirup  of  the  hypophosphites 
gives  rise  to  distressing  tormina.  This  may  be  obviated  by  combining 
with  it  dilute  phosphoric  acid — a  combination  very  effective,  therapeu- 
tically :  5  Syrp.  hypophos.  comp.,  f  iijss ;  acid,  phosphor,  dil.,  f  ss.  M. 
S.  :  A  teaspoonful  three  times  a  day.  Such  a  combination  may  be 
advantageously  given  with  cod-liver  oil,  after  meals,  in  chronic  phthisis. 
The  addition  of  arsenic  contributes  very  materially  to  the  therapeutical 
effects  of  the  lacto-phosphate  ;  for  example :  IJ  Syrp.  calcii  lacto-phos., 
§  iv  ;  liq.  potassii  arsen.,  3  j.  M.  S. :  A  dessertspoonful  ter  die. 

Late  favorable  reports  regarding  the  curative  effects  of  phosphorus 
and  its  compounds  in  pernicious  ancemia  have  not  been  confirmed  by 
the  most  recent  experience. 

Percy,  who  has  made  some  useful  researches  on  phosphorus,  pre- 
pares hypophosphorous  acid  by  passing  through  a  solution  of  phos- 
phorus in  oil,  perfectly  pure  and  dry  oxygen.  He  maintains  that  hy- 
pophosphorous acid  is  the  only  preparation  of  phosphorus  which  should 
be  employed  in  medicine. 

Further  experience  with  the  phosphate  of  soda  justifies  the  author 
in  the  expression  of  his  belief  that  it  has  the  power  to  retard  the  growth 
of  the  changes  known  as  sclerosis  of  the  liver,  and  possibly,  under 
favorable  circumstances,  to  arrest  them  and  to  restore  a  comparatively 
normal  functional  state.  When,  in  obese  subjects,  a  succession  of  boils 
portends  the  development  of  diabetes,  this  remedy  is  highly  useful 
especially  when  combined  with  the  arseniate  of  soda.  It  has  seemed 
very  beneficial  in  the  hepatic  form  of  diabetes.  No  remedy  is  more 
effective  in  removing  that  condition  of  the  system  which  produces 
furuncles,  or  boils. 


IRON.  141 


IRON   AND   ITS  PREPARATIONS. 

Fermm. — Fer,  Fr.  ;  Eisen,  Ger.  "  In  the  form  of  fine,  bright,  non- 
elastic  wire." 

Ferrum  Reductum. — Reduced  iron.  Ferri  pulvis.  A  tasteless 
powder  of  an  iron-gray  color.  Dose,  gr.  ss — gr.  ij. 

Ferri  Carbonas  Saccharatus. — Saccharated  ferrous  carbonate.  A 
greenish-gray  powder,  odorless,  having  at  first  a  sweetish,  afterward 
a  slightly  ferruginous  taste.  It  is  only  partially  soluble  in  water. 
Dose,  gr.  ij. 

Trochisci  Ferri. — Troches  of  hydrated  oxide  of  iron.  Composition  : 
Hydrated  oxide  of  iron,  vanilla,  sugar,  and  mucilage  of  tragacanth. 
Dose,  one  to  five. 

Ferri  Oxidum  Hydratum. — Ferric  hydrate.  Kept  in  the  form  of 
a  soft  magma  and  used  as  an  antidote  to  arsenic. 

Ferri  Oxidum  Hydratum  cum  Magnesia. — Ferric  hydrate  with 
magnesia.  (For  arsenical  poisoning.) 

Pilulce  Ferri  Carbonatis. — Pills  of  carbonate  of  iron.  Blaud's 
pills.  Contain  ferrous  sulphate,  potassium  carbonate,  sugar,  althaea, 
etc.  Dose,  one  to  three  pills. 

Massa  Ferri  Carbonatis. — Mass  of  ferrous  carbonate  (Vallet's 
mass).  Ferrous  sulphate,  sodium  carbonate,  honey,  sugar,  etc.  Dose, 
gr.  iij— gr.  v. 

Mistura  Ferri  Composita. — Griffith's  compound  mixture  of  iron. 
Composition  :  Myrrh,  sugar,  potassium  carbonate,  ferrous  sulphate, 
spirit  of  lavender,  rose-water.  Dose,  a  tablespoonful. 

Emplastrum  Ferri. — Iron-plaster,  strengthening-plaster.  Compo- 
sition :  Subcarbonate  of  iron,  lead-plaster,  and  Burgundy  pitch. 

Ferri  HypophospTiis. — Ferric  hypophosphite.  A  white  or  grayish- 
white  powder,  odorless  and  nearly  tasteless,  only  slightly  soluble  in  water. 

Ferri  Phosphas  Solubilis. — Soluble  ferric  phosphate.  In  bright- 
green,  transparent  scales,  freely  soluble  in  water.  Dose,  gr.  ij — gr.  v. 

Ferri  Pyrophosphas  Solubilis. — Soluble  ferric  pyrophosphate.  In 
apple-green  scales,  having  an  acidulous,  slightly  saline  taste,  and  wholly 
soluble  in  water.  Dose,  gr.  ij — gr.  v. 

Ferri  Sulphas. — Ferrous  sulphate.  In  transparent,  bluish-green 
crystals,  which,  on  exposure  to  the  air,  effloresce  and  change  color.  Is 
wholly  soluble  in  water.  Dose,  gr.  j — gr.  iij. 

Ferri  Sulphas  Exsiccatus. — Dried  ferrous  sulphate.  A  grayish- 
white  powder,  soluble  in  water  with  the  exception  of  a  small  residue. 
Dose,  gr.  j— gr.  ij. 

Ferri  Sulphas  Granulatus. — Granulated  ferrous  sulphate.  A  pale, 
bluish-green  powder ;  oxidizes  in  contact  with  moisture  ;  soluble  in 
1*8  part  of  water  at  60°  Fahr.  Dose,  gr.  ij — gr.  v. 

Liquor  Ferri  Subsulphatis. — Solution  of  ferric  subsulphate.    Mon- 


142  RESTORATIVE   AGENTS. 

sel's  solution.  Composition  :  Sulphate  of  iron,  sulphuric  acid,  nitric 
acid.  An  inodorous,  sirupy  liquid,  of  a  ruby-red  color,  and  of  an  ex- 
tremely astringent  taste,  without  causticity.  It  mixes  with  water  and 
alcohol,  in  all  proportions,  without  decomposition. 

Liquor  Ferri  Tersulphatis. — Solution  of  ferric  sulphate.  Compo- 
sition :  Same  as  preceding  preparation,  except  the  quantity  of  acid. 
A  dark,  reddish-brown  liquid,  nearly  devoid  of  odor,  and  of  an  acid 
and  extremely  styptic  taste. 

Ferri  Chloridum. — Ferric  chloride.  In  orange-yellow,  crystal- 
line pieces,  very  deliquescent,  and  wholly  soluble  in  water,  alcohol, 
and  ether.  Dose,  gr.  j — gr.  ij. 

Liquor  Ferri  Chloridi. — Solution  of  ferric  chloride. 

Tinctura  Ferri  Chloridi. — Tincture  of  ferric  chloride.  Compo- 
sition :  Solution  of  chloride  of  iron,  alcohol.  Dose,  m  v — m  xx. 

Liquor  Ferri  Nitratis. — Solution  of  ferric  nitrate.  A  transparent 
liquid,  having  a  pale  amber  color.  Dose,  m,  ij — m  v. 

Syrupus  Ferri  lodidi. — Sirup  of  ferrous  iodide.  A  transparent 
liquid  of  a  pale-green  color.  Composition  :  Iodine,  iron,  sirup.  Dose, 
m,  x — T\[  Ix. 

Pilulce  Ferri  lodidi. — Pills  of  ferrous  iodide.  Composition  :  Iodine, 
iron,  sugar,  licorice,  and  gum  arabic.  Dose,  one  to  three  pills. 

Ferri  lodidum  Saccharatum. — Saccharated  ferrous  iodide.  Dose, 
gr.  j— gr.  v. 

Liquor  Ferri  Citratis. — Solution  of  ferric  citrate.  Used  in  the 
preparation  of  ferri  citras  and/erri  et  ammonii  citrus. 

Ferri  Citras. — Ferric  citrate.  "Transparent,  garnet-red  scales, 
odorless,  and  having  a  very  faint  ferruginous  taste  and  an  acid  reac- 
tion ;  slowly  but  completely  soluble  in  cold  water." 

Ferri  et  Ammonii  Citras. — Iron  and  ammonium  citrate.  In  gar- 
net-red, translucent  scales,  having  a  slightly  ferruginous  taste,  and 
readily  and  wholly  soluble  in  water.  Dose,  gr.  ij — gr.  v. 

Ferri  et  Ammonii  Sulphas. — Iron  and  ammonium  sulphate.  Am- 
monio-ferric  alum.  In  octahedral  crystals  of  a  pale  violet  color, 
soluble  in  one  and  a  half  part  of  water  at  60°.  Dose,  gr.  j — gr.  ij. 

Ferri  et  Ammonii  Tartras. — Iron  and  ammonium  tartrate.  In 
transparent,  garnet-red  scales,  which  have  a  saccharine  taste.  It  is 
slowly  soluble  in  rather  more  than  its  weight  of  water,  but  insoluble 
in  alcohol  and  ether.  Dose,  gr.  ij — gr.  v. 

Ferri  et  Potassii  Tartras.  Iron  and  potassium  tartrate.  In  trans- 
parent scales,  of  a  dark  ruby-red  color,  and  wholly  soluble  in  water. 
Dose,  gr.  ij — gr.  v. 

Ferri  et  Quinince  Citras. — Iron  and  quinine  citrate.  In  thin,  trans- 
parent scales,  reddish  or  yellowish  brown.  Taste  ferruginous  and  bit- 
ter. Slowly  soluble  in  cold,  more  readily  in  hot  water,  and  not  soluble 
in  alcohol  and  ether.  Dose,  gr.  j — gr.  v. 


IRON.  143 

Ferri  et  Quinince  Citratis  Solubilis. — Soluble  iron  and  quinine 
citrate.  Thin,  transparent  scales,  of  a  greenish  golden-yellow  color, 
without  odor,  and  having  a  bitter,  mildly  ferruginous  taste.  Rapidly 
and  completely  soluble  in  cold  water.  Dose,  gr.  j — gr.  v. 

Liquor  Ferri  et  Quinince  Citratis. — Solution  of  iron  and  quinine 
citrate.  Contains  6  per  cent  of  quinine. 

Ferri  et  Strychnince  Citras. — Iron  and  strychnine  citrate.  Con- 
tains one  grain  of  strychnine  to  100  grains  of  the  compound.  Dose, 
gr.  j— gr.  iij. 

Liquor  Ferri  Acetatis. — Solution  of  ferric  acetate. 

Tinctura  Ferri  Acetatis. — Tincture  of  ferric  acetate.  A  clear, 
dark,  reddish-brown  liquid,  having  the  odor  of  acetic  ether,  an  acidu- 
lous and  astringent  taste,  and  mixes  with  water  in  all  proportions. 
Dose,  Til  x  to  3  ij. 

Ferri  Lactas. — Ferrous  lactate.  In  greenish-white  crystalline  crusts 
or  grains,  of  a  mild,  sweetish,  ferruginous  taste,  soluble  in  forty-eight 
parts  of  cold  water,  but  insoluble  in  alcohol.  Dose,  gr.  ij — gr.  x. 

Ferri  Valerianas. — Ferric  valerianate  ;  a  dark  brick-red,  amor- 
phous powder,  insoluble  in  water.  Dose,  gr.  ij — gr.  v. 

Vinum  Ferri  Amarum. — Bitter  wine  of  iron  (soluble  iron  and 
quinine  citrate,  tincture  of  sweet  orange-peel,  sirup,  and  white  wine). 
Dose,  a  teaspoonful  to  a  tablespoonful. 

Vinum  Ferri  Citratis. — Wine  of  ferric  citrate.  Dose,  a  teaspoon- 
ful to  a  tablespoonful. 

Liquor  Ferri  et  Ammonii  Acetatis. — Solution  of  iron  and  am- 
monium acetate  (Basham's  mixture).  Contains  tincture  of  ferric  chlo- 
ride, solution  of  ammonium  acetate,  diluted  acetic  acid,  aromatic  elixir, 
glycerin,  and  water.  Dose,  3  j —  3  ij. 

Ferropyrine. — A  combination  of  ferric  chloride  and  antipyrin.  It 
contains  12  parts  of  iron,  24  parts  chlorine,  and  64  parts  of  antipyrine. 
It  is  a  dry,  orange-red  powder  which  is  soluble  in  5  parts  of  cold 
water  and  9  parts  of  boiling  water,  in  alcohol  and  benzene.  The  dose 
ranges  from  five  to  fifteen  grains  in  pill,  powder,  in  solution,  or  wafer. 
It  is  employed  externally  as  an  antiseptic  ;  internally  as  an  analgesic. 
It  is  used  in  anaemia,  migraine,  and  locally  in  gonorrhoea.  (Unofficial.) 

Mistura  Ferri  Laxans. — Composition  :  Sulphate  of  iron,  2  grains  ; 
sulphate  of  magnesia,  1  drachm  ;  dilute  sulphuric  acid,  3  minims  ; 
spirit  of  chloroform,  20  minims  ;  peppermint-water,  to  1  oz.  (Squire). 

Ferrum  Dialysatum. — Dialyzed  iron.  This  preparation  is  made  by 
the  process  of  diffusion,  and  is  iron  in  the  colloid  state.  It  is  odorless, 
without  the  styptic  taste  of  the  ferruginous  preparations,  does  not 
blacken  the  tongue  and  teeth,  is  free  from  irritant  action,  and  does 
not  constipate.  It  is  precipitated  by  sulphuric  acid,  by  acids,  and  by 
various  salts,  but  neither  by  alcohol  nor  sugar.  It  is  doubtful  whether 
it  be  a  good  form  in  which  to  administer  iron.  Dose,  t\[  v —  3  j.  If 


j44  RESTORATIVE  AGENTS. 

any  given  preparation  has  a  styptic  taste,  and  acts  on  the  tongue  and 
teeth,  it  is  not  genuine. 

Reduced  iron  is  one  of  the  most  useful  ferruginous  preparations  for 
internal  administration,  comparatively  tasteless,  and  therefore  easy  of 
administration,  and  readily  soluble  in  the  juices  of  the  stomach.  The 
objection  to  its  use  is  the  occurrence  of  eructations,  sulphureted  or 
phosphureted,  owing  to  the  oxidation  of  the  iron,  the  evolution  of 
hydrogen,  and  the  combination  of  the  nascent  hydrogen  with  sulphur 
or  phosphorus. 

The  so-called  subcarbonate  of  iron  is  really  little  more  than  the  red 
oxide.  In  the  official  pilulse  ferri  carbonatis,  the  oxidation  of  the  iron 
and  the  loss  of  carbonic  acid  are  prevented  by  the  sugar.  This  prepa- 
ration is  very  soluble  in  the  stomach-juice,  and  is  readily  assimilated. 
The  troches  of  carbonate  of  iron  are  convenient  for  administration  to 
children,  who  take  them  readily.  The  hydrated  oxide  of  iron  is  solely 
used  as  the  antidote  to  arsenic  in  solution.  For  remarks  on  its  admin- 
istration I  have  to  refer  the  reader  to  the  article  on  Arsenic.  Corre- 
sponding to  these  carbonates  are  the  pilulse  ferri  composite,  which 
contain  iron  in  the  form  of  the  carbonate,  sulphate  of  soda,  and  myrrh. 
The  mistura  ferri  composita  is  also  a  solution  of  the  carbonate,  con- 
tains myrrh  and  sulphate  of  potash,  with  a  sufficient  quantity  of  the 
latter  to  form  an  emulsion  which  suspends  the  iron. 

Of  the  phosphates  the  better  preparation  is  the  pyrophosphate, 
which  is  readily  soluble,  unirritating,  and  easily  assimilable.  The  sul- 
phate is  an  active  astringent,  and  is  an  efficient  remedy.  When  pre- 
scribed in  pillular  form  the  dried  sulphate  should  be  used,  as  the  sul- 
phate in  efflorescing  destroys  the  cohesion  of  the  mass.  Of  the  several 
solutions  intended  for  topical  use,  the  liquor  ferri  subsulphatis,  or 
Monsel's  solution,  is  the  best,  as  it  is  powerfully  styptic  without  being 
corrosive.  The  tincture  of  the  chloride  of  iron  is  most  agreeably  taken 
in  the  form  of  Creuse's  tasteless  preparation,  which  appears  to  be  an 
efficient  chalybeate  without  possessing  the  causticity  of  the  pharma- 
ceutical preparation.  In  the  sirup  of  the  iodide  of  iron  and  the  sirup 
of  the  iodides  of  iron  and  manganese,  sugar  is  used  to  prevent  oxida- 
tion of  the  iron  and  the  setting  free  of  the  iodine.  In  the  iodide-of- 
iron  pill  the  same  result  is  obtained  by  sugar  or  gelatin  coating. 

Less  irritating  to  the  stomach,  but  probably  less  efficient  as  chalyb- 
eates,  are  the  combinations  of  iron  with  vegetable  acids.  These  may 
be  administered  dissolved  in  Rhine,  Catawba,  or  sherry  wine.  An 
elegant  mode  of  prescribing  them  is  in  effervescence — the  citrates  or 
tartrates  dissolved  in  a  solution  of  citric  or  tartaric  acid,  and  poured 
into  a  solution  of  sodium  or  potassium  bicarbonate — to  be  drunk  in 
effervescence. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  carbonates  are  incompati- 
ble with  acids  and  acidulous  salts  and  vegetable  astringents  ;  the 


IRON.  145 

citrates  and  tartrates  with  mineral  acids,  alkalies  and  their  carbonates, 
tannic  acid  ;  the  iodides  with  acids,  acidulous  salts,  alkalies  and  their 
carbonates,  lime-water,  vegetable  astringents  ;  the  tincture  of  the 
chloride,  with  alkalies  and  their  carbonates,  lime-water,  carbonate  of 
lime,  magnesia  and  its  carbonate,  and  astringent  vegetables  turn  it 
black. 

SYNERGISTS. — All  agents  promoting  constructive  metamorphosis  are 
synergistic  to  iron,  especially  animal  aliment,  the  simple,  aromatic,  and 
astringent  bitters,  cinchona,  manganese,  bismuth,  etc. 

PHYSIOLOGICAL  ACTIONS. — Although  metallic  iron  is  inert,  yet  in 
the  stomach  it  enters  into  combination  dissolved  in  the  acids,  and 
then  acquires  molecular  activity.  As  a  result  of  its  oxidation  in  the 
stomach,  hydrogen  is  liberated,  which  in  its  nascent  state  combines 
with  sulphur,  forming  sulphureted  hydrogen.  In  part,  iron  is  ab- 
sorbed by  the  stomach,  probably  as  an  albuminate  ;  in  part,  in  the 
intestinal  canal.  The  stools  under  a  course  of  iron  become  brownish 
and  even  black,  a  result  which  indicates  that  a  part  of  the  metal  taken 
fails  to  be  absorbed  ;  but,  since  it  has  been  shown  that,  whether  taken 
by  the  stomach  or  injected  into  the  blood,  elimination  takes  place  by 
the  intestinal  canal,  it  remains  uncertain  how  much  is  excreted  or  is 
merely  discharged  unaltered  in  the  faeces. 

Iron  is  not  a  substance  foreign  to  the  organism.  Chemical  analysis 
has  demonstrated  its  constant  presence  in  the  blood,  in  the  gastric  juice, 
chyle,  lymph,  bile,  in  the  pigment  of  the  eye,  and  in  traces  in  the  milk 
and  urine.  According  to  Gorup-Basanez  (analysis  of  C.  Schmidt),  the 
blood  of  man  contains  one  part  of  iron  to  230  of  red  globules,  and  that 
of  beef  one  part  of  iron  to  194  of  red  globules.  Iron  exists  in  com- 
bination in  hsematin  ;  according  to  some  in  the  state  of  oxide,  accord- 
ing to  others  as  metallic  iron.  That  it  performs  a  very  important  office 
is  shown  in  the  rapid  construction  of  red  blood-globules  when  iron  is 
administered  in  anaemia.  Without  it  haematin  is  not  formed,  and  the 
red  globules  diminish  in  number.  By  its  medicinal  use  we  furnish  to 
the  blood  a  material  which  it  needs.  In  health  a  mixed  diet  contains 
sufficient  iron  for  all  the  purposes  of  the  economy.  The  blood  being 
improved  in  quality  by  the  administration  of  iron,  the  tissues  are  better 
nourished,  and  all  the  functions  are  performed  with  more  vigor. 

The  physiological  action  of  iron  is  not  limited  merely  to  the  con- 
struction of  red  blood.  When  there  is  no  intolerance  to  its  presence 
in  the  stomach,  it  promotes  the  appetite  and  invigorates  the  digestion. 
By  increasing  the  disposition  for  food  and  the  ability  to  dispose  of  it, 
iron  acts  as  a  stomachic  tonic.  Hence,  when  given  in  the  healthy 
state,  or  when  administered  for  too  long  a  period  in  disease,  the  gas- 
tric glands  become  exhausted  by  over-stimulation,  and  then  it  is  said 
the  iron  disagrees.  Being  a  restorative,  its  use  is  contraindicated  in  a 
condition  of  plethora,  especially  when  there  exists  a  tendency  to  hsem- 


146  RESTORATIVE   AGENTS. 

orrhao-e,  or  when  there  is  reason  to  suspect  an  atheromatous  state  of 
the  cerebral  vessels. 

In  large  doses  the  soluble  preparations  of  iron  give  rise  to  nausea 
and  vomiting.  Some  of  them  possess  more  or  less  toxic  activity  ;  the 
per-salts  are  more  active  than  the  proto-salts.  The  iodide  and  chloride, 
the  nitrate  and  sulphate,  are  the  most  active,  death  having  ensued 
from  the  tincture  of  the  chloride  in  one  case  (Christison),  and  alarm- 
ing symptoms  having  occurred  in  others  (Taylor). 

Certain  of  the  salts  of  iron,  the  sulphates,  the  nitrates,  the  chlo- 
rides, possess  a  high  degree  of  astringency.  Hence  they  produce  con- 
stipation when  taken  internally.  Brought  into  contact  with  blood, 
they  coagulate  it,  forming  a  tough,  brownish  magma  ;  and,  as  the  al- 
buminous elements  of  the  tissues  are  also  solidified,  they  are  powerful 
haemostatics. 

Iron  is  eliminated  by  several  channels.  Its  passage  down  the  in- 
testinal canal  and  exit  by  this  route  have  already  been  alluded  to.  As 
the  experiments  of  Lussana  have  shown,  a  large  part  of  the  iron  which 
enters  the  portal  circulation  is  eliminated  by  the  liver  in  the  bile,  and 
this  view  is  further  supported  by  the  recently  made  investigations  of 
Zaleski,  of  Dorpat.  But  a  small  part  of  the  iron  taken,  therefore, 
finally  enters  the  systemic  circulation,  and  of  this,  the  part  unappro- 
priated in  tissue  or  blood-globule  formation  is  finally  eliminated  by 
the  kidneys. 

The  acid  and  astringent  preparations  of  iron  act  on  the  teeth  with 
considerable  energy,  as  the  experiments  of  Dr.  Smith  (of  Edinburgh) 
prove. 

The  tincture  of  the  chloride  and  the  sulphate  are  more  corrosive 
than  the  wine,  and  of  course  are  more  injurious  than  the  compounds 
of  iron  with  the  vegetable  acids. 

THEKAPY. — Iron-spray — a  weak  solution  of  the  liquor  ferri  subsul- 
phatis  (  3  j —  §  viij) — is  very  serviceable  as  an  astringent  in  obstinate 
cases  of  epistaxis.  The  nozzle  of  the  delivery-tube  of  the  spray-douche 
should  be  inserted  just  within  the  anterior  nares,  and  the  spray  be 
driven  with  considerable  force.  The  «ame  application  is  beneficial  in 
chronic  coryza,  but  the  objection  to  its  use  is  the  danger  of  coloring 
the  teeth.  In  pulmonary  hmmorrhage,  the  same  application  made  to 
enter  the  throat  with  the  inspired  air  will  often  arrest  the  flow  of  blood  ; 
and  this,  notwithstanding  so  little  iron  can  pass  the  chink  of  the  glottis. 

The  subsulphate  and  pernitrate  solutions  are  the  most  efficient 
remedies  for  arresting  hcematemesis.  They  should  be  given  in  small 
doses — one  or  two  drops,  well  diluted  with  ice-water,  and  frequently. 
In  the  absence  of  these,  the  tincture  of  the  chloride  may  be  used  in  the 
same  way.  In  intestinal  hcemorrhage  the  astringent  preparations  of 
iron  are  much  less  beneficial,  if,  indeed,  they  serve  any  useful  purpose 
— for  they  are  converted  into  inert  sulphides  as  they  descend  the  canal 


IRON.  147 

The  author  has  seen  the  intestinal  haemorrhage  of  typhoid  fever  much 
increased  by  the  rectal  injection  of  a  solution  of  Monsel's  salt.  The 
bleeding  from  hcemorrhoids  may  be  much  diminished  and  even  arrested 
by  washing  the  tumors,  when  they  protrude,  with  the  solution  of  the 
subsulphate.  After  the  application  of  the  iron,  the  tumors  should  be 
well  oiled  before  returning  them  into  the  rectum.  The  solution  of  the 
pernitrate  of  iron  has  been  very  efficacious  as  an  astringent  in  chronic 
diarrhoea,  and  dysentery ',  in  that  known  as  the  army  diarrhoea.  These 
diseases,  as  they  occur  in  civil  practice,  may  sometimes  be  arrested  by 
this  agent,  but  not  usually,  in  the  author's  experience.  A  solution  of 
the  tincture  of  iron  is  one  of  the  numerous  remedies  used  to  destroy 
the  ascarides  vermiculares — the  thread-worms  which  infest  the  rectum. 
As  the  development  of  these  parasites  is  favored  by  the  anaemic  state, 
it  is  good  practice  to  conjoin  with  any  local  treatment  the  internal  use 
of  iron,  notably  the  sirup  of  the  iodide. 

Iron  is  frequently  given  with  advantage  to  promote  appetite  and 
digestion  merely.  Indeed,  it  is  the  opinion  of  some  eminent  authori- 
ties that  the  chief  use  of  iron  as  a  remedy,  even  in  anaemia,  is  to  pro- 
mote the  digestive  function.  For  the  purpose  of  increasing  appetite 
and  energizing  digestion,  the  sulphate  is  the  best  chalybeate,  unless, 
indeed,  the  mucous  membrane  prove  intolerant.  When  digestion  is 
feeble,  and  the  intestinal  movements  sluggish,  it  is  often  advantageous 
to  combine  aloes  with  iron,  as  in  the  official  aloes-and-iron  pill,  or  with 
sulphate  of  magnesia,  as  in  the  mistura  ferri  laxans,  the  formula  for 
which  has  been  given. 

The  condition  most  usually  requiring  iron  is  ancemia,  a  deficiency 
not  only  of  the  haematin  but  of  the  red  corpuscles.  Iron  is  given  in 
this  state  with  the  view  of  supplying  to  the  organism  a  material  in 
which  it  is  deficient,  and  in  this  way  promoting  the  construction  of  the 
red  globules.  As,  however,  food,  especially  beef,  is  rich  in  iron,  and 
as  but  a  small  amount  of  that  administered  is  really  assimilated,  there 
is  much  reason  for  holding  that  at  least  an  important  function  of  iron 
in  anaemia  consists  in  its  power  to  promote  appetite  and  digestion. 
Practical  physicians  are  familiar  with  the  fact  that  iron  improves  but 
little,  if  at  all,  the  condition  of  the  anaemic,  when  it  does  not  increase 
the  desire  for  food  and  the  ability  to  digest  it.  In  anaemia,  iron  is 
given  with  two  objects  :  to  furnish  a  needed  material  to  the  blood  ;  to 
increase  the  energy  of  the  primary  assimilation.  To  accomplish  the 
first  object,  small  doses — one  or  two  grains — of  reduced  iron  or  of  the 
carbonates,  or  some  one  of  the  combinations  with  vegetable  acids,  are 
most  suitable.  The  second  object  is  best  attained  by  the  more  active 
astringent  preparations,  especially  the  sulphate  and  the  chloride.  Large 
doses  of  these  are  frequently  well  borne.  When  they  disagree,  other 
salts  may  be  tried,  but  preference  should  be  given  to  the  most  astrin- 
gent preparation  which  the  patient's  stomach  will  tolerate. 
12 


!48  RESTORATIVE   AGENTS. 

In  chlorosis,  the  good  effects  of  iron  are  not  so  conspicuous  as  in 
anaemia,  although  they  are  allied  states.  During  a  course  of  iron  in 
chlorosis,  purgatives  are  now  and  then  necessary.  Better  results  are 
obtained  from  a  combination  of  iron  and  arsenic,  and  iron  and  strychnine, 
than  from  iron  alone.  The  arseniate  of  iron  is  an  excellent  remedy  in 
chlorosis,  but  it  must  be  given  in  larger  doses  than  the  posological 
tables  authorize,  for  it  is  by  no  means  so  actively  toxic  as  is  commonly 
supposed.  A  good  formula  is  the  following  :  IJ  Ferri  arseniat.,  gr. 
ij  ;  ext.  cinchonae,  gr.  xij.  M.  Ft.  pil.  no.  xij.  Sig.  :  One  three  times 
a  day  after  meals. 

In  anaemia  and  chlorosis,  the  iron  should  be  taken  after  meals  to  be 
mixed  with  the  food.  The  preparations  of  iron  should  not  be  continued 
too  long  ;  occasional  intermissions  in  their  use  are  necessary,  otherwise 
the  digestive  organs  become  deranged,  and  the  good  effects  are  lost. 
Occasional  purgation  is  useful,  and  acts  in  a  way  to  favor  the  absorp- 
tion and  assimilation  of  the  iron.  Air  and  exercise  should  always,  if 
practicable,  be  prescribed  in  a  ferruginous  course,  for  the  assimilation 
of  iron  is  directly  favored  by  these  hygienic  influences. 

The  anaemia  of  chronic  malarial  poisoning  is  especially  improved 
by  iron.  If  enlargement  of  the  spleen  and  engorgement  of  the  portal 
circulation  co-exist,  the  use  of  the  compound  jalap-powder  should  pre- 
cede the  iron  ;  or  the  latter  may  be  combined  advantageously  with 
resin  of  podophyllin,  as  follows  :  $  Quininae  sulphat.,  3  j  ;  resinae 
podophylli,  gr.  iv  ;  ferri  sulphatis  exsic.,  3  j.  M.  Ft.  pil.  no.  xx. 
Sig.  :  One  or  two  pills  three  times  a  day. 

According  to  some,  massa  ferri  carbonatis  is  preferable  to  the 
sulphate  ;  it  is  certainly  sometimes  better  borne.  IJ,  Mas.  ferri  carbo- 
natis, 3  j  ;  acidi  arseniosi,  gr.  j  ;  quininae  sulph.,  $  ij.  M.  Ft.  pil.  no. 
xl.  Sig.  :  Two  pills  three  times  a  day.  In  enlarged  spleen  of  malarial 
origin,  a  combination  of  sulphate  of  iron  with  sulphate  of  quinine  is 
generally  preferred.  IJ  Quininae  sulphat.,  3  ij  ;  ferri  sulphat.  exsic., 
3  SB.  M.  Ft.  pil.  no.  xxx.  Sig. :  One  pill  three  times  a  day,  or 
four  or  five  during  the  day. 

Although  the  preparations  of  iron  are  of  little  service  in  leucocy- 
thcemia,  they  are  certainly  in  a  high  degree  useful  in  pseudo-leucocy- 
thcemia,  or  cachexia  of  the  spleen.  In  the  latter  disease  the  relative 
number  of  blood-corpuscles  may  be  greatly  reduced,  but  they  can  be 
increased  in  number  and  raised  to  the  normal  by  the  use  of  those 
materials  needed  by  the  blood-making  organs,  especially  by  the  use 
of  iron. 

In  syphilitic  cachexia,  the  preparations  of  the  iodide  of  iron  possess 
a  high  degree  of  utility.  In  sloughing  phagedena,  or  simple  chancroid, 
the  iodide  is  frequently  prescribed  when  these  accidents  occur  in  debili- 
tated constitutions.  Some  authorities  prefer  the  tartrate  of  iron  under 
these  circumstances,  but  the  iodide  acts  with  more  promptness  and 


IRON.  149 

vigor.  In  the  treatment  of  constitutional  syphilis,  the  ferruginous  prep- 
arations are  only  useful  in  so  far  as  they  may  be  applied  to  promote 
constructive  metamorphosis.  More  commonly  than  is  supposed  by  the 
advocates  of  special  plans  of  treatment,  tonic  remedies,  especially  cha- 
lybeates,  exercise  a  most  favorable  influence  over  the  course  and  dura- 
tion of  syphilis.  I>  lodoformi,  3  j  ;  hydrargyri  chloridi  corrosiv.,  gr. 
j  ;  ferri  redacti,  3j.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill  three  times 
a  day.  $  lodoformi,  chinoidin.,  ferri  redacti,  aa  3  j.  M.  Ft.  pil.  no. 
xx.  Sig. :  One  pill  three  times  a  day. 

Iron  is  one  of  the  remedies  most  useful  in  the  treatment  of  acute 
rheumatism.  As  was  originally  suggested  by  Reynolds,  the  tincture 
of  the  chloride  is  most  serviceable.  It  is  more  especially  adapted  to 
the  treatment  of  pale,  delicate,  and  cachectic  subjects,  and  is  much 
less  beneficial,  if  not  positively  harmful,  in  the  plethoric  and  overfed. 
Given  in  suitable  cases,  the  tincture  of  iron,  in  doses  of  m,  xx — x*x 
every  four  hours,  diminishes  the  pain,  fever,  and  sweats,  lessens  the 
chances  of  cardiac  mischief,  and  hastens  convalescence.  By  retarding 
waste  and  favoring  excretion  of  uric  acid  through  the  kidneys,  the 
duration  of  the  disease  is  shortened  and  a  tedious  convalescence  is  pre- 
vented. We  owe  to  Dr.  Anstie  the  important  suggestion  that  tinc- 
ture of  chloride  of  iron  may  be  used  successfully  as  a  prophylactic 
against  acute  rheumatism.  Here,  again,  the  author  must  state,  as  a 
result  of  his  personal  observation,  that  such  prophylactic  treatment  is 
very  useful  in  weak  and  cachectic  subjects  and  not  applicable  to  the 
robust  and  full-blooded.  The  tincture  of  iron  should  be  administered 
without  delay  in  such  weak  subjects  with  a  rheumatic  history,  when 
they  complain  of  lassitude,  muscular  pains,  sore  joints,  furred  tongue, 
although  they  are  yet  free  from  fever  and  joint-swellings. 

The  treatment  of  erysipelas  by  large  doses  (in  x —  3  j  every  four 
hours)  of  tincture  of  chloride  of  iron  is  now  very  generally  adopted. 
It  is  questionable  whether  this  practice  is  directly  beneficial.  Its  utility 
depends  chiefly  on  the  support  which  it  affords  to  the  organism  while 
laboring  under  a  debilitating  disease,  and,  as  an  abundant  supply  of 
aliment  is  prescribed  with  the  iron,  it  is  impossible  to  estimate  in  any 
given  case  how  far  the  result  may  be  attributable  to  the  remedy. 

Influenced  by  the  same  considerations,  the  tincture  of  iron  is  fre- 
quently prescribed  in  diphtheria,  alone  or  in  combination  with  chlorate 
of  potassa.  Although  it  possesses  no  special  utility  in  this  disease,  it 
may  serve  as  one  of  the  means  for  maintaining  the  forces  of  the  body, 
and  in  this  way  indirectly  contribute  to  a  favorable  result.  There  is 
no  advantage  in  applying  the  tincture  of  iron  to  the  fauces  in  diph- 
theria ;  it  is  not  a  solvent  of  the  false  membrane,  and  can  not  prevent 
the  spread  of  the  exudation  ;  it  is,  however,  now  freely  used,  and  it  is 
said  with  good  results. 

In  the  treatment  of  scrofula,  strumous  enlargement  of  the  cervical, 


150  RESTORATIVE  AGENTS. 

inguinal,  and  mesenteric  glands,  and  in  rickets,  the  preparations  of  iron 
occupy  a  most  important  place.  In  these  affections  the  sirup  of  the 
iodide  of  iron  is  generally  preferred,  and  excellent  results  are  obtained 
from  a  combination  of  phosphate  of  iron  and  phosphate  of  lime,  espe- 
cially in  rickets.  In  these  cases,  also,  the  sirup  of  the  iodides  of  iron 
and  manganese  is  indicated.  Iron  is  one  of  the  remedies  most  fre- 
quently prescribed  in  chronic  tuberculosis,  but  it  has  no  special  influ- 
ence over  the  deposition  of  tubercle.  It  helps  to  a  better  state  of  the 
blood-making  process,  and,  by  promoting  the  constructive  metamor- 
phosis, hinders  the  progress  of  the  malady. 

As  neuralgia  so  often  depends  on  anaemia,  it  happens  that  iron  is 
one  of  the  most  frequently  prescribed  remedies  for  this  disease.  Anstie 
prefers  large  doses  (m  xxx — xl  ter  die)  of  the  tincture  of  the  chloride, 
and  twenty-grain  doses  of  the  saccharated  carbonate  twice  or  three 
times  a  day. 

In  disorders  of  the  mind,  either  dependent  on  or  increased  by  an 
anremic  state,  iron  is  often  useful.  In  chronic  mania  and  melancholia, 
when  debility  is  present,  iron  is  employed  as  a  restorative  agent.  The 
ferruginous  preparations  are  especially  useful  in  the  anaemic  forms  of 
puerperal  mania,  and  in  the  insanity  of  lactation.  Bucknill  and  Tuke 
prefer  the  tincture  of  the  chloride  in  these  affections. 

Iron  has  been  much  used  in  the  epilepsy  of  weak  and  anaemic  sub- 
jects, but  it  seems  to  the  author  to  be  more  hurtful  than  beneficial,  as 
a  rule,  yet  he  has  seen  excellent  results  from  a  combination  of  bromide 
of  iron  and  bromide  of  potassium  in  such  cases  :  JJ  Potassii  bromidi, 
|  j  ;  f  erri  bromidi,  gr.  iv  ;  aquae,  §  ij  ;  syrup,  simplicis,  §  vj.  M. 
Sig. :  A  tablespoonful  bis  die. 

Large  doses  of  subcarbonate  of  iron  have  long  been  used  with  ad- 
vantage in  chorea.  When  the  subject  of  this  disease  is  distinctly 
anaemic,  iron,  in  some  of  its  forms,  is  unquestionably  serviceable,  and 
its  utility  is  often  increased  by  combination  with  purgatives.  When 
anaemia  is  not  present,  arsenic  is  preferable  to  iron.  Chorea  arising 
from  moral  causes  (anger,  fright,  etc.),  and  from  pregnancy,  is  not 
benefited  by  iron.  This  remedy  is  especially  adapted  to  the  chorea  of 
anaemic  girls  about  the  age  of  puberty. 

The  preparations  of  iron  are  of  course  inadmissible  in  acute  affec- 
tions of  the  respiratory  organs,  but,  in  certain  of  the  chronic  forms 
and  stages  of  these  diseases,  some  of  the  chalybeates  are  very  useful. 
In  chronic  bronchitis,  with  free  expectoration,  the  mistura  ferri  com- 
posita  has  long  been  used  with  advantage.  At  the  present  time  the 
phosphate  of  iron,  quinine,  and  strychnine,  is  generally  preferred  in 
chronic  bronchitis,  in  the  chronic  forms  of  phthisis,  in  emphysema, 
and  in  humid  asthma.  Iron  is  contraindicated  when  pulmonary 
haemorrhage  exists  or  is  threatened.  A  combination  of  tincture  of 
digitalis  and  tincture  of  chloride  of  iron  abates  the  temperature  and 


IRON.  151 

diminishes  the  sweats  of  hectic  fever.  I£  Tinct.  digitalis,  3  iij  ; 
tinct.  ferri  chloridi,  3  v.  M.  Sig. :  Fifteen  drops  three  or  four 
times  a  day. 

In  fatty  degeneration  of  the  heart,  the  preparations  of  iron  render 
important  service,  by  improving  the  nutrition  of  the  organ.  The  pal- 
pitations, the  murmur,  and  prcecordial  anxiety  which  accompany  cases 
of  anaemia  and  chlorosis,  are  relieved  by  chalybeate  medicines.  In 
dilatation  of  the  cavities  of  the  heart,  especially  the  right,  accompanied 
by  cough,  difficult  breathing,  and  general  dropsy,  greater  relief  is  some- 
times experienced  from  the  preparations  of  iron  than  by  the  so-called 
cardiac  sedatives  and  diuretics.  In  these  cases,  as  also  in  mitral  regurgi- 
tation,  the  distress  of  the  patient  increases  with  increasing  thinness  of 
the  blood,  and  is  diminished  by  those  remedies,  such  as  iron,  which 
improve  the  quality  of  the  blood.  A  combination  of  iron,  digitalis,  and 
squill,  is  sometimes  extremely  serviceable  in  these  cases — for  example  : 
1J  Ferri  redacti,  quininae  sulphat.,  pulv.  digitalis  (English),  aa  3  j ;  pulv. 
scillae,  gr.  x.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill  three  or  four  times  a 
day.  Iron  may  be  used  with  advantage  to  assist  in  the  process  of 
compensation  in  valvular  lesions,  when  the  condition  is  one  of  anaemia. 
Iron  is  contraindicated  in  all  cases  of  cardiac  disease  occurring  in  those 
who  are  full-blooded. 

In  the  passive  forms  of  haemorrhage — in  purpura,  the  hcemorrhagic 
diathesis,  epistaxis,  gastric,  intestinal,  and  renal  haemorrhage,  when 
they  are  due  to  anaemia  or  favored  by  it — iron  is  unquestionably  use- 
ful, and  the  preparation  most  generally  applicable  is  the  tincture  of 
the  chloride. 

Derangements  of  the  menstrual  function,  when  associated  with 
anaemia,  more  especially  when  produced  by  anaemia,  are  often  removed 
by  the  use  of  chalybeate  medicines.  Amenorrhoea  is,  more  frequently 
than  to  any  other  cause,  due  to  anaemia  of  the  ovaries,  consecutive  to 
chlorosis  or  general  anaemia,  and  dysmenorrhcea  may  depend,  in  one  of 
its  forms  at  least,  upon  the  same  condition  of  the  blood.  Menorrhagia 
may  also  be  one  of  the  results  of  an  impoverished  state  of  the  blood. 
Iron  is  the  most  appropriate  medicament  in  these  disorders.  It  is  the 
judgment  of  Graily  Hewitt  and  Barnes  that  "  small  doses  of  iron  are 
generally  the  best"  in  amenorrhcea.  Barnes  prefers  the  solution  of  the 
acetate,  and  speaks  favorably  of  the  citrate  of  iron  and  ammonia,  given 
in  an  effervescent  state,  and  of  the  combination  of  iron  and  strychnine. 
The  use  of  ferruginous  preparations  in  menstrual  disorders  should  be 
determined  by  the  results  of  a  careful  differentiation  of  the  causes. 
The  absence  of  the  uterus  and  ovaries,  occlusion  of  the  cervix,  and 
various  other  conditions  besides  anaemia,  should  be  eliminated,  and  the 
use  of  iron  restricted  to  those  cases  in  which  an  impoverished  state  of 
the  blood  is  either  the  only  factor  or  an  influential  one. 

The  injection   of  the  various   styptic  solutions  of  iron  into  the 


152  RESTORATIVE   AGENTS. 

uterine  cavity,  to  arrest  post-partum  haemorrhage,  is  now  common 
practice.  Notwithstanding  the  alleged  innocuousness  of  this  treat- 
ment, it  is  probable,  as  Snow  Beck  has  shown,  that  fatal  results  have 
ensued  from  the  incautious  use  of  these  injections.  The  official  solu- 
tions of  the  perchloride  and  subsulphate  have  been  thrown  into  the 
uterine  cavity,  with  the  effect  to  cause  uterine  thrombosis,  followed 
by  systemic  infection.  These  solutions  are  much  too  strong ;  one  part 
of  Monsel's  solution  to  three  of  water  is  sufficiently  styptic,  and  is 
probably  perfectly  safe.  The  uterine  cavity  should  be  cleared  of  clots, 
and  the  nozzle  of  the  syringe  carried  well  up  to  the  fundus,  when  the 
injection  should  be  slowly  delivered.  The  reader  need  hardly  be  re- 
minded that  this  expedient  is  only  proper  after  the  usual  means  for 
securing  uterine  contractions  have  failed.  The  same  plan  of  styptic 
injections  has  been  used  to  arrest  the  haemorrhage  from  abortion,  but 
caution  is  necessary  in  these  cases,  for  it  is  essential  to  safety  that 
there  be  an  open  and  patulous  condition  of  the  os,  to  permit  escape  of 
coagula.  Similarly  these  injections  are  used  to  restrain  bleeding  in 
cases  of  uterine  fibroids,  uterine  cancer,  and  in  the  uterine  haemorrhage 
dependent  on  spongy  granulation  of  the  mucous  membrane.  In  every 
case  of  such  use  of  styptic  iron  injections,  it  is  essential,  first,  that  air 
be  not  pumped  into  the  uterine  cavity,  and  second,  that  sufficient  dila- 
tation of  the  cervical  canal  exist  to  permit  ready  exit  to  the  surplus 
fluid  and  coagula. 

In  albuminuria,  connected  with  chronic  changes  of  the  kidney,  iron 
is  often  very  serviceable  to  improve  the  digestion,  and  to  correct  the 
anaemia,  which  is  such  an  obvious  feature  of  these  maladies.  The 
tincture  of  the  chloride  and  the  tincture  of  the  acetate — especially  the 
latter — are  preferred,  partly  on  account  of  their  value  as  haematinic 
remedies,  and  partly  because  of  their  supposed  diuretic  action.  When 
spermatorrhoea  is  dependent  upon  an  impoverished  condition  of  the 
blood,  with  relaxation  of  the  vesicula?  seminales,  the  tincture  of  iron 
is  useful,  but  it  is  rarely  of  itself  sufficient  to  effect  a  cure.  The  chalyb- 
eates  are  only  harmful  in  those  cases  of  nocturnal  seminal  losses  which 
in  the  robust  are  merely  significant  of  plethora.  In  gleet  occurring  in 
anaemic  subjects,  and  in  the  prostorrhoza  and  catarrh  of  the  urethra 
which  arise  from  relaxation,  the  preparations  of  iron  are  useful 
adjuncts  to  other  measures.  ^  Tinct.  ferri  chloridi,  3  vj  ;  tinct. 
cantharidis,  3  ij.  M.  Sig.  :  Fifteen  drops  in  water,  three  times  a 
day. 

The  sirup  of  iodide  of  iron  is  one  of  the  most  successful  remedies 
in  the  nocturnal  incontinence  of  urine  in  children.  The  precise  indi- 
cations for  its  use  are  not  evident.  Sometimes  belladonna  succeeds 
better.  It  appears  to  the  author  that  the  iodide  of  iron  is  more  useful 
in  the  case  of  pale,  delicate,  and  strumous  children,  and  belladonna  in 
those  who  are  more  robust,  the  condition  in  the  former  being  one  of 


IROX.  153 

atony  of  the  muscular  wall  of  the  bladder,  in  the  other  too  ready  con- 
traction from  the  reflex  stimulation  of  acid  urine.  In  these  cases  of 
incontinence  of  urine  the  sirup  of  the  iodide  should  be  given  in  doses 
of  fifteen  to  twenty  minims,  well  diluted  with  water,  three  times 
a  day. 

LOCAL  USES. — The  styptic  preparations  of  iron  are  frequently  used 
to  restrain  haemorrhage.  Leech-bites  that  bleed  too  profusely,  hcemor- 
rhage  after  extraction  of  teeth  or  in  minor  surgical  operations,  oozing 
from  a  large  wounded  surface,  may  often  be  checked  by  the  use  of 
Monsel's  solution. 

As  a  topical  application  in  gonorrhoea  after  the  acute  symptoms 
have  subsided,  in  mucous  cervicitis,  in  leucorrhoea,  the  styptic  prepa- 
rations of  iron  are  certainly  useful,  but  a  strong  objection  to  their  use 
arises  from  the  staining  of  the  clothing. 

Monsel's  solution  is  an  effective  application  to  fissured  nipples :  $ 
Liquor  ferri  subsulphatis,  3  ij  ;  glycerini,  3  vj.  M.  Sig.  :  Apply  with 
a  camel's-hair  brush  to  affected  parts.  Pure  solution  of  subsulphate  of 
iron  will  arrest  the  growth  and  cause  the  exfoliation  of  syphilitic  vege- 
tations of  the  glans  and  prepuce. 

Ferratin. — By  this  term  is  meant  a  proprietary  preparation  of  iron 
and  albumin,  the  discovery  of  which  we  owe  to  Schmiedeberg  and 
Marfori.  It  is  an  organic  preparation,  and  exists  preformed  in  the 
liver  and  other  parts  of  animals. 

Ferratin  is  a  reddish-brown  powder,  odorless  and  tasteless,  and 
contains  about  7  per  cent  of  iron.  It  is  not  a  mechanical  mixture  of 
iron  salts  with  albumin,  but  a  genuine  chemical  combination.  The 
dose  ranges  from  5  to  15  grains,  and  is  best  given  in  powder,  wafer, 
or  capsule.  In  children  it  may  be  suspended  in  milk.  A  solution 
may  be  made  with  the  aid  of  sodium  bicarbonate,  and  this  presents 
some  advantages  in  certain  states  of  the  stomach  and  some  forms  of 
disease. 

Ferratin  is  a  combination  of  iron  of  special  utility  in  that  it  is  pre- 
pared for  assimilation  both  primary  and  secondary.  It  is  readily 
taken  and  well  borne  by  children  and  fastidious  adults,  and  as  a 
chalybeate  is  both  prompt  and  efficient.  As  it  is  already  in  combina- 
tion with  albumin,  it  is  especially  adapted  to  the  formation  of  red- 
blood  globules  and  should  therefore  be  employed  when  the  relative 
proportion  of  them  is  too  low.  It  has  the  advantage  of  all  other 
preparations  of  iron,  that  they  must  be  converted  into  this  before 
being  absorbed.  In  anaemia,  chlorosis,  convalescence  from  acute  dis- 
eases, chronic  cardiac  and  renal  diseases  with  anaemia,  and  in  nervous 
affections,  it  has  been  found  most  effective.  That  ferratin  is  taken  up 
in  the  structure  of  the  blood  and  tissues  is  apparent  in  the  fact  that 
no  portion  of  that  taken,  nor  any  product  thereof,  escapes  by  the  kid- 
neys. (Schmiedeberg,  Marfori,  G.  See,  and  others.) 


154  RESTORATIVE   AGENTS. 

Hffimol.  Haemogalol. — Kobert  has  recently  brought  forward  two 
new  preparations  of  iron,  obtained  by  the  action  of  reducing  agents 
on  the  blood.  They  are  compounds  of  iron  and  albumin — intermedi- 
ate between  haemoglobin  and  hsematin.  They  are  proposed  for  use  in 
anaemia,  chlorosis,  in  convalescence  from  acute  diseases,  and  in  condi- 
tions of  depression  where  a  restorative  is  needed.  The  dose  ranges 
from  5  to  15  grains.  (Kobert,  Lang,  Weiss,  and  others.) 

Authorities  referred  to : 

ANSTIE,  DR.  FRANCIS  E.  Neuralgia  and  its  Counterfeits,  Macmillan  &  Co.,  London, 
1871,  p.  181. 

BARKER,  DR.  FORDYCE.     Puerperal  Diseases,  New  York,  1874,  p.  183. 

BARNES,  DR.  ROBERT.    A  Clinical  History  of  Diseases  of  Women,  London,  1873,  p.  185. 

BUCKNILL  AND  TUKE.  Manual  of  Psychological  Medicine,  third  edition,  London,  1874, 
p.  764. 

CHRISTISON,  DR.  ROBERT.     A  Treatise  on  Poisons,  Edinburgh,  1 832,  p.  573. 

ECLENBURG,  DR.  ALBERT.  Lehrbuch  der  functionellen  Nervenkrankheiten,  Berlin,  1871, 
pp.  71,  198,  448,  etc. 

GUBLER,  DR.  A.    Commentaires  Therapeutiques  du  Codex  Medicamentarius,  Paris,  1868. 

HEWITT,  DR.  GRAILY.     Diseases  of  Women,  second  edition,  London,  1868,  p.  413. 

Jahresbericht  uber  die  Fortschritte  der  Pharmacoanosie,  Pharmacie  und  Toxicologie, 
Gottingen,  1872,  p.  237,  art.  Eisen. 

Ibidem,  1872,  p.  523,  Eisengehalt  verschiedener  vegetabilischer  und  thierischer  Sub- 
stanzen. 

LUSSANA,  PROF.  VON  PH.  Lo  Sperimentale,  October,  1872,  Schmidt's  Jahrbucher  der 
aesammten  Medicin,  vol.  clvi,  p.  262. 

NOTHNAOEL,  DR.  HERMANN.    Handbuch  der  Arzneimittellehre,  Berlin,  1870,  p.  411,  et  seq. 

POKROWSKY,  DR.  W.     Virchow's  Archiv,  vol.  xxii. 

SQUIRE,  PETER.    Companion  to  the  British  Pharmacopoeia,  eighth  edition,  London,  1871. 

TAYLOR,  DR.  A.  S.     On  Poisons,  third  English  edition,  1875,  p.  484. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Matiere  Medicale,  huitifeme 
Edition,  art.  Fer. 

UNITED  STATES  DISPENSATORY,  thirteenth  edition. 

WALDENBURG  UND  SIMON.  Handbuch  der  allgemeinen  und  speciellen  Arzneiverordnungs* 
Lehre,  achte  Auflage,  1873. 

WORONICHIN,  DR.  N.  Wien.  med.  Jahrbuch,  xv,  Schmidts  Jahrbucher  der  gesammten 
Medicin,  vol.  cxxxviii,  p.  288. 

MANGANUM. 

Manganese. — Mangan,  Ger.  ;  manganese,  Fr. 

Mangani  Dioxidum. — Manganese  dioxide.  Dose,  gr.  ij — gr.  x. 
In  pill  or  powder. 

Mangani  Sidphas. — Manganese  sulphate.  In  colorless  or  pale 
rose-colored  transparent  crystals,  freely  soluble  in  water.  Dose,  gr. 
ij— gr.  v. 

Unofficial  preparations  : 

Syruptis  Ferri  et  Mangani  lodidi. — A  pale  straw-colored  sirup. 
Dose,  m  x  —  3  ss. 

Ferri  et  Mangani  Carbonas  Sacch. — A  tasteless,  reddish-brown 
powder.  Dose,  gr.  v — 3j. 


MANGANUM.  155 

Syrupus  Mangani  lodidi. — A  sirup  which  corresponds  in  strength 
to  the  official  sirup  of  the  iodide  of  iron,  and  may  be  given  in  corre- 
sponding doses. 

Besides  the  above,  a  carbonate,  phosphate,  tartrate,  malate,  and  lac- 
tate  have  been  proposed  for  use,  but  hitherto  they  have  not  attracted 
attention  and  are  rarely  employed.  The  official  and  unofficial  prepa- 
rations named  above  are  all  that,  according  to  the  present  state  of  pro- 
fessional experience  on  the  subject,  will  ever  be  required.  It  will  be 
most  convenient,  however,  to  include  with  the  manganic  preparations 
the  following  : 

Potassii  Permanganas. — Potassium  permanganate.  In  needle- 
shaped  crystals  of  a  deep  purple  color.  It  is  soluble  in  sixteen  parts 
of  cold  water,  and  the  solution  has  a  deep  purple  to  a  rose-color,  ac- 
cording to  the  state  of  dilution  of  the  salt.  Dose,  gr.  ss — gr.  ij.  In 
prescribing  the  permanganate,  freshly  distilled  or  boiled  and  filtered 
river-water,  to  free  it  from  organic  matter,  should  be  directed. 

PHYSIOLOGICAL  ACTIONS. — The  sulphate  has  an  extremely  disagree- 
able styptic  and  metallic  taste  ;  the  black  oxide  less  so,  and  the  saccha- 
rated  carbonate  is  free  from  any  taste  except  that  of  the  sugar.  The 
preparations  of  manganese  are  somewhat  irritant  to  the  gastro-intesti- 
nal  mucous  membrane,  and  the  sulphate  is  emeto-cathartic  in  full  doses. 
There  seems  to  be  no  doubt  that  the  sulphate  has  a  decided  cholagogue 
effect,  for  very  large  discharge  of  bile  is  a  result  of  its  cathartic  action. 
In  small  doses  the  manganic  salts  promote  the  appetite  and  digestive 
function.  They  probably  enter  the  blood  as  albuminates.  The  inti- 
mate association  of  manganese  with  iron  throughout  the  economy  of 
Nature  is  exemplified  in  the  human  body.  They  are  found  together 
in  the  blood,  hair,  bile,  biliary  concretions,  and  renal  calculi.  The  pro- 
portion of  manganese  to  iron  in  the  red  blood-corpuscles  is  as  one  to 
twenty.  As  an  essential  constituent  of  the  blood,  it  undoubtedly  has 
to  do  with  the  constructive  metamorphosis  of  the  body.  Used  in  large 
doses  and  for  a  considerable  period  of  time,  it  produces  effects  analogous 
to  those  of  zinc — progressive  wasting  and  feebleness,  a  staggering  gait 
and  paralysis  (paraplegia).  In  toxic  doses,  according  to  the  researches 
of  Laschkewitsch,  it  causes  in  animals  death  by  convulsions.  In  smaller 
doses  it  diminishes  the  pulse-rate,  lowers  the  action  of  the  heart,  and 
lessens  the  blood-pressure.  Like  phosphorus,  manganese  induces  acute 
fatty  degeneration  of  the  liver.  When  it  is  injected  into  the  veins  of 
animals,  it  causes  tetanic  cramp,  dilatation  of  the  pupil,  exophthalmus, 
and  death  ;  and  after  death  the  heart-muscle  does  not  respond  to  elec- 
trical stimulation  (Laschkewitsch). 

ANTAGONISTS. — The  preparations  of  manganese  are  not  incompat- 
ible with  the  vegetable  astringents.  The  salts  of  lead,  silver,  and 
mercury,  and  the  caustic  alkalies,  are  chemically  incompatible  with 
manganese. 


156  RESTORATIVE   AGENTS. 

SYXERGISTS. — Iron  is  synergistic  as  regards  haematinic  effects,  and 
the  salts  of  copper,  silver,  and  zinc,  as  regards  the  effects  on  the  nerv- 
ous system. 

THERAPY. — Although  manganese  has  not  of  itself  been  very  useful 
in  the  treatment  of  ancetnia  and  chlorosis,  yet  there  is  no  doubt  that  its 
combination  with  iron  much  increases  the  efficacy  of  the  latter.  Some 
of  the  preparations  named  at  the  head  of  this  article,  especially  the  sac- 
charated  carbonate  of  manganese  and  iron,  may  be  usefully  prescribed  in 
these  diseases.  Cachectic  states  arising  from  syphilis,  cancer,  struma, 
gout,  prolonged  suppuration,  chronic  malarial  infection,  etc.,  are  ad- 
vantageously treated  by  the  sirup  of  the  iodide  of  iron  and  manganese. 

Gastrodynia  and  pyrosis,  according  to  Dr.  Leared,  are  relieved  by 
ten  to  fifteen  grain  doses  of  the  black  oxide — not  the  commercial  article, 
but  the  oxide  purified  by  washing  with  hydrochloric  acid.  In  these 
disorders  the  effects  of  manganese  are  similar  to  those  of  bismuth 
(nitrate  and  carbonate),  of  zinc,  and  silver  (oxide).  Small  doses  of 
manganese  (sulphate)  may  be  usefully  combined  with  iron  and  quinine 
when  prescribed  to  promote  constructive  metamorphosis.  R  Quininae 
sulph.,  ferri  sulph.  exsic.,  mangani  sulph.  exsic.,  aa  3  j.  M.  Ft.  pil.  no. 
xx.  Sig.  :  One  to  three  pills  three  times  a  day.  In  jaundice  of  mala- 
rial origin,  or  from  catarrh  of  the  biliary  passages,  the  author  has  seen 
excellent  results  from  the  use  of  manganese.  R  Cinchonidinae  salicy- 
lat.,  3  ij  ;  mangani  sulph.  exsic.,  $  ij.  M.  Ft.  pil.  no.  xx.  Sig. :  Two 
pills  three  times  a  day.  R  Fel.  bovin.  purif.,  3  j  ;  mangani  sulph. 
exsic.,  ^  ij  ;  resinae  podophylli,  gr.  v.  M.  Ft.  pil.  no.  xx.  Sig.  : 
One  three  times  a  day  in  catarrh al  jaundice.  In  the  disordered  di- 
gestion of  gouty  subjects,  and  to  restore  the  activity  of  the  assimilative 
functions  after  attacks  of  gout,  manganese  is  most  serviceable,  espe- 
cially as  combined  with  salicylates. 

Manganese  (chloride)  has  been  used  by  Osborne  with  success  in 
haemorrhage  (epistaxis),  and  the  sulphate  is  one  of  the  remedies  for 
chronic  rheumatism,  neuralgia,  cholera,  and  syphilis. 

An  ointment  of  the  oxide  (  3  ij  —  %  j  adeps  suil.)  has  been  used  with 
advantage  in  tinea,  scabies,  and  other  chronic  skin-diseases.  R  Man- 
gani oxid.,  sulphuris,  saponis  dur.,  aa  §  j  ;  adipis  suilli,  f  iij.  M.  Oint- 
ment for  porrigo. 

Actions  and  Uses  of  the  Permanganate  of  Potassa. — This  salt  is  a 
very  powerful  oxidizing  agent,  and  yields  up  its  oxygen  readily  in  the 
form  of  ozone.  Its  use  as  an  internal  and  external  remedy  is  based  on 
this  chemical  fact.  That  it  parts  with  its  oxygen  so  readily  is  held  by 
some  to  demonstrate  its  entire  inutility  when  administered  by  the 
stomach.  Although  it  must  instantly  be  decomposed  on  reaching  the 
stomach,  there  are  satisfactory  reasons  for  believing  that  it  exerts  a 
favorable  influence  on  certain  diseases  in  which,  theoretically  consid- 
ered, it  may  be  indicated.  The  author  has  seen  marked  advantage 


MANGANUM.  157 

from  its  use  in  the  dyspepsia  and  flatulence  so  constantly  attendant  on 
obesity.  It  has  also  appeared  to  be  very  serviceable  as  a  remedy  for 
an  abnormal  and  excessive  deposition  of  fat.  In  the  so-called  uric-acid 
diathesis  it  favors  the  conversion  of  uric  acid  into  urea,  and  thus  pre- 
vents the  formation  of  uric-acid  calculi.  Pain  in  the  lumbar  region, 
frequent  micturition,  acid  urine,  much  brick-dust  sediment,  and  intes- 
tinal indigestion,  are  associated  symptoms  relieved  by  the  perman- 
ganate. Under  the  same  conditions,  it  is  probable  acute  rheumatism 
is  developed,  and  to  the  action  of  the  permanganate  as  an  oxidizing 
agent  is  attributable  the  benefit  which  is  sometimes  obtained  from  its 
use  in  this  disease.  In  scarlatina  and  diphtheria  the  permanganate  is 
used  with  undoubted  benefit,  applied  to  the  throat  and  taken  by  the 
stomach.  In  erysipelas,  puerperal  fever,  septicaemia,  it  has  been  given 
with  advantage.  Lately  it  has  been  used  with  success  as  a  remedy 
for  the  bites  of  venomous  snakes  and  other  animal  poisons,  applied 
locally  and  given  internally  (Lacerda). 

Recent  trials  have  shown  that  this  agent  is  effective  against  other 
forms  of  poisoning  as  well  as  that  of  the  snake.  It  has  been  used  with 
success  in  morphine  poisoning,  even  when  the  poison  has  been  ab- 
sorbed and  is  acting  on  the  system  at  large.  As  experiment  has 
proved  that  it  forms  chemical  combinations  with  alkaloids  and  ren- 
ders them  inactive,  this  property  explains  its  utility  when  the  poison 
is  directly  accessible.  In  cases  of  opium,  coca,  or  other  narcotic  poi- 
soning, when  the  toxic  agent  is  yet  retained  in  the  stomach,  its  local 
action  can  be  relied  on  to  destroy  or  inhibit  the  poison  and  thus  pre- 
vent systemic  action.  The  stomach-pump  having  been  used,  the  cav- 
ity should  be  well  washed  out  with  the  permanganate  solution — one 
or  two  grains  to  the  ounce  of  water.  Besides  this  local  action,  the 
evidence  is  conclusive  that  it  possesses  antidotal  power  against  the 
systemic  effects.  Injected  subcutaneously,  it  is  asserted  that  it  com- 
pletely antagonizes  the  morphine,  one  grain  being  effective  against 
the  same  amount  of  the  narcotic.  It  acts  in  a  similar  manner  against 
cocaine,  and,  we  may  well  suppose,  against  atropine  and  strychnine, 
and  other  organic  alkaloids.  It  is  difficult  to  conceive  of  such  remote 
and  systemic  effects,  when  the  remarkable  facility  with  which  it  parts 
with  its  oxygen  in  the  presence  of  organic  matter  is  remembered.  It 
is  known,  however,  that  injected  in  the  neighborhood  poisoned  by 
snake-bite,  the  action  of  the  poison  is  arrested. 

Drs.  Ringer  and  Murrell  have  found  it  an  effective  remedy  in  the 
treatment  of  amenorrhoza,  one  or  two  grains  being  given  in  pill  form 
three  times  a  day.  Since  the  publication  of  this  discovery,  many  cases 
confirming  its  truth  have  been  reported  from  all  quarters.  Recently  it 
has  been  affirmed  that  the  salts  of  manganese  possess  this  property  in 
common,  and  that  it  is  not  a  special  endowment  of  permanganate.  The 
author  can  not  but  regard  this  as  doubtful,  since  he  has  not  obtained 


158  RESTORATIVE   AGENTS. 

the  same  results  from  the  other  manganese  preparations,  although 
recognizing  the  desirability  of  having  less  irritating  agents  for  the 
purpose.  The  dose  of  three  to  five  grains  recommended  by  Drs.  Ring- 
er and  Murrell  can  be  taken  by  few  patients — if  any — without  experi- 
encing very  considerable  gastric  disturbance. 

The  mode  of  administering  permanganate  in  the  condition  of  amen- 
orrhcea  has  much  importance,  since  it  is  usually  necessary  to  give  the 
largest  doses  that  can  be  taken  without  causing  so  much  gastric  dis- 
turbance as  to  compel  its  suspension.  The  best  form  in  which  to  pre- 
scribe it  is  probably  the  compressed  pellets  containing  one  or  two 
grains  of  the  salt.  A  large  draught  of  water  that  has  been  recently 
distilled,  or,  better,  that  has  been  boiled  and  filtered,  should  immedi- 
ately follow  the  pellet — for  free  dilution  in  the  stomach  will  not  only 
promote  absorption,  but  will  lessen  the  action  on  the  mucous  mem- 
brane. The  rapidity  with  which  the  color  of  a  permanganate  solution 
will  be  discharged  in  common  river-water  has  been  much  exagger- 
ated ;  the  author  ascertained  that,  when  added  to  a  vessel  of  the  Schuyl- 
kill  water,  no  appreciable  change  took  place  in  a  half -hour.  Further, 
when  a  solution  made  by  dissolving  a  compressed  pellet  in  ordinary 
river- water  is  put  into  urine,  the  color  is  not  at  once  discharged,  but 
an  interval  of  several  minutes  elapses  before  the  change  is  completed. 

That  the  large  proportion  of  active  oxygen  present  in  the  perman- 
ganate contributes  to  the  therapeutical  action  can  hardly  be  denied, 
and  that  it  is  an  element  in  the  action  on  the  organs  of  menstruation 
must  be  admitted  also.  The  author,  therefore,  advises  the  use  of 
permanganate  of  potassium  in  amenorrhcea,  rather  than  the  salts  of 
manganese,  although  the  latter  may  be  used  when  the  former  can  not 
be  borne.  The  remedy  should  be  administered  during  the  week  pre- 
ceding the  time  of  the  menstrual  flow,  and  the  dose  given  must  be 
small,  with  the  necessary  frequency,  so  that  about  ten  grains  be  received 
each  day.  When  the  other  salts  of  manganese  are  substituted,  such 
combinations  as  the  following  will  be  found  useful :  $  Ferri  sulph. 
exsic.,  mangani  sulph.  exsic.,  aa  3j ;  ext.  aloes,  gr.  iv  ;  ext.  ignatige 
vel  nucis  vomicae,  gr.  v.  M.  Ft.  pil.  no.  xx.  Sig. :  One  pill  three 
times  a  day.  The  amount  of  manganese  in  this  prescription  can  be 
trebled  if  need  be.  I£  Ferri  et  mangani  carb.  sacch.,  3  ij.  Ft.  pulv. 
xx.  Sig.  :  One  powder  three  times  a  day.  This  latter  remedy  is  espe- 
cially commended  because  of  its  remedial  value  and  of  the  ease  with 
which  it  is  administered,  since  it  is  almost  tasteless. 

The  value  of  permanganate  of  potassium  in  amenorrhcea  having 
been  confirmed  by  Lvaff  (Russia),  Vargunin  was  induced  to  try  it  in 
cases  of  dysmenorrhwa  characterized  by  scanty  flow,  and  a  general  con- 
dition of  anaemia.  The  result  justified  the  a  priori  judgment,  and 
equally  fortunate  cases  have  been  reported  by  others  since.  It  is  a 
necessary  condition  for  the  successful  use  of  permanganate  in  these 


CHALYBEATE   SPRINGS.  159 

affections  that  the  state  of  the  patient  be  that  of  depression,  anaemia, 
or  chlorosis,  and  that  the  organs  concerned  in  the  menstrual  function 
be  wanting  in  activity.  Congestion  or  inflammation  of  the  pelvic  or- 
gans is  a  positive  contraindication. 

It  should  not  be  forgotten  that  pills  containing  permanganate  of 
potassium  in  some  combinations  are  explosive.  There  is,  however,  no 
actual  necessity  for  combinations  of  this  kind. 

Among  the  important  uses  of  permanganate  of  potassa  are  its  ex- 
ternal applications  as  a  disinfectant.  It  is  a  deodorizer  as  well  as  a 
disinfectant.  It  is  very  frequently  used  (  3  j — Oj)  to  correct  the  fetor 
of  cancer,  ulcers,  caries,  abscesses,  etc.  It  is  used  as  an  injection,  or  in 
the  form  of  spray,  to  destroy  the  odor  of  the  discharges  and  to  alter 
the  morbid  action,  in  cases  of  ozcena,  otorrhoea,  etc.  It  is  an  elegant 
toilet  preparation  (gr.  j  —  3  j)  for  destroying  the  odor  of  a  foul 
breath,  the  smell  of  the  axilla,  and  the  fetor  of  the  sweat  of  the  feet. 
See  "  Antiseptics  "  for  further  information. 

Recently  solutions  of  permanganate  of  potassium  have  been  em- 
ployed successfully  in  the  treatment  of  dysentery.  Among  the  cases 
thus  benefited  have  been  the  formidable  cases  of  dysentery  coming 
from  South  Africa.  Dr.  Bennett  ("Lancet,"  December  21,  1901) 
reports  the  cure  of  many  cases  of  "  asylum  dysentery  "  in  this  way. 
For  this  purpose  a  "weak  solution"  is  made  use  of  to  irrigate  the 
bowel  morning  and  evening,  and  this,  it  is  reported,  had  "seldom 
to  be  used  after  the  second  day."  This  method  is  applicable  also  to 
any  case  of  diarrhrea  accompanied  by  straining. 

CHALYBEATE  MINERAL  SPRINGS. 
1.   NOETH  AMERICAN. 

Bailey  Springs,  Lauderdale  County,  Alabama. 

These  springs  contain  carbonates  of  potassa,  soda,  magnesia,  car- 
bonic-acid gas,  oxide  of  iron,  etc. 

Rawley  Springs,  Rockingham  County,  Virginia. 

Carbonate  of  iron  (0'203  grain)  is  the  most  important  ingredient  in 
these  waters.  They  contain,  also,  carbonates  of  manganese,  magnesia, 
lime,  and  lithia,  and  sulphates,  etc. 

Sweet  Chalybeate  Springs,  Alleghany  County,  Virginia. 

The  name  of  this  water  is  derived  from  its  sweetish  taste.  It  is 
highly  charged  with  carbonic-acid  gas,  and  contains  sesquioxide  of 
iron,  with  sulphate  of  lime  (4 '110  grains),  sulphates  of  magnesia  and 
soda,  and  chlorides  of  lime,  sodium,  magnesium,  etc. 

Rockbridge  Alum  Springs,  Rockbridge  County,  Virginia. 

Bath  Alum,  Bath  County,  Virginia. 

These  waters  are  remarkable  for  containing  free  sulphuric  acid. 
They  contain  also  sulphates  of  magnesia  and  lime,  protoxide  of  iron, 
and  carbonic-acid  gas.  The  Bath  Alum  waters  contain  twice  as  much 
iron  as  the  Rockbridge  Alum. 


160  RESTORATIVE   AGENTS. 

Bedford  Alum  Springs,  Bedford  County,  Virginia. 

Similar  in  composition  to  the  above,  but  contain  a  larger  proportion 
of  iron,  and  of  the  salts  of  potassa,  magnesia,  and  lime. 

Bedford  Springs,  Bedford  County,  Pennsylvania. 

This  water  contains  carbonate  of  iron  (0*625  grain)  associated  with 
a  large  proportion  of  sulphate  of  magnesia  (10  grains),  and  is,  there- 
fore, a  laxative  chalybeate. 

2.  EUROPEAN. 

Bascombe,  Bournemouth,  Hampshire,  England. 

Chalybeate  springs  containing  carbonic  acid  in  combination, 

Dorton,  Buckinghamshire,  England. 

Contains  sulphate  of  iron  and  is  charged  with  carbonic  acid.  Re- 
quires dilution  for  drinking. 

Hastings,  Sussex,  England. 

Contains  sulphates  of  iron,  magnesia,  lime,  and  soda. 

Sandrock,  Isle  of  Wight. 

Is  a  strong  aluminous  chalybeate — 4l£  grains  of  sulphate  of  iron, 
and  31|  grains  of  sulphate  of  alumina  in  twenty  ounces — and  therefore 
requires  dilution  for  drinking. 

Tunbridge,  Kent,  England.    Altitude,  289' ;  temperature,  50°  Fahr. 

This  water  contains  one  eighth  of  a  grain  of  iron  with  carbonic 
acid,  in  twenty  ounces. 

Spa,  Belgium.  Altitude,  1,030'.  Season,  August  and  September. 
Temperature  of  water,  52°  Fahr. 

These  waters  contain  carbonates  of  iron,  manganese,  soda,  lime,  and 
magnesia,  etc.,  and  are  highly  charged  with  carbonic  acid. 

Pyrmont,  Waldeck.  Altitude,  404'  ;  mean  annual  temperature, 
48-5°  Fahr. 

The  quantity  of  carbonic-acid  gas  is  unusually  great  in  these  waters. 
They  contain  sulphates  of  lime,  soda,  magnesia,  and  carbonates  of  iron, 
soda,  magnesia,  and  lime. 

Alexisbad,  near  Harzgerode,  Germany. 

Alexisbrunnen.    Same. 

Both  contain  iron  and  manganese  in  large  quantity,  and  also  car- 
bonic-acid gas.  The  first  named,  being  highly  impregnated  with  chloride 
and  sulphate  of  iron,  is  used  for  bathing,  and  the  other  for  drinking. 

Schwalbach,  Nassau.  Altitude,  909'.  Season,  June  to  September. 
Temperature,  64°  Fahr. 

According  to  the  analysis  of  Fresenius,  this  valuable  water  contains 
bicarbonates  of  iron,  manganese,  soda,  magnesia,  and  lime,  sulphates  of 
soda  and  potash,  and  chloride  of  sodium.  It  is  very  highly  charged 
with  carbonic  acid. 

St.  Moritz,  Upper  Engadin,  Switzerland.  Altitude,  5,464'.  Mean 
temperature  of  summer  months,  51°  Fahr. 


BISMUTH.  161 

These  springs  contain  from  ten  to  fourteen  grains  of  solids  in  a 
pint,  consisting  of  carbonates  of  lime,  magnesia,  manganese,  iron,  and 
soda,  etc.,  and  as  much  as  39*5  cubic  inches  of  carbonic  acid. 

THERAPY  OF  CHALYBEATE  WATEES. — The  uses  of  these  waters  are 
the  same  as  the  purely  medicinal  preparations  of  iron.  They  are  in- 
dicated in  chlorosis  and  anaemia,  to  supply  to  the  blood  the  material 
in  which  it  is  deficient.  For  this  purpose  the  milder  waters,  contain- 
ing carbonate  of  iron  and  abundant  carbonic  acid,  are  most  suitable  ; 
for  example,  in  this  country,  Bedford  (Pennsylvania) — Columbian 
Spring,  Saratoga,  and  the  "  Sweet,"  of  Virginia,  etc.  ;  in  England, 
Bascombe  and  Tunbridge  ;  on  the  Continent,  Pyrmont,  Spa,  Schwal- 
bach,  St.  Moritz.  When  passive  haemorrhages — the  hcemorrhagic  di- 
athesis— require  ferruginous  waters,  the  alum  and  iron  waters  are  more 
effective.  Amenorrhcea,  hysteria,  and  other  pelvic  disorders,  when 
dependent  on  anaemia,  the  paludal  cachexia,leucocythemic-exophthalmic 
goitre,  are  either  cured  or  decidedly  ameliorated  by  chalybeate  waters. 

The  purgative  iron  waters  are  useful  in  engorgement  of  the  liver, 
haemorrhoids,  and  dyspepsia  of  ancemic  subjects,  in  albuminuria  and 
dropsy  ;  the  alum  springs  in  chronic  diarrhcea  and  strumous  diseases. 

Neuralgia,  chorea,  cerebral  anaemia,  and  other  nervous  disorders 
due  to  an  impoverished  condition  of  the  blood,  are  much  improved  by 
the  use  of  the  milder  chalybeate  waters. 

In  making  selection  of  a  chalybeate  water  the  psychical  influences 
of  mountain  scenery,  or  other  pleasant  surroundings,  should  not  be  dis- 
regarded. For  the  anaemic  pulmonary  invalid,  elevation  of  the  spring 
and  the  absence  of  humidity  are  important  considerations  to  determine 
a  selection.  Hence,  the  present  popularity  of  St.  Moritz.  In  this  coun- 
try a  great  variety  is  afforded — mountain  scenery  like  Bedford,  Penn- 
sylvania, and  the  Virginia  springs,  or  rolling  upland  like  Bailey's  and 
Sharon.  As  respects  composition,  the  ferruginous  springs  of  the  United 
States  are  equal  to  any  in  the  world. 

For  authorities  referred  to,  see  articles  on  Alkaline  and  Saline 
Springs. 

The  remedies  promoting  constructive  metamorphosis  previously 
considered  are  constituent  elements  of  the  human  body.  Those  now 
to  be  discussed  act  indirectly,  by  stimulating  the  organs  concerned  in 
blood-making. 

BISMUTHUM. 

Bismuth.  —  Bismuthi  Subcarbonas. — Bismuth  subcarbonate.  A 
white  or  yellowish-white  powder,  without  taste  or  smell,  insoluble  in 
water.  Dose,  gr.  x —  3  j,  in  powder  or  emulsion. 

JBismuthi  Subnitras. — Bismuth  subnitrate.     A  heavy,  white  pow- 


102  RESTORATIVE   AGENTS. 

der,  with  a  faintly  acid  odor  and  taste,  insoluble  in  water.  Dose, 
gr.  x  —  3  j,  in  powder  or  emulsion. 

Bismuthi  Citras. — Bismuth  citrate.  "  A  white,  amorphous  pow- 
der, odorless  and  tasteless,  insoluble  in  water  or  alcohol."  Dose,  gr. 
v-3j. 

Bismuthi  et  Ammonii  Citras. — Bismuth  and  ammonium  citrate. 
Small,  translucent  scales,  soluble  in  water.  Dose,  gr.  v — gr.  xv. 

Xeroform  contains  besides  bismuth  50  per  cent  of  tribromphenol, 
and  is  antiseptic  and  astringent.  It  is  a  greenish-yellow  powder,  hav- 
ing but  little  odor  or  taste,  and  is  insoluble.  Applied  to  sloughing 
wounds  and  ulcers,  it  is  an  efficient  deodorant  and  antiseptic.  Inter- 
nally it  acts  as  an  astringent,  corrects  intestinal  decomposition,  and 
arrests  diarrhoea.  The  dose  for  adults  ranges  from  five  to  twenty 
grains,  and  for  children  two  to  eight  grains.  It  is  best  given  in  wafer 
or  capsule. 

PHYSIOLOGICAL  ACTIONS. — The  insoluble  preparations  have  a  very 
slightly  metallic  taste.  They  coat  the  tongue  black  by  the  formation 
of  a  sulphide.  Given  in  suitable  cases,  they  promote  the  appetite  and 
increase  the  digestive  power,  and  a  gain  in  body-weight  is  one  result 
of  their  administration.  They  are  somewhat  astringent,  and  retard  the 
intestinal  movements.  As  they  are  nearly  insoluble,  they  pass  down 
the  intestinal  tract  and  are  converted  into  sulphides  ;  hence  the  faeces 
under  their  use  become  a  dark  slate  color.  They  are  not  entirely  in- 
soluble, for  bismuth  can  be  detected  in  the  blood,  urine,  and  other 
secretions,  after  a  course  of  these  medicines.  Sufficient  is  absorbed 
under  some  circumstances,  it  is  said,  especially  after  prolonged  admin- 
istration, to  cause  toxic  symptoms  ;  but  such  a  result  must  be  due  to 
accidental  combinations,  or  to  the  presence  of  arsenic,  which  is  a  very 
constant  impurity  in  the  ordinary  commercial  preparations  of  subni- 
trate  and  subcarbonate  of  bismuth.  Trousseau  and  Pidoux  remark, 
with  regard  to  its  presumed  toxic  effect,  as  follows  :  "  When  the  sub- 
nitrate  of  bismuth  has  been  prepared  from  the  perfectly  pure  metal, 
precipitated  and  well  washed,  it  may  be  given  in  single  doses  from 
one  to  four  grammes  (fifteen  grains  to  a  drachm)  without  producing 
the  least  malaise"  According  to  the  same  authority,  Dr.  Monneret 
has  often  given  as  much  as  ten  to  sixty  grammes  a  day,  without  any 
recognized  ill  effects.  It  may  therefore  be  concluded  that  the  action 
of  bismuth  is  chiefly  local.  The  elaborate  investigation  of  Steinfeld, 
made  on  animals,  does  not  affect  the  question  as  just  stated.  His 
results  were  obtained  by  injecting  solutions  into  the  blood,  and  thus 
new  elements  enter  into  the  problem,  not  of  a  character  to  be  consid- 
ered as  pertaining  to  the  stomachal  administration  of  insoluble  salts. 

THERAPY. — In  the  aphthae  of  children,  nursing  sore  mouth,  the 
milder  cases  of  mercurial  salivation,  and  in  those  painful  ulcers  of 
the  mucous  membrane  of  the  mouth  due  to  disorders  of  digestion,  bis- 
muth applied  freely  to  the  affected  parts  is  often  very  serviceable,  by 


BISMUTH.  163 

diminishing  the  pain  and  promoting  the  healing  process.  Bismuth 
allays  the  irritability  of  the  mucous  membrane  in  cases  of  acute  indi- 
gestion, if  given  after  the  contents  of  the  stomach  are  fully  evacuated. 
It  is  especially  indicated  when  there  is  not  only  painful  digestion,  but 
a  tendency  to  diarrhoea,  the  inclination  for  stool  coming  on  soon  after 
the  food  has  been  taken.  It  is  given  with  great  advantage  in  subacute 
and  chronic  gastritis,  and  in  gastralgia  arising  from  a  state  of  irrita- 
tion of  the  gastric  mucous  membrane.  It  is  contraindicated,  and  is 
not  beneficial,  in  the  gastralgia  produced  by  habitual  constipation  and 
in  the  gastralgia  of  chlorosis  and  hypochondria.  The  pain  and  vomit- 
ing attendant  on  gastric  ulcer  and  scirrhus  of  the  stomach  are  relieved 
by  bismuth,  and  in  the  case  of  the  former  disease  this  remedy  con- 
tributes to  the  cure.  In  these  painful  affections,  the  good  effects  of 
the  bismuth  are  enhanced  by  combination  with  morphine.  ]J  Bismuth! 
subnitrat.,  3  ij  ;  morphinae  sulphat.,  gr.  j.  M.  Ft.  pulv.  no.  vj.  Sig.  : 
One  three  times  a  day  in  milk.  When  morphine  is,  from  any  cause,  in- 
admissible, hydrocyanic  acid  may  be  given  in  a  mixture  with  bismuth. 
r>,  Bismuthi  subnitrat.,  3  ij ;  acid,  hydrocyan.  dil.,  3  ss  ;  mucilag.  acaciae, 
aquae  menthse  pip.,  aa  f  ij.  M.  Sig.  :  A  tablespoonful  three  times  a 
day.  Although  arsenic  as  an  impurity  is  so  objectionable  that  special 
pains  are  taken  in  the  pharmaceutical  process  to  separate  it  in  the 
preparation  of  subnitrate,  yet  the  author  has  witnessed  excellent  re- 
sults from  a  combination  of  arsenic  and  bismuth  in  the  more  chronic 
stomach-disorders  for  which  the  latter  is  prescribed. 

When  bismuth  is  not  well  borne  by  the  stomach,  it  may  be  com- 
bined with  aromatic  powder,  or,  when  alkalies  are  indicated,  it  may 
be  given  with  chalk  or  magnesia.  When  constipation  is  produced  by 
it,  bismuth  can  be  administered  with  rhubarb  or  magnesia. 

Bismuth  is  one  of  the  remedies  most  frequently  employed  in  the 
treatment  of  the  vomiting  of  teething  children,  cholera  infantum,  and 
summer  diarrhoea.  Numerous  combinations  are  employed  :  with  pep- 
sin, when  these  disorders  appear  to  depend  on  the  condition  known  as 
apepsia,  the  discharges  containing  masses  of  undigested  casein  ;  with 
rhubarb,  when  the  symptoms  are  produced  by  undigested  aliment,  or 
when  the  stools  are  white  and  pasty  ;  with  soda  and  chalk,  when  the 
stools  are  acid  and  excoriate  the  buttocks.  In  cases  of  vomiting  of 
pregnancy,  the  vomiting  of  teething  children,  acidity,  and  pyrosis,  ex- 
cellent results  are  sometimes  obtained  from  bismuth  and  carbolic  acid. 
t>  Bismuthi  subnitrat.,  3  ii ;  acid,  carbol.,  gr.  ij — gr.  iv  ;  mucil.  acaciae, 
|  j  ;  aquae  menthae  pip.,  f  iij.  M.  Sig.  :  A  tablespoonful  for  adults 
and  a  proportionate  quantity  for  children  three  or  four  times  a  day. 

The  diarrhoea  of  typhoid  fever  is  restrained  by  bismuth  in  scruple 

to  half-drachm  doses.     In  chronic  diarrhoea  large  doses  of  bismuth 

are  beneficial  and  often  curative,  but  thirty  to  sixty  grains  must  be 

given  every  three  or  four  hours.     Equally  large  doses  check  the  diar- 

13 


164  RESTORATIVE   AGENTS. 

rhoea  of  phthisis.  The  salicylate  of  bismuth  has  been  much  used  of 
late  in  these  maladies,  and  its  action,  especially  in  typhoid,  has  been 
much  commended. 

Bismuth  is  employed  for  a  variety  of  purposes  in  the  treatment  of 
external  maladies.  It  is  a  good  application  to  the  reddened  surface  of 
the  skin  in  cases  of  acne  rosacea,  and  may  be  used  as  a  cosmetic  in 
this  mortifying  disease.  The  author  has  seen  excellent  results  from 
the  free  application  of  bismuth  in  cases  of  eczema  when  there  was 
much  serous  exudation.  Under  the  crusts  thus  formed  healing  pro- 
ceeded satisfactorily.  In  intertrigo  and  in  the  erythema  which  occurs 
about  the  genitals  of  infants,  dusting  the  affected  surface  with  bis- 
muth soothes  the  pain  and  promotes  healing.  Bismuth  is  one  of  the 
numerous  applications  to  the  eye  in  cases  of  chronic  conjunctivitis  and 
granular  lids.  It  is  also  used  as  an  injection,  mixed  with  mucilage,  or 
with  cocoa-butter  in  the  form  of  a  suppository,  in  chronic  gonorrhoea 
and  in  gleet,  and  in  leticorrhoea.  I£  Bismuthi  subnitrat.,  gr.  vj  ; 
hydrarg.  chlor.  cor.,  gr.  ss  ;  tinct.  camphors,  m,  jss  ;  aquae  ad  §  j. 
M.  Lotion  for  skin  diseases. 

The  best  vehicle  for  the  administration  of  bismuth  is  milk.  It  should 
be  given  before  meals  as  a  rule  when  employed  in  stomach-disorders. 

Bismuth  (subnitrate  and  salicylate)  has  become  a  very  popular 
antiseptic  dressing  for  wounds,  ulcers,  and  epithelioma.  Eltzina  suc- 
ceeded in  curing  an  unpromising  case  of  noma  by  the  application  of 
bismuth  and  resorcin.  Gosselin  and  Here"t  have  employed  it  as  an 
antiseptic  dressing  for  wounds  in  general,  and  they  advocate  it  for  its 
influence  over  the  process  of  suppuration,  and  its  power  to  prevent 
septic  decomposition.  On  the  other  hand,  Dr.  Delbastaille  finds  vari- 
ous objections  to  the  use  of  bismuth  for  surgical  dressing,  although 
admitting  its  antiseptic  power.  The  weight  of  evidence  is  in  its 
favor,  on  the  whole. 

Dennatol  is  the  proprietary  designation  of  the  subgallate  of  bis- 
muth. It  contains  somewhat  more  than  50  per  cent  of  the  oxide  of 
bismuth.  It  is  a  yellowish,  odorless,  and  permanent  powder,  insoluble 
in  the  ordinary  menstrua.  For  internal  administration  it  may  be  pre- 
scribed in  powder,  wafer,  or  capsule,  in  tablets  or  pills,  or  suspended 
in  mucilage.  The  dose  ranges  from  5  gr.  to  3  j.  In  surgical  practice 
it  may  be  applied  in  powder  or  in  the  form  of  gauze. 

ACTIONS  AND  USES. — Topically,  it  is  astringent,  deodorant,  and 
antiseptic.  Opinions  differ  somewhat  as  to  its  germicide  power. 
Wiemer,  for  example,  highly  extols  it  for  its  antiseptic  qualities  ; 
Stone,  of  Boston,  holds  that  it  is  not  destructive  of  pathogenic  organ- 
isms, basing  his  opinion  on  culture  experiments.  There  is,  however, 
a  general  consensus  of  opinion  as  to  its  power  to  prevent  septic  de- 
composition, to  change  the  character  of  poisoned  wounds,  to  pre- 
vent or  arrest  suppuration.  According  to  Hecht,  of  Breslau,  it  is  an 


ARSENIC.  165 

efficient  haemostatic,  quickly  arresting  haemorrhage  from  accessible 
parts. 

As  a  local  application,  it  is  much  esteemed  by  ophthalmic  and  aural 
surgeons  in  suppurating  wounds  and  ulcerations.  In  surgical  practice 
in  general  it  has  been  found  a  valuable  antiseptic  dressing  in  the  treat- 
ment of  unhealthy  wounds,  abscesses,  sinuses,  and  to  promote  healing 
without  suppuration  in  the  case  of  ordinary  wounds.  It  is  said  to  be 
an  excellent  application  in  the  intertrigo  of  children,  in  eczema,  and 
in  general  in  cases  with  abundant  secretion.  It  affords  great  relief  in 
excessive  and  foetid  perspiration  of  the  feet.  Suspended  in  mucilage, 
dermatol  is  a  capital  injection  in  gonorrhoea,  and  as  a  dry  powder  is 
an  excellent  application  to  soft  chancre  and  to  herpes  of  the  prepuce. 

By  Colasanti  and  Dutto,  dermatol  is  held  to  be  the  great  antidiar- 
rhoea  medicine.  They  have  found  it  highly  effective  in  the  entero- 
colitis  of  children,  in  the  diarrhoea  of  phthisis  and  of  typhoid  fever.  It 
has  proved  useful  in  the  author's  knowledge  in  chronic  diarrhoea.  In 
gastric  catarrh,  pyrosis,  acid  fermentation,  and  in  general  when  there  is 
excessive  secretion  in  stomachal  disorders,  it  has  proved  highly  useful. 
When  pain  is  present  in  these  maladies,  opium  can  be  combined  with  it. 

Authorities  referred  to  : 

COLASANTI,  C.,  UNO  W.  DCTTO.  Untersuchungen  uber  die  therapeut.  Wirkung.  Vir- 
chow  u.  Hirsch  Jahresbericht,  1893. 

DORNBERGER,  EuGEN.  Ueber  die  Behandlung  mit  Dermatol.  Therapeutische  Monats- 
hefte,  February,  1892. 

HECHT,  DR.      Ueber  Dermatol  als  Haemostaticum.     Ibid.,  June,  1895. 

WEIMER,  DR.  0.     Zur  Characteristik  des  Dermatol.     Ibid.,  January,  1895. 

STONE,  DR.  ARTHUR  K.     Boston  Journal,  September,  1892. 

ARSENICUM. 

Arsenic. — Acidum  arsenosum ;  arsenous  acid.  Acide  arsenieux, 
Fr.  ;  Arsenige  Sdure,  Ger.  Dose,  -^ — TV  grain. 

Arseni  lodidum. — Arsenic  iodide.  Is  an  orange-red,  crystalline 
solid,  soluble  in  7  parts  of  water,  and  wholly  volatilized  by  heat. 
Dose,  gr.  -fa. 

Liquor  Acidi  Arsenosi. — Solution  of  arsenous  acid.  Dose,  m  ij 
— v. 

Liquor  Arseni  et  Hydrargyri  lodidi.  —  Solution  of  arsenic  and 
mercury  iodide  ;  Donovan's  solution.  Dose,  fliij — v. 

Liquor  Potassii  Arsenitis.  —  Solution  of  potassium  arsenite. 
Fowler's  solution.  (Arsenous  acid,  potassic  bicarbonate,  compound 
spirit  of  lavender,  and  distilled  water.)  Dose,  fll  ij — x. 

Liquor  Sodii  Arsenatis. — Solution  of  sodium  arsenate  ;  Pearson's 
solution.  Dose,  HI  ij — xx. 

The  organic  compound  of  arsenic  called  cacodylic  acid  has  recently 
come  into  use.  It  is  much  less  poisonous,  and  its  combination  with 
sodium  is  freely  soluble  in  water  and  can  be  given  subcutaneously. 


16(3  RESTORATIVE  AGENTS 

It  is  used  successfully  in  the  treatment  of  pernicious  anaemia  and  in 
incipient  phthisis.  The  dose  of  this  salt  is  from  one  grain. 

When  a  course  of  arsenic  is  begun,  large  doses  should  be  pre- 
scribed, and  the  quantity  administered  should  be  regularly  reduced. 
In  this  way  chronic  arsenical  poisoning  is  avoided.  When  continually 
increasing  doses  are  given,  the  arsenic  accumulates,  and  toxic  symp- 
toms are  quickly  induced.  As  a  rule,  unless  very  small  doses  are  pre- 
scribed, arsenic  should  be  taken  after  meals.  Some  subjects  are  soon 
seriously  affected  by  even  small  doses  of  arsenic.  For  this  reason, 
when  the  idiosyncrasies  of  the  patient  are  unknown,  it  were  better  to 
make  tentative  experiments  with  a  few  small  doses  before  beginning 
with  large  ones.  A  few  drops  of  laudanum  given  with  arsenic  will 
enable  it  to  be  better  borne  by  some  susceptible  subjects. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  salts  of  iron,  magnesia, 
and  lime,  and  astringents,  are  chemically  incompatible.  The  arseniate 
of  iron,  although  not  actively  so,  does  cause  toxic  symptoms  if  con- 
tinued in  full  medicinal  doses.  The  hydrated  sesquioxide  of  iron, 
freshly  precipitated,  and  in  a  soft  magma,  is  the  antidote  to  arsenic  in 
solution.  About  eight  grains  of  the  antidote  are  required  for  each 
grain  of  the  poison  swallowed.  As  the  hydrated  sesquioxide  of  iron 
is  harmless,  it  should  be  given  in  teaspoonful  to  tablespoonful  doses, 
every  few  minutes.  In  every  case  of  poisoning  by  arsenic,  prompt 
efforts  to  secure  evacuation  of  the  contents  of  the  stomach  are  neces- 
sary. Large  doses  of  the  antidote  may  be  given  with  the  emetic  em- 
ployed. In  the  absence  of  the  hydrated  sesquioxide  of  iron,  magnesia, 
chalk,  and  lime-water  may  be  given  freely.  These  agents  act  in  part, 
and  probably  chiefly,  mechanically,  by  enveloping  the  particles  of  ar- 
senic, and  so  hindering  absorption.  It  is  held  by  some  that  freshly 
precipitated  hydrate  of  magnesia  is  more  effective  as  an  antidote  than 
the  hydrated  sesquioxide  of  iron.  Large  draughts  of  oil,  milk,  and 
substances  containing  mucilage,  by  protecting  the  mucous  membrane, 
render  important  service  in  cases  of  arsenical  poisoning.  Dialyzed 
iron,  later  experiences  show,  is  quite  as  efficient  as  the  hydrated  sesqui- 
oxide, and  is  always  ready.  It  is  an  important  point  to  favor  rapid 
elimination  of  the  poison  when  the  patient  survives  the  acute  symp- 
toms. This  is  accomplished  by  the  use  of  diluent  drinks,  skimmed 
milk,  slightly  alkaline  mineral  waters,  etc. 

SYNERGISTS. — All  those  agents  which  promote  constructive  meta- 
morphosis are  synergistic  to  arsenic. 

PHYSIOLOGICAL  ACTIONS. — Applied  to  the  tissues,  arsenic  excites 
violent  inflammation  and  causes  destruction  of  the  part ;  it  is  there- 
fore, an  escharotic.  Great  pain  attends  its  action.  In  consequence  of 
the  high  degree  of  inflammation  which  it  excites,  when  applied  in  suf- 
ficient strength,  absorption  does  not  follow  its  local  use,  but  weak  ap- 
plications may  excite  dangerous  symptoms  by  diffusion  into  the  blood. 


ARSENIC.  167 

Symptoms  of  poisoning  follow  the  inhalation  of  arsenical  fumes, 
Numerous  instances  have  occurred  in  which  wall-papers  colored  with 
arsenical  pigments  have  poisoned  the  occupants  of  an  apartment.  Gar- 
ments covered  with  aniline  dyes,  fixed  by  arsenical  mordants,  have 
induced  local  ulcerations  and  systemic  symptoms  from  absorption  of 
arsenic.  Applications  to  a  large  portion  of  even  the  unbroken  integu- 
ment, and  to  ulcerated  surfaces,  have,  in  numerous  instances,  excited 
dangerous  symptoms,  and  have  produced  fatal  results.  That  arsenic, 
wherever  applied,  manifests  a  selective  action  on  the  mucous  mem- 
brane of  the  respiratory  and  digestive  tracts,  is  a  curious  fact. 

Arsenic,  in  small  medicinal  doses,  promotes  the  appetite  and  diges- 
tive functions,  and  improves  the  body  nutrition.  It  increases  secretion 
of  the  gastro-intestinal  mucous  membrane,  and  hastens  the  peristaltic 
movements.  Arsenic  diffuses  into  the  blood  with  facility.  It  probably 
enters  into  combination  with  the  red  blood-globules.  It  certainly 
lessens  the  excretion  of  carbonic  acid,  probably  also  of  urea  ;  in  other 
words,  it  checks  the  retrograde  metamorphosis.  It  stimulates  the 
cerebral  functions  and  induces  a  feeling  of  well-being,  and  in  some 
subjects  decided  mental  exhilaration. 

In  larger  doses,  yet  not  in  quantity  to  produce  acute  poisoning,  and 
when  full  medicinal  doses  have  been  administered  for  a  lengthened 
period,  arsenic  causes  more  characteristic  physiological  actions  than 
are  described  above.  As  regards  the  digestive  organs,  the  following 
phenomena  occur  :  A  metallic  taste  ;  increased  flow  of  saliva  ;  nausea, 
vomiting  of  glairy  mucus,  epigastric  pain,  and  soreness  ;  diarrhoea, 
tenesmus,  and  sometimes  dysenteric  stools.  As  regards  the  circulatory 
and  respiratory  organs  :  the  action  of  the  heart  becomes  irritable  and 
feeble,  palpitations,  cough,  oppressed  breathing,  oedema  of  the  eyelids, 
general  oedema,  and  albuminuria  occur.  As  regards  the  skin  :  itching 
of  the  eyelids,  urticaria,  eczema,  pityriasis,  psoriasis,  and  falling  out 
of  the  nails  and  hair.  As  regards  the  nervous  system  :  disorders  of 
motility — trembling,  stiffness,  and  contraction  of  the  joints,  disorders 
of  sensibility,  herpes  zoster. 

Notwithstanding  the  effects  above  described  are  so  frequently  ob- 
served to  follow  the  use  of  arsenic,  it  is  undoubtedly  true  that  a  cer- 
tain degree  of  tolerance  may  be  established  when  doses  in  themselves 
toxic  can  be  taken  with  impunity.  This  state  has  been  produced  in  a 
course  of  the  legitimate  administration  of  arsenic,  and  has  been  wit- 
nessed on  a  considerable  scale  among  the  arsenic-eaters  of  Styria  and 
Southern  Austria.  The  arsenicophagi  begin  the  habit  of  arsenic-eat- 
ing at  an  early  age,  and  become  habituated  to  the  use  of  enormous 
doses.  They  find  that  this  practice  is  serviceable  in  several  respects  : 
they  improve  in  bodily  condition,  gain  in  breathing-power,  and  be- 
come stronger  and  more  pugnacious,  and  also  more  salacious. 

When  arsenic  is  swallowed  in  sufficient  quantity  to  cause  the  symp- 


168  RESTORATIVE   AGENTS. 

toms  of  acute  poisoning,  the  phenomena  produced  are  of  two  kinds — 
gastro-intestinal  irritation  and  cerebral  effects.  The  former  is  much 
the  more  common.  The  following  are  the  symptoms  of  the  gastro-in- 
testinal form  of  acute  arsenical  poisoning  :  Burning  at  the  epigastrium 
and  radiating  thence  over  the  abdomen  ;  violent  and  uncontrollable 
vomiting  ;  great  dryness  of  the  mouth  and  fauces  ;  intense  thirst  ; 
intestinal  irritation,  bloody  and  offensive  stools,  retracted  abdomen  ; 
strangury,  priapism,  suppression  of  urine  or  bloody  urine,  and  in  fe- 
males meuorrhagia  ;  rapid  and  feeble  action  of  the  heart,  oppressed 
breathing  ;  great  agitation  and  restlessness  ;  shrunken  features,  cold 
breath  ;  involuntary  evacuations  ;  collapse  —  consciousness  being  re- 
tained to  the  last.  In  the  cerebral  form  of  acute  poisoning,  without 
any  symptoms  of  gastro-intestinal  irritation,  the  patient  is  suddenly 
put  into  a  condition  of  profound  insensibility  and  coma,  not  unlike 
extreme  opium  narcosis. 

Recovery  from  the  effects  of  acute  arsenical  poisoning  is  rarely 
complete.  For  a  long  time  afterward  a  considerable  degree  of  gastro- 
enteric  irritability  will  persist,  and  life  may  at  last  be  lost  from  the 
continued  operation  of  this  pathological  state  on  the  function  of  nu- 
trition. An  irritable  state  of  the  skin  and  stiffness  of  the  joints  may 
also  continue  for  some  time,  and  paralysis  may  supervene,  accompa- 
nied with  neuralgic  pains,  numbness,  formication,  etc. 

The  changes  found  after  death  in  the  gastro-intestinal  mucous 
membrane  are  those  due  to  an  irritant :  deep  redness,  erosions,  ecchy- 
moses,  and  softening.  These  alterations  are  also  produced  when  toxic 
effects  are  caused  by  the  external  application  of  arsenic.  More  or  less 
redness  of  the  tracheal  and  bronchial  mucous  membrane  and  conges- 
tion of  the  lungs  have  been  observed.  It  must  not  be  forgotten  that 
arsenic  has  caused  a  fatal  result  without  producing  any  gastro-intesti- 
nal lesions  except  some  uncharacteristic  redness.  Fatty  degeneration 
of  the  liver,  kidneys,  spleen,  and  other  organs,  has  been  observed  in 
cases  of  acute  poisoning,  even  when  the  symptoms  have  existed  for  a 
few  hours.  The  icterode  hue  of  the  skin  and  the  albuminuria  which 
occur  in  the  course  of  chronic  arsenical  poisoning  are  probably  due  to 
fatty  degeneration  of  the  liver-cells  and  of  the  renal  epithelium. 

Arsenic,  although  like  other  mineral  poisons  it  tends  to  accumulate 
in  the  system,  is  nevertheless  eliminated  with  considerable  rapidity. 
If  the  patient  survive  a  week  after  the  ingestion  of  a  toxic  dose,  it  is 
difficult  to  detect  it  in  the  body  after  death.  If  the  poison  is  retained 
and  death  ensues  before  elimination  can  take  place,  it  undoubtedly  re- 
tards putrefaction.  Arsenic  is  eliminated  by  various  organs — by  the 
liver,  intestinal  canal,  kidneys,  and  bronchial  tubes— and  some  of  the 
symptoms  produced  by  it  probably  have  their  origin  in  the  local  effect 
of  the  poison  on  the  channels  of  excretion. 

The  quantity  of  arsenic  required  to  produce  a  fatal  effect  varies  ac- 


ARSENIC.  169 

cording  to  the  state  of  the  stomach  and  the  susceptibilities  of  the  pa- 
tient. Ounces  have  been  swallowed  without  producing  even  serious 
symptoms,  because  promptly  rejected  by  vomiting.  When  the  stom- 
ach is  full  of  food,  absorption  is  slow  and  vomiting  is  easily  induced, 
and  hence  a  toxic  dose  may  not  under  these  circumstances  produce 
any  of  the  phenomena  of  poisoning.  A  half -grain  of  arsenious  acid 
has  caused  symptoms  of  poisoning  (Taylor),  and,  according  to  the 
same  authority,  from  two  to  four  grains  may  prove  fatal  to  an  adult. 
Much  depends  on  the  idiosyncrasies  of  the  individual,  which,  as  has 
been  stated  above,  differ  greatly  in  different  persons.  These  facts 
should  not  be  forgotten  in  prescribing  strictly  medicinal  doses  of  ar- 
senical preparations. 

From  this  general  survey  of  the  effects  of  arsenic,  we  may  properly 
proceed  to  study  the  results  of  more  minute  investigations.  Virchow 
has  pointed  out  the  similarity  in  the  post-mortem  appearances  of  arsenic 
and  of  cholera.  The  cholera-fungus  of  Klebs  and  the  oharacteristic 
rice-water  contents  of  the  intestinal  canal  were  not  wanting  to  com- 
plete the  resemblance.  Hoffman  has  since  fully  confirmed  these  ob- 
servations. Croupous  exudations  are  sometimes  encountered  in  the 
stomach  and  intestines,  and  crystals  of  arsenic  have  been  found  im- 
bedded in  the  false  membrane.  This  result  is  due  to  the  action  of 
arsenic  when  swallowed  in  powder,  and  is  not  produced  when  the 
poison  is  taken  in  solution  (Filehne,  Lesser).  The  gastro-intestinal  in- 
flammation, present  in  a  large  proportion  of  cases,  is  due  in  part  to  the 
local  action  of  the  arsenic,  in  part  to  its  selective  action,  but  this  fact 
does  not  justify  the  statements  of  Bohm  and  Unterberger  that  a  larger 
dose  of  the  poison  is  required  to  destroy  life  by  the  intravenous  injec- 
tion than  by  the  stomachal  administration.  Lesser  holds  with  the 
authorities  in  general  that  arsenic,  in  common  with  other  poisons,  is 
more  fatal  by  intravenous  injection.  In  a  small  proportion  of  cases, 
as  has  been  stated,  gastro-intestinal  inflammation  does  not  occur,  but 
the  effects  of  the  poison  are  expended  on  the  nervous  centers  ;  several 
hours  after  the  ingestion  of  a  large  dose,  delirium,  followed  by  coma, 
and  convulsions  come  on,  and  with  these  albuminuria,  occasionally 
urinary  suppression.  The  relation  of  the  attacks  of  eclampsia  to  the 
albuminuria  has  not  been  settled.  In  still  other  cases  the  gastro-intes- 
tinal disturbance,  the  rice-water  discharges,  the  collapse,  simulate  the 
algid  stage  of  cholera.  The  remarkable  fall  in  the  blood-pressure  of 
the  abdominal  vessels  produced  by  arsenic  certainly  throws  light  on 
these  phenomena  (Bohm  and  Unterberger). 

The  experiments  of  Sklarek  have  demonstrated  that  arsenic  decid- 
edly impairs  sensibility,  leaving  the  motor  functions  untouched.  In 
the  human  subject,  however,  as  the  result  of  acute  poisoning,  and 
sometimes  after  the  acute  symptoms  have  subsided,  certain  paralyses 
develop.  They  may  be  preceded  by  numbness  and  tingling,  and  may 


170 


RESTORATIVE   AGENTS. 


be  accompanied  by  contractures  which  disappear  in  curable  cases,  and 
remain  permanently  in  incurable  cases.  The  paralysis  may  be  limited 
to  a  sino-Ie  member,  and  when  several  are  thus  affected  the  usual  form 

O  * 

of  paralysis  is  paraplegia  ;  but  all  four  members  may  be  thus  disabled. 
The  rectum  and  bladder  are  not  affected  (Christison).  These  clinical 
observations  by  Christison  are  confirmed  by  the  researches  of  Ringer 
and  Murrell,  who  have  shown  that  Sklarek's  statements  were  incorrect, 
and  that  motor  paralysis  precedes  sensory  paralysis  in  the  frog  poi- 
soned by  arsenic.  (See  Ponteland  Poisoning  Cases,  "  Lancet,"  Sep- 
tember, 1866.) 

The  effects  of  arsenic  on  the  circulation  are  not  the  same  in  cold 
and  warm  blooded  animals,  for,  according  to  Sklarek,  in  the  former 
the  action  of  the  heart  is  slowed,  then  arrested,  while  in  the  latter  the 
action  of  the  heart  persists  after  the  cessation  of  respiration  (Bohnx 
and  Unterberger,  Lesser).  This  fundamental  difference  in  the  action 
of  arsenic  on  the  two  classes  of  animals  requires  us  to  accept  with 
caution  the  observations  made  on  the  vaso-motor  system  of  the  cold- 
blooded. It  has  been  pretty  definitely  ascertained  that  arsenic  causes 
a  fall  in  the  blood-pressure,  which  is  especially  strong  in  the  abdomi- 
nal blood-vessels  (Bohm  and  Unterberger). 

A  fact  of  great  importance,  first  ascertained  by  Saikowsky,  is  the 
fatty  degeneration  of  the  liver,  kidneys,  heart,  and  other  organs.  The 
case  of  Grohl  and  Mosler,  reported  in  the  same  volume  of  Virchow's 
"  Archiv  "  containing  Saikowsky 's  paper,  is  confirmatory  more  or  less 
completely  of  the  observations  in  the  latter.  They  found,  as  their 
figures  well  exhibit,  fatty  degeneration  to  a  greater  or  less  extent  in 
the  glandular  epithelium  of  the  intestinal  canal,  and  less  conspicuous 
evidences  of  the  same  change  in  the  kidneys,  the  liver,  and  the  muscu- 
lar tissue  of  the  heart.  As  the  extent  of  the  change  is  determined 
largely  by  the  duration  of  the  case,  when  death  occurs  in  a  few  hours, 
or  in  a  day  or  two,  little  alteration  is  discernible. 

The  effect  of  arsenic  on  the  function  of  nutrition  is  as  yet  involved 
*n  doubt.  It  is  a  recognized  fact  that  arsenic  promotes  constructive 
metamorphosis  when  administered  in  medicinal  doses.  It  has  been 
ascertained  by  Saikowsky  that  it  arrests  the  formation  of  glycogen  by 
the  liver,  and  C.  Schmidt  has  shown  that  it  lessens  the  excretion  of 
carbonic  acid  and  urea.  Although  doubt  has  been  thrown  on  these 
statements,  they  seem  to  be  supported  by  the  observations  of  Lesser 
on  the  temperature,  which  has  been  constantly  and  considerably  de- 
pressed under  the  action  of  lethal  doses.  The  effect  of  arsenic  in 
lowering  the  functional  activity  of  the  respiratory  center  is  a  fact 
which  supports  the  same  view,  for  a  diminution  in  the  quantity  of  oxy- 
gen admitted  to  the  blood  must  necessarily  lessen  the  rate  of  oxidation. 
On  the  other  hand  are  the  adverse  experiments  of  Kassel,  a  medical 
student  under  Prof.  Gathgens,  and  Gathgens  himself,  which  appar- 


ARSENIC.  171 

ently  demonstrate  an  actual  increase  in  the  amount  of  urea  excreted. 
Arsenic  has  an  anti-fermentative  action  ;  but  it  is  not  universally 
destructive  of  the  minute  organisms  on  the  presence  of  which  the 
various  fermentations  are  dependent.  Thus  it  is  poisonous  to  Torula 
cerevisice  and  to  some  micrococci,  but  not  to  all,  and  it  does  not  impair 
the  activity  of  certain  animal  ferments,  as  pepsin,  pancreatin,  etc. 
(Johannsohn,  Schafer,  and  Bohm).  On  the  trophic  system  it  acts  a& 
a  depressant  when  taken  in  considerable  quantity.  The  dust  from 
arsenical  Avail-papers  has  induced  a  cachectic  state,  accompanied  by 
headache,  vertigo,  and  tinnitus  (Donkin).  Aniline  dyes  fixed  by  a 
mordant  of  arsenic  have  excited  ulceration  of  the  nails,  phlegmon  of 
the  hands,  and  anaesthesia  and  paresis  of  the  extremities  (Clemans). 

THERAPY. — The  preparations  of  arsenic  are  applicable  to  the  treat- 
ment of  the  diseases  of  those  tissues  upon  which  it  has  a  selective  ac- 
tion. 

No  remedy  is  more  useful  than  arsenic  in  the  so-called  irritative 
dyspepsia,  manifested  by  these  symptoms  :  a  red  and  pointed  tongue, 
poor  appetite,  distress  after  meals,  the  presence  of  the  food  causing 
intestinal  pain,  colic,  and  the  desire  to  go  to  stool.  Drop-doses  of 
Fowler's  solution,  given  before  meals,  quickly  relieve  this  state  of 
things.  The  effects  of  the  arsenic  are  frequently  favored  by  the  con- 
joint administration  of  a  little  laudanum. 

In  some  cases  of  the  vomiting  of  pregnancy,  a  drop  of  Fowler's 
solution  given  before  each  meal  will  afford  astonishing  relief.  The 
particular  indications  for  its  use  are  these  :  vomiting  of  food,  followed 
by  retching  and  straining,  the  vomited  matters  being  streaked  with 
blood,  or  blood  alone  being  thrown  up  ;  these  symptoms  accompanied 
by  gastralgia  and  pain  between  the  scapula?. 

The  vomiting  of  chronic  gastric  catarrh,  especially  the  alcoholic 
form,  is  relieved  by  one  or  two  drops  of  Fowler's  solution  taken  before 
meals.  It  effects  a  cure  in  these  cases  by  relieving  the  morbid  state 
of  the  mucous  membrane  on  which  the  vomiting  depends.  Arsenic  is 
also  very  beneficial  in  these  small  doses  in  chronic  ulcer  of  the  stomach. 
It  checks  the  vomiting,  relieves  the  pain,  and  improves  the  appetite 
for  food.  It  is  not  equally  effective  in  the  acute  ulcer.  Although  ar- 
senic exercises  but  little  influence  over  the  progress  of  these  cases,  it 
is  very  serviceable  in  cancer  of  the  stomach,  by  diminishing  the  pain 
and  checking  the  vomiting.  Gastralgia  and  enteralgia,  when  idio- 
pathic,  are  sometimes  made  to  disappear  in  a  very  surprising  manner 
by  the  same  remedy,  but  there  are  no  certain  indications  of  the  kind 
of  case  to  which  it  is  best  adapted. 

In  the  treatment  of  stomach-disorders,  only  small  doses  of  arsenic 
are  admissible.  Large  doses,  by  creating  an  irritation  of  the  gastric 
mucous  membrane,  will  only  defeat  the  end  in  view. 

That  form  of  diarrhoea  which  consists  merely  in  an  intolerance  of 


172  RESTORATIVE   AGENTS. 

the  presence  of  food,  an  evacuation  of  the  undigested  aliment  taking 
place  soon  after  it  is  swallowed,  is  cured  by  arsenic.  Chronic  diar- 
rhcea  and  dysentery  (entero-colitis),  especially  when  dependent  on 
the  changes  induced  by  chronic  malarial  infection,  are  often  greatly 
benefited  by  the  same  remedy.  In  these  cases,  two  drops  of  Fowler's 
solution  with  five  drops  of  laudanum  should  be  given  before  meals. 
Attention  to  the  diet  is,  of  course,  imperative.  Constipation,  when 
due  to  deficient  secretion  and  dryness  of  the  fa3ces,  is  sometimes  over- 
come by  small  doses  of  Fowler's  solution. 

Arsenic  is  one  of  the  numerous  remedies  proposed  for  the  treat- 
ment of  epidemic  cholera.  It  is  a  curious  circumstance,  first  demon- 
strated by  Virchow,  that  some  cases  of  acute  arsenical  poisoning  are 
not  distinguishable  by  their  symptomatology  or  morbid  anatomy  from 
cases  of  epidemic  cholera. 

Arsenic  has  been  used  with  success  in  the  treatment  of  the  jaun- 
dice due  to  catarrh  of  the  bile-ducts  succeeding  to  catarrh  of  the 
duodenum.  It  seems  to  the  author  to  be  better  adapted  to  cases  of 
jaundice  of  malarial  origin.  Excellent  results  are  obtained  by  the 
persevering  use  in  small  doses  of  arsenic  in  cirrhosis.  As  arsenic 
tends  to  accumulate  in  the  liver,  and  as  it  produces  fatty  degeneration 
of  this  organ,  the  curative  effect  in  the  above-named  disorders  may 
depend  on  this  selective  action. 

There  is  no  doubt  that  arsenic  promotes  in  a  very  decided  manner 
the  constructive  metamorphosis.  It  is  one  of  the  most  valuable  agents 
which  we  possess  in  the  treatment  of  chlorosis  and  anaemia.  It  is  es- 
pecially adapted  to  those  cases  in  which  iron  does  not  agree  or  fails  of 
effect.  The  efficiency  of  iron  in  these  disorders  is  much  increased  by 
combination  with  arsenic. 

Cases  of  acute  coryza  and  hay-asthma  are  often  decidedly  relieved 
by  this  remedy.  Chronic  catarrh  of  the  broncho-pulmonary  mucous 
membrane,  emphysema,  sclerosis  of  the  lungs,  are  maladies  in  which 
arsenic,  long  used  in  ordinary  medicinal  doses,  is  capable  of  effecting 
considerable  amelioration.  We  have  no  single  drug  of  equal  utility 
in  the  chronic  forms  of  phthisis,  but  it  is  not  serviceable  in  caseous 
pneumonia.  It  is  said,  and  this  statement  corresponds  to  the  author's 
observation,  that,  when  there  are  much  hectic  and  rapid  disintegration 
of  the  pulmonary  tissues,  arsenic  is  not  beneficial.  Besides  the  stom- 
ach administration  of  arsenic  in  the  above-mentioned  maladies  of  the 
respiratory  organs,  it  is  used  with  advantage  by  the  process  of  fumi- 
gation. The  following  is  the  formula  of  Trousseau  for  arsenical  cigar- 
ettes : 

Arsenlte  of  potassa 16  grains. 

Distilled  water 1  ounce. 

"Unsized  white  paper  is  thoroughly  moistened  with  this  solution, 
dried  and  cut  into  twenty  equal  parts,  and  each  part  rolled  into  a 


ARSENIC.  173 

cigarette.  Two  or  three  of  these  are  smoked  daily  for  the  relief  of 
chronic  bronchitis,  emphysema,  spasmodic  asthma,  phthisis,  hay-asth- 
ma, etc.  The  arseniate  of  soda  may  be  used  in  the  same  way,  and 
under  the  same  conditions  ;  for  example,  take  a  half -drachm  to  one 
drachm  of  arseniate  of  soda,  one  ounce  of  distilled  water,  and  moisten 
a  bit  of  unsized  paper  with  the  solution,  so  that  every  piece  of  a  given 
size  shall  contain  a  determined  quantity  of  the  arsenic,  ordinarily 
from  one  fourth  to  one  grain.  When  the  cigarette  is  lighted,  the  pa- 
tient inhales  the  smoke  by  a  single  inspiration,  and  this  inhalation  is 
practiced  three  or  four  times  a  day.  In  cases  of  acute  and  chronic 
coryza,  great  advantage  is  obtained  by  snuffing  into  the  nares  the 
fumes  of  arsenical  cigarettes.  The  arsenite  of  antimony,  according  to 
Dr.  Lucien  Papillaud,  is  especially  serviceable  in  pulmonary  affections. 

"When,  in  consequence  of  feebleness  of  the  heart,  there  are  present 
short  breathing  on  making  slight  exertion,  and  oedema  of  the  feet  and 
ankles,  especially  as  these  symptoms  occur  in  old  people,  arsenic  is  in- 
dicated. Attacks  of  angina  pectoris  may  be  lessened  or  prevented  by 
the  persistent  use  of  arsenic  in  the  interval. 

Certain  disorders  of  the  nervous  system  are  greatly  benefited  by 
the  use  of  arsenical  preparations.  The  author  has  seen  it  extremely 
useful  in  cerebral  congestion,  for  the  treatment  of  which  it  was  origi- 
nally recommended  by  Dr.  Lemare-Picquot.  It  is  indicated  when  there 
are  commencing  atheroma?  of  the  cerebral  vessels,  sluggish  venous  cir- 
culation, puffiness  of  the  eyes,  tendency  to  drowsiness,  and  intellectual 
torpor.  In  the  melancholy  and  hypochondria  of  the  aged,  it  gives  great 
comfort,  and  frequently  entirely  dispels  the  gloomy  fancies  which  take 
possession  of  the  mind  under  these  circumstances.  The  arsenic  acts 
most  favorably  when  combined  with  minute  doses  of  opium  ;  viz.,  two 
drops  of  Fowler's  solution,  with  three  to  five  drops  of  tincture  of  opium, 
given  three  times  a  day.  Arsenic  is  one  of  the  remedies  successful  in 
the  treatment  of  neuralgia.  Generally  its  curative  influence  is  indirect, 
and  exerted  through  the  improvement  in  the  bodily  nutrition  which  fol- 
lows its  administration.  It  is  directly  curative,  however,  in  the  cases 
of  hemicrania,  and  other  neuralgice  of  malarial  origin,  but  it  holds  a 
place  strictly  secondary  to  quinine  in  these  affections.  It  is  certainly 
one  of  the  most  effective  remedies  which  we  possess  in  the  treatment 
of  chorea.  In  this  disease,  large  doses — five  minims  ter  in  die — must 
be  given.  Young  subjects,  it  should  be  remembered,  bear  large  doses 
of  arsenic,  relatively,  better  than  adults.  Cases  of  epilepsy  have  been 
reported  cured  by  arsenic,  but  these  were  probably  instances  of  epilepti- 
form  vertigo  caused  by  stomach-disorder,  in  which  this  remedy  is  un- 
doubtedly of  great  utility.  Charcot  has  found  the  subcutaneous  injec- 
tion of  Fowler's  solution  of  real  value  in  paralysis  agitans.  The  same 
expedient  has  succeeded  in  local  chorea  and  histrionic  spasm.  The  in- 
jection should  be  made  into  the  affected  muscles,  whenever  practicable. 


1~4  EESTORATIVE   AGENTS. 

Arsenic  produces,  in  the  course  of  its  medicinal  administration,  affec- 
tions of  the  skin,  and  notably  those  dependent  on  an  unknown  state  of 
the  trophic  nerves.  In  the  treatment  of  various  skin-affections  we  avail 
ourselves  of  this  physiological  fact,  and  set  up  by  means  of  arsenical 
preparations  a  substitutive  action  in  the  skin.  It  follows,  that  arsenic 
will  not  be  serviceable  in  acute  affections  of  the  skin,  and  experience 
demonstrates  that,  whenever  active  cell-proliferation  is  taking  place, 
arsenic  is  contraindicated.  It  is  most  serviceable  when  the  affection 
of  the  skin  is  superficial  in  its  seat — in  the  epidermis  and  the  superfi- 
cial layers  of  the  derma.  In  cases  of  psoriasis  much  good  may  be  ex- 
pected from  it,  but,  the  more  chronic  the  disease,  the  more  beneficial 
is  it.  When  the  arsenic  begins  to  exert  an  influence  on  psoriasis,  the 
skin  appears  more  inflamed,  but  this  is  an  evidence  that  the  curative 
action  is  taking  place,  and  the  remedy  should  then  be  persisted  in. 
Acute  eczema  is  rather  exasperated  by  arsenic,  but  chronic  eczema, 
especially  eczema  squamosum,  is  often  greatly  benefited  by  it.  When 
eczema  infests  the  vulva,  anal  region,  and  scrotum,  arsenic  is  said  to  be 
useful,  but  its  efficacy  in  these  cases  is  largely  determined  by  the  chro- 
nicity  of  the  attacks.  Pemphigus  is  an  affection  of  the  skin  which,  as 
was  more  particularly  shown  by  Mr.  Hutchison,  is  curable  by  arsenic, 
but  the  more  chronic  the  disease  the  more  certainly  beneficial  the 
remedy.  In  old  cases  of  acne,  especially  acne,  rosacea,  arsenic  is  some- 
times serviceable,  but  it  is  often  very  disappointing.  The  author  has 
not  observed  much  good  to  follow  the  use  of  arsenic  in  the  acne  which 
occurs  at  puberty  and  for  some  years  subsequently.  In  all  cases  of 
acne  the  strictest  attention  to  diet  and  a  proper  hygiene  is  very  im- 
portant. Arsenic  given  with  bromide  of  potassium  lessens  or  prevents 
the  very  disfiguring  acne  which  appears  in  the  course  of  the  adminis- 
tration of  that  agent.  Furuncle  (boils)  is  successfully  treated  by  the 
long-continued  use  of  arsenic.  This  practice  is  strongly  urged  by 
Dr.  Delioux  de  Savignac.  A  succession  of  boils  is  the  indication  for 
the  use  of  this  remedy. 

In  the  treatment  of  skin-affections,  Fowler's  solution  is  the  arsenical 
preparation  most  frequently  employed.  The  commencing  dose  need 
not  be  larger  than  five  drops  three  times  a  day,  given  after  meals.  It 
is  better  to  commence  with  the  maximum  dose,  and  to  diminish  the 
amount  gradually.  As  arsenic  needs  to  be  administered  for  a  long 
time  in  skin-diseases,  such  toxic  symptoms  as  irritation  of  the  eye- 
lids, puffmess  of  the  eyes,  and  epigastric  pain  and  soreness,  are  apt  to 
arise.  These  symptoms  are  indications  for  the  use  of  laxatives,  and 
for  a  reduction  in  the  dose  of  the  remedy,  but  not  for  its  entire  sus- 
pension. In  order  to  prevent  relapses,  the  use  of  arsenic  should  be 
continued,  in  diminishing  doses,  for  some  time  after  the  entire  disap- 
pearance of  the  eruption. 

Arsenic  is  very  useful  in  a  certain  form  of  chronic  arthritis.     The 


ARSENIC.  175 

cases  to  which  it  is  adapted  are  those  in  which  the  joints  become  tumid 
and  stiff  and  painful  in  consequence  of  a  peculiar  state  of  the  nervous 
system ;  indeed,  the  condition  is  one  allied  to  neuralgia,  the  trophic 
nerves  being  involved.  This  is  a  malady  very  different  from  that  kind 
of  chronic  rheumatism  or  rheumatic  gout  which  is  accompanied  by  no- 
dosities of  the  joints,  in  which  arsenic  has  been  recommended,  but  over 
which,  according  to  the  experience  of  the  author,  it  exerts  no  control. 

Arsenic  has  seemed  to  the  author  remarkably  beneficial  in  diabetes 
of  hepatic  origin.  It  has  also  been  found  useful  by  Johannsohn. 
Arseniate  of  soda  has  lately  been  shown  to  be  a  very  excellent  remedy. 
It  may  usefully  be  given  with  phosphate  of  sodium —  3  j  of  the  phos- 
phate and  ^  of  the  arseniate  of  soda  three  times  a  day  dissolved  in 
warm  water.  At  the  present  time  Clemens's  solution  of  bromide  of 
arsenic  is  much  in  favor  as  a  remedy  for  diabetes,  and  I  therefore  sub- 
join the  formula  for  preparing  it  :  Powdered  arsenious  acid  and  car- 
bonate of  potassium,  of  each  57£  grains  ;  boil  in  8  ounces  of  distilled 
water  until  dissolved,  and  when  cold  make  up  to  11£  troy  ounces  by 
sufficient  distilled  water.  To  this  solution  add  115  grains  of  pure 
bromine.  The  resulting  solution  should  be  well  shaken  several  times 
a  day  during  the  first  week.  It  should  be  colorless  at  the  expiration 
of  the  fourth  week,  when  it  is  fit  for  use.  The  dose  is  one  drop  three 
times  a  day,  gradually  increased  to  three  drops.  It  should  be  given 
in  about  two  ounces  of  water.  Brunton  reports  good  results  from  its 
administration  in  albuminuria,  apparently  due  to  defective  digestion 
of  albumen. 

Amenorrhcea,  when  due  to  functional  inactivity  of  the  ovaries,  and 
menorrhagia,  when  produced  by  anaemia,  are  equally  benefited  by  the 
preparations  of  arsenic,  especially  when  combined  with  iron.  Sperma- 
torrhoea, if  dependent  on  a  weak  and  relaxed  state  of  the  seminal  vesi- 
cles, and  functional  impotence,  are  sometimes  greatly  improved  by 
full  doses  of  the  arseniate  of  iron. 

Next  to  quinine,  arsenic  has  the  most  important  position  in  the 
treatment  of  malarial  fevers.  It  may  be  used  to  prevent  the  recur- 
rence of  attacks  of  ague  when  quinine  for  any  reason  is  not  admissible. 
As  regards  acute  malarial  toxaemia,  arsenic  is  more  useful  as  an  ad- 
junct to  quinine  than  as  the  sole  remedy.  The  treatment  of  acute  cases 
may  be  formulated  as  follows  :  large  doses  of  quinine  to  interrupt  the 
paroxysms,  and  at  the  septenary  periods  ;  arsenic  given  daily  to  pre- 
vent relapses.  It  plays  a  more  important  role  in  chronic  malarial  dis- 
eases. As  has  been  shown  by  Boudin,  arsenic  diminishes  the  engorge- 
ment of  the  spleen.  The  author  has  witnessed  the  rapid  disappearance 
of  malarial  jaundice,  and  the  cure  of  the  alterations  in  the  glandular 
appendages  of  the  intestinal  mucous  membrane,  under  its  use.  It  is 
most  useful  generally  to  combine  iron  with  arsenic  in  the  chronic  form 
of  malarial  disease.  3  Mas.  ferri  carbon.,  3  j  ;  acidi  arseniosi,  gr.  j. 


I~Q  RESTORATIVE   AGENTS. 

M.  Ft.  pil.  no.  xx.  Sig.  :  One  three  times  a  day.  $  Quininae  sulph., 
3  j  ;  ferri  sulph.  exsic.,  3  j  ;  acidi  arseniosi,  gr.  j.  M.  Ft.  pil.  no.  xx. 
Si"-.  :  One  three  times  a  day.  Boudin  justly  insists  upon  abundant  ali- 
mentation during  a  course  of  arsenical  treatment  of  intermittents,  and, 
with  a  view  of  preparing  the  digestive  organs,  administers  a  prelimi- 
nary emetic  to  relieve  the  stomach  of  the  embarras  gastrique.  Arsenic 
has  also  been  used  as  a  prophylactic  against  malarial  infection,  and  as 
a  remedy  for  various  intermittent  diseases  due  to  malarial  influence. 
The  author  has  seen  excellent  results  from  the  use  of  small  doses  of 
Fowler's  solution  three  times  a  day  in  typho-malarial  fever.  When 
there  is  much  diarrhoaa,  a  few  drops  of  tincture  of  opium  should  be 
added  to  each  dose  of  arsenic.  In  doses  of  half  a  drop  to  one  drop  of 
Fowler's  solution,  the  tongue  cleans,  the  skin  becomes  moist,  and  the 
delirium  lessens  sometimes  in  a  most  remarkable  manner.  When 
arsenic  is  used  alone  in  the  treatment  of  intermittents,  large  doses  are 
necessary.  Ten  drops  of  Fowler's  solution  may  be  given  after  meals 
to  adults,  but  in  a  few  days — three,  four,  or  five,  according  to  the  sus- 
ceptibility of  the  patient — the  dose  must  be  reduced  two  drops  each 
day  until  four  drops  are  reached.  If  the  stomach  does  not  become 
disordered,  slight  irritation  of  the  conjunctivas  and  puflmess  of  the 
eyelids  may  be  disregarded. 

There  can  be  no  doubt  that  the  long-continued  use  of  small  doses  of 
arsenic  exercises  a  favorable  influence  over  the  course  and  progress  of 
epithdioma.  It  has  appeared,  indeed,  to  be  useful  in  scirrhus,  especially 
as  this  morbid  process  manifests  itself  in  the  stomach.  Rodent  ulcer, 
which  is  closely  allied  in  its  nature  to  epithelioma,  is  also  improved  by  it. 
With  the  internal  use  of  the  arsenical  preparations  may  be  conjoined 
the  local  applications  of  arsenious  acid.  Many  physicians,  notably  the 
late  Dr.  Atlee,  of  Philadelphia,  entertain  the  belief  that  the  long- 
continued  use  of  arsenic  retards  the  growth  of  uterine  cancer.  Bill- 
roth  reports  a  case  of  multiple  tymphoma  cured  by  the  use  of  arsenic. 

External  Uses  of  Arsenic. — An  arsenical  paste  having  the  follow- 
ing composition  is  used  to  destroy  the  sensibility  of  a  carious  tooth  : 
arsenious  acid,  ij  ;  sulphate  of  morphia,  j  ;  sufficient  creosote  to  make 
a  paste.  A  small  quantity  of  this  is  applied  by  a  bit  of  cotton-wool 
to  the  carious  portion  of  the  tooth. 

Arsenious  acid  is  sometimes  employed  to  destroy  cancerous  growths. 
But,  as  it  is  extremely  painful,  and  as  the  danger  of  absorption  is  great, 
other  escharotics,  as,  for  example,  the  chloride  of  zinc,  are  generally 
preferred.  When  it  is  used,  the  operator  should  be  careful  to  employ 
an  arsenical  paste  of  sufficient  strength  to  set  up  a  limiting  inflamma- 
tion, and  thus  prevent  absorption.  From  one  sixth  to  one  fifth  of 
arsenious  acid  is  the  proper  proportion,  and  it  may  be  mixed  with 
calomel,  starch,  or  other  impalpable  powder.  If  the  surface  to  be  de- 
stroyed is  large,  a  portion  of  it  should  be  submitted  at  a  time  to  the 


ARSENIC.  177 

action  of  the  escharotic.  Poultices  should  then  be  applied  until  the 
slough  separates,  when  a  healthy  granulating  surface  is  obtained.  The 
excessive  pain  caused  by  the  escharotic  may  be  much  alleviated  by 
combining  morphine  and  carbolic  acid  in  the  arsenical  paste,  or  by  the 
use  of  morphine  hypodermatically  until  the  escharotic  action  ceases. 

An  arsenical  paste  prepared  as  follows  is  sometimes  used  as  a  de- 
pilatory :  quicklime,  f  ss  ;  yellow  sulphide  of  arsenic,  grs.  xx  ;  starch, 
3  ij.  Sulphide  of  barium  and  oxide  of  zinc  is  a  more  efficient  combi- 
nation. Esmarch's  caustic  is  composed  of  :  Arsenious  acid,  one  part ; 
morphine  sulph.,  one  part ;  calomel,  eight  parts  ;  and  powdered  acacia, 
forty-eight  parts.  Mix.  Sprinkle  thickly  every  day  on  a  surface  either 
raw  or  denuded  of  cuticle  by  a  blister. 

In  addition  to  the  above  local  uses  of  arsenic,  the  results  achieved 
by  its  hypodermatic  injection  should  be  mentioned.  Dr.  Radcliffe 
was  the  first  to  employ  this  practice  in  cases  of  local  chorea,  of  the 
head  and  neck,  and  in  histrionic  spasm.  In  these  affections  Fowler's 
solution  or  Pearson's,  in  doses  of  two  to  ten  minims,  diluted  with  an 
equal  measure  of  water,  is  thrown  into  the  affected  muscles  daily, 
sometimes  curing  after  some  weeks  of  treatment.  In  obstinate  cases  of 
general  chorea  the  subcutaneous  injection  of  arsenic  is  now  practiced, 
with  good  effects,  a  cure  resulting  more  speedily  than  by  the  stomachal 
method  of  administration.  Arsenic  used  by  this  method  has  proved  to 
be  the  most  effective  remedy  for  lymphadenoma. 

Authorities  referred  to  : 

GATHGENS,  C.  Zur  KenntnJKs  der  Arsenwirkungen.  Centralblatt  f.  d.  med.  Wis.,  32, 
1875,  p.  529. 

GIES,  DR.  THOMAS.  Experimentelle  Untersuchungen  iiber  den  Einfluss  des  Arsens  auf 
den  Organismus.  Archiv  fur  experimentelle  Path,  und  Pharm.,  vol.  viii,  p.  176. 

GKOHE,  FR.,  UND  MOSLER,  FR.,  PROFS.  Zur  Kenntniss  der  Veranderungen  innerer  Or- 
gane  bei  acuter  Ar&envergiftung.  Virchow^s  Archiv,  Band  xxxiv,  p.  208. 

HEBRA,  PROF.  DR.     On  Diseases  of  the  Skin.     Syd.  Society  edition,  1868. 

HERMANN,  PROF.  DR.  Lehrbuch  der  experimentellen  Toxicologie,  Berlin,  1874,  p.  224. 
Arsenverbindungen. 

HOFFMAN,  PROF.  DR.  Arsenikvergiftung  und  Cholera.    Virchmo's  Archiv,  vol.  1,  p.  455. 

HUNT,  THOMAS,  MR.  On  the  Treatment  of  Chronic  Diseases  of  the  Skin.  The  Lancet, 
vol.  i,  1846. 

ISNARD,  M.     Bulletin  General  de  Therapeutique,  vol.  Ixxxiv,  p.  80.     Ibid.,  vol.  Ixxii. 

JOHANNSOHN,  NICOLA!.  Ueber  die  Einwirkung  der  arsenigen  Saure  auf  Gahrungsvor- 
gdnge.  Archiv  fur  experiment.  PatJiol.  und  PharmacoL,  vol.  ii,  p.  99. 

KOSSHL,  ALBRECHT.  Zur  Kejintniss  der  Arsenwirkungen  in  Prof.  Gathgens  Labor,  zu 
Rostock.  Archiv  f.  exper.  Pathol.  u.  Pharm.,  vol.  v,  p.  128. 

LESSER,  A.  Archiv  fur  path.  Anatomie  und  Physiologic,  1873,  p.  398,  and  1874, 
p.  603. 

LOLLIOT,  M.     Bulletin  General  de  Therapeutique,  vol.  Ixxv,  p.  338. 

MARME,  W.  Vergleichende  Versuche  uber  die  Wirkungen  der  arsenigen  Saure  und 
der  Arsensaure.  Abstract  in  Virchoio  und  ffirsch,  vol.  i,  1876. 

MARSDEN,  DR.  ALEXANDER.  A  New  and  Successful  Mode  of  treating  Cancer,  London, 
1869,  p.  96. 


178  RESTORATIVE   AGENTS. 

PONTILAND  POISONING  CASES.     The  Lancet,  September  22,  1866,  p.  337. 

ROCTH,  DR.  C.  H.  F.     Obstetrical  Transactions,  vol.  viii,  p.  290. 

RINGER  AND  MURRELL.     Journal  of  Physiology,  vol.  i,  p.  217. 

SCOLOSUBOFF,  DR.  Sur  la  localisation  de  Farsenic  dans  les  ti&sus  ct  la  suite  de  V  usage 
des  Arsenicaux.  Archives  de  Physiol.  Norm,  et  Path.,  vol.  v,  p.  563. 

SKLAREK,  DR.  W.  Archiv  fur  Anat.  und  Physiologic,  1866,  p.  41.  The  Physiological 
Effects  of  Arsenious  Acid. 

SCHAFER,  F.,  CND  BoHM.  Ueber  den  Einfluss  des  Arsen  auf  die  Wirkung  ungeformtes 
Fermente.  Virchow  u.  Hirsch,  vol.  i,  1872. 

SHULZ,  DR.  H.  Weiterer  Beitrag  zur  Theorie  des  Arsenwirkung.  Archiv  fur  experi- 
ment. Pathologic  u.  Pharmacol.,  vol.  xiii,  p.  256. 

UNTERBERGER,  S.  Mitgetheilt  von  Prof.  Bohm.  Beitrdge  zur  Kenntniss  der  physiolo- 
gischen  Wirkungen  der  Arsenigen  Saure.  Ibid.,  vol.  ii,  p.  89. 

VIRCHOW,  R.  His  Archiv,  vol.  xlvii,  p.  524.  Choleraahnlicher  Befund  bei  Arsenik- 
vergiftung. 

THE   SIMPLE  BITTERS. 

Quassia. —  Quassi  amer,  Fr.  ;  Quassienholz,  Ger.  The  wood  of 
Pier  ciena  excelsa  Lindley  ( Quassia  excelsa  Swartz  ;  Nat.  Ord.  Simaru- 
bacece). 

PREPARATIONS. — Extractum  Quassice.  Extract  of  quassia.  Dose, 
gr.  j— gr.  iij. 

Tinctura  Quassice. — Tincture  of  quassia  (100  grm.  to  1,000  c.  c.  of 
diluted  alcohol).  Dose,  in  v  —  3  j. 

Extractum  Quassice  Fluidum. — Fluid  extract  of  quassia.  Dose, 
ui  v —  3  ss. 

COMPOSITION. — Quassia-wood  contains  a  crystallizable  bitter  prin- 
ciple, neutral,  called  quassin. 

Gentiana.—  Gentian,  gentiane,  Fr.  ;  Hitterwurzel,  Ger.  The  root 
of  Gentiana  lutea  Linn6  (Nat.  Ord.  Gentianacece). 

PREPARATIONS. — Infusum  Gentiance  Compositum.  (Not  official.) 
Compound  infusion  of  gentian.  (Gentian,  bitter  orange-peel,  corian- 
der.) Dose,  3  j —  1  j. 

Tinctura  Gentiance  Composita. — Compound  tincture  of  gentian. 
(Gentian,  bitter  orange-peel,  cardamom,  alcohol.)  Dose,  3  ss —  3  ij. 

Extractum  Gentiance  Fluidum. — Fluid  extract  of  gentian.  Dose, 
3  ss—  3  ij. 

Extractum  Gentiance. — Extract  of  gentian.     Dose,  gr.  j — gr.  v. 

COMPOSITION. — Gentian  contains  a  peculiar  principle,  gentianine, 
and  an  acid,  gentisic  acid. 

Gentiana  Catesbffli. — Blue  gentian,  American  gentian.  This  in- 
digenous remedy  may  be  used  as  a  substitute  for  the  foreign  gentian, 
and  similar  preparations  to  the  official  formula  for  gentian,  as  above, 
may  be  prepared  from  it. 

UNOFFICIAL  FORMULAE. — Mistura  gentiance  alkalina.  Dilute  hy- 
drocyanic acid,  ui  iij  ;  bicarbonate  of  soda,  grs.  xv  ;  compound  infu- 
sion of  gentian  to  oz.  j. 

Mistura  Gentiance  et  Sennce. — Infusion  of  gentian,  drachms  vj  ; 


THE   SIMPLE   BITTERS.  179 

infusion  of  senna,  drachms  iij  ;  compound  tincture  of  cardamoms, 
drachm  j. 

Calumba. —  Colombe  (ratine  de),  Fr. ;  Ruhrwurzel,  Ger.  The  root 
of  J~ateorrhiza  calumba  Meiers  (Nat.  Ord.  Menispermacece). 

PREPARATIONS. — Infusum  Calumbce.  (Not  official.)  Infusion  of 
calumba  (  3  j — Oj).  Dose,  §  ss —  f  ij. 

Tinctura  Calumbce. — Tincture  of  calumba  (100  grin,  to  1,000  c.  c. 
of  diluted  alcohol).  Dose,  3  ss —  3  ij. 

Extractum  Calumbce  Fluidum. — Fluid  extract  of  calumba.  Dose, 
3  ss —  3  ij. 

COMPOSITION. — A  peculiar  principle,  colombin,  berberine,  and  a  pe- 
culiar acid,  Colombia  acid. 

Coptis. —  Goldthread.  The  root  of  Coptis  trifolia.  There  are  no 
official  preparations  of  coptis.  It  contains,  in  common  with  some 
other  bitters,  the  alkaloid  berberine,  and  another  alkaloid  in  minute 
quantity  which  has  been  called  coptine,  closely  allied  to,  if  not  iden- 
tical with,  hydrastine.  The  tincture  and  fluid  extracts  are  the  best 
preparations. 

Calendula. — The  florets  of  Calendula  officinalis,  Linn  6  (Nat.  Ord. 
Compositce). 

Tinctura  Calendulce. — Tincture  of  calendula.  Calendula,  200  grm., 
and  alcohol  q.  s.  to  make  1,000  c.  c. 

Cornus. — Dogwood.  The  bark  of  the  root  of  Cornusflorida  Linne1 
(Nat.  Ord.  Cornacece). 

PREPARATION. — Extractum  Cornus  Fluidum.  —  Fluid  extract  of 
dogwood.  Dose,  m  x —  3  j. 

Decoctum  Cornus  Florida^. — (Not  official.)  Decoction  of  dogwood 
( I  j— Oj)-  D°se,  I  ss—  I  ij. 

ANTAGONISTS  AND  INCOMPATIBLES. — Quassia  and  calumba  can  be 
administered  with  the  salts  of  iron.  The  sulphate  of  iron,  and  the  sil- 
ver and  lead  salts,  are  incompatible  with  gentian.  The  infusion  of 
coptis  is  not  affected  by  the  salts  of  iron,  but  is  precipitated  by  the 
nitrate  of  silver  and  acetate  of  lead.  Therapeutically,  all  those  agents 
which  promote  waste  or  destructive  metamorphosis  are  opposed  to  the 
action  of  the  simple  bitters. 

SYNERGISTS. — Iron,  the  mineral  acids,  pepsin,  bismuth,  etc.,  are 
synergistic  to  the  bitters,  and  under  some  circumstances  the  alkalies 
promote  their  therapeutic  action. 

PHYSIOLOGICAL  ACTIONS. — The  simple  bitters  increase  secretion 
from  the  mucous  membrane.  In  the  mouth  they  promote  the  flow  of 
saliva,  and  in  the  stomach  they  appear  to  stimulate  the  production 
of  gastric  juice,  and  also  of  gastric  mucus.  It  follows  that  an  increase 
of  digestive  capacity  is  one  result  of  their  administration.  The  in- 
creased appetite  which  is  observed  from  the  use  of  the  bitters  is  prob- 
ably due  to  two  factors  :  the  sense  of  bitterness  which  increases  the 
14 


180  RESTORATIVE   AGENTS. 

desire  for  food,  and  the  improved  digestive  power  which,  enabling  more 
food  to  be  disposed  of,  postpones  the  sense  of  satiety.  Furthermore,  the 
bitters,  by  removing  morbid  states  of  the  intestinal  mucous  membrane, 
favor  assimilation.  More  food  being  taken  and  more  thoroughly  digest- 
ed, it  is  obvious  that  the  bitters  promote  constructive  metamorphosis. 

The  active  constituents  of  some  of  them  have  been  studied  in 
detail.  Berberine,  which  enters  into  the  constitution  of  several  bitters, 
is  possessed  of  some  antiseptic  and  antiperiodic  power,  but  is  not  ac- 
tive from  the  physiological  point  of  view.  In  animals  it  causes  low- 
ering of  the  blood  pressure,  and  lessens  body-heat  (Curci).  According 
to  Kohler,  it  contracts  the  blood-vessels,  and  in  the  intestinal  canal  acts 
in  a  similar  manner  to  the  tannates.  It  is  said,  also,  that  when  ap- 
plied to  the  walls  of  the  intestines  they  contract  energetically.  Quas- 
sin  has  recently  been  studied  by  Dr.  Campardou,  and  his  observations 
were  published  in  a  special  memoir.  There  are,  however,  no  new  facts 
produced.  Quassin,  as  might  be  supposed  from  its  origin,  acts  after 
the  manner  of  the  bitter  tonics  ;  it  increases  the  appetite,  and  pro- 
motes the  digestive  functions  by  stimulating  the  secretions  of  the 
gastro-intestinal  mucous  membrane,  and  the  contractility  of  the  mus- 
cular fiber  of  the  intestine.  In  an  overdose  quassin  causes  the  local 
and  systemic  symptoms  of  an  irritant  poison. 

Although  these  remedies,  used  judiciously  and  for  a  short  period, 
undoubtedly  promote  the  constructive  metamorphosis,  yet  their  long- 
continued  use  will  produce  gastric  catarrh,  decrease  the  flow  of  healthy 
gastric  juice,  and  impair  digestion. 

THERAPY. — An  infusion  of  coptis  has  much  reputation  in  New  Eng- 
land as  a  remedy  in  aphthae,  psoriasis  of  the  mucous  membrane,  ulcers, 
and  epithelioma,  but  it  is  probable  that  this  supposed  curative  power 
is  unfounded,  and  that  it  is  no  more  useful  than  any  bitter  so  applied. 

A  few  drops  of  the  tincture  of  calumba,  or  a  teaspoonful  of  the  in- 
fusion, will  sometimes  greatly  relieve  the  vomiting  of  pregnancy,  and 
is  also  occasionally  efficacious  in  sea-sickness.  The  simple  bitters  are 
especially  indicated  in  atonic  dyspepsia,  and  in  chronic  gastric  catarrh. 
They  are  useful  in  this  state  of  things  :  pain  after  food,  slow  diges- 
tion, constipation,  alternating  with  diarrhoea.  Calumba  is  the  mildest, 
and  may  be  borne  when  quassia  and  gentian  disagree.  According  to 
Wilson  Fox,  "  calumba  holds  the  chief  place  in  point  of  therapeutic 
value  as  a  remedy  which  can  be  safely  employed  when  others  of  the 
class  would  be  too  irritating."  When  there  are  much  relaxation  and 
torpor,  quassia  is  very  useful  as  a  stomachic  tonic.  Sometimes  an  ex- 
temporaneous cold  infusion  of  quassia  is  used,  made  by  filling  over- 
night with  cold  water  a  quassia-cup — a  goblet  turned  out  of  quassia- 
wood.  When  constipation  exists  in  cases  of  atonic  dyspepsia,  good 
results  are  obtained  by  a  combination  of  gentian  with  senna,  as  in  the 
formula  already  given.  The  compound  tincture  of  gentian  is  an  ex- 


THE   SIMPLE   BITTERS.  181 

cellent  vehicle  for  the  administration  of  cod-liver  oil,  and  contributes 
to  its  digestion  and  assimilation. 

The  infusions  of  gentian,  calumba,  and  quassia  are  usefully  em- 
ployed as  vehicles  for  the  administration  of  acids  and  alkalies  in  cases 
of  acidity  and  deficient  supply  of  gastric  juice,  under  the  rules  given 
in  the  articles  on  acids  and  alkalies. 

In  convalescence  from  acute  diseases,  the  simple  bitters,  especially 
gentian  and  calumba,  are  employed  to  promote  the  appetite  and  diges- 
tion, and  thus  to  aid  in  the  process  of  constructive  metamorphosis. 

In  the  diarrhoea  which  is  due  to  relaxation  of  the  mucous  mem- 
brane, and  is  not  dependent  on  inflammation,  the  tincture  of  calumba 
is  often  useful.  The  author  has  obtained  good  results  from  the  use 
of  tincture  of  calumba  combined  with  opium  in  the  treatment  of  an 
irritable  state  of  the  intestinal  mucous  membrane,  indicated  by  these 
symptoms  :  Soon  after  taking  food,  the  occurrence  of  pain  referable 
to  the  small  intestines,  nausea,  loose  evacuations  containing  undigest- 
ed aliments,  and  followed  by  weakness  and  depression.  IJ  Tinct.  ca- 
lumbse,  3  xv  ;  tinct.  opii  deodor.,  3  j.  M.  Sig. :  A  teaspoonful  in  a 
wineglassful  of  water  before  meals.  Calumba  is  also  serviceable  in 
the  relaxation  of  the  bowels  succeeding  to  acute  affections  of  the  in- 
testinal mucous  membrane. 

The  infusion  of  quassia  is  one  of  the  most  effective  injections  for 
the  destruction  of  the  ascarides  vermiculares  which  infest  the  rectum. 
The  stomach  administration  of  simple  bitters  undoubtedly  hinders  the 
development  of  intestinal  worms,  probably  by  correcting  a  morbid 
state  of  the  mucous  membrane.  In  the  treatment  of  intestinal  para- 
sites much  good,  therefore,  is  derived  from  the  use  of  bitters,  admin- 
istered with  the  view  of  restoring  normal  digestion. 

According  to  Wood,  the  remedy  most  effective  to  remove  and 
"  permanently  cure  a  disposition  to  the  accumulation  of  flatus  in  the 
bowels  is  an  infusion  made  with  half  an  ounce  of  calumba,  half  an 
ounce  of  ginger,  a  drachm  of  senna,  and  a  pint  of  boiling  water,  and 
given  in  the  dose  of  a  wineglassful  three  times  a  day." 

The  bitters  are  used  as  remedies  in  malarial  fever.  Although  they 
exercise  but  little  influence  over  the  course  of  intermittent  and  remit- 
tent fever,  they  are  useful  in  the  form  of  infusion  as  vehicles  for  the 
administration  of  more  active  drugs.  In  the  convalescence  from  mala- 
rial fever,  and  in  chronic  malarial  poisoning,  they  are  more  actively 
beneficial  as  agents  promoting  constructive  metamorphosis.  Calen- 
dula is  chiefly  used  as  a  topical  application  in  chronic  pharyngitis  and 
suppurative  affections  of  the  throat  and  external  auditory  canal.  It 
has  also  been  applied  to  the  treatment  of  chronic  stomachal  dis- 
orders, catarrh  of  the  stomach,  of  the  duodenum,  and  conjoint  implica- 
tion of  the  bile-ducts.  It  was  first  introduced  into  medical  practice 
by  Dr.  Sexton,  of  New  York,  by  whom  it  is  employed  in  suppura: 


182  RESTORATIVE   AGENTS. 

tive  inflammation  of  the  ear,  and  given  internally  in  cases  of  sup- 
puration to  obviate  septic  infection.  While  the  local  application 
seems  beneficial,  there  is  little  reason  to  suppose  that  it  has  any  in- 
fluence over  a  systemic  septic  state. 

AROMATIC  BITTERS. 

Serpentaria. —  Virginia  snakeroot.  Serpentaire  de  Virginie,  Fr.  ; 
Schlangenwurzel,  Ger.  The  rhizoma  and  rootlets  of  Aristolochia  ser- 
pentaria Linne,  and  of  Aristolochia  reticulata  Nuttall  (Nat.  Ord. 
Aristolochiai),  U.  S.  P. 

PREPARATIONS. — Infusum  /Serpentarice.  —  Infusion  of  serpentaria 
(  3  ss — Oj).  Dose,  3"  ss —  f  j.  (Not  official.) 

Tinctura  Serpentarice. — Tincture  of  serpentaria  (100  grm. — 1,000 
c.  c.).  Dose,  3  ss —  3  ij. 

Extractum  Serpentarice  Fluidum, — Fluid  extract  of  serpentaria. 
Dose,  3  ss —  3  ij. 

COMPOSITION. — A  volatile  oil,  resin,  a  bitter  principle,  etc. 

Prunus  Virglniana. —  Wild  cherry.     The  bark  of  Primus  serotina. 

PREPARATIONS.  —  Infusum  Pruni  Virginiance. — Infusion  of  wild 
cherry  (40  grm.  and  water  to  make  1,000  c.  c.).  Dose,  f  ss —  f  ij. 

Extractum  Pruni  Virginiance  Fluidum. — Fluid  extract  of  wild- 
cherry  bark.  Dose,  3  ss —  3  j- 

Syrupus  Pruni  Virginiance. — Sirup  of  wild  cherry.  Dose,  3  j — 
3ij- 

COMPOSITION. — Amygdalin  and  emulsin,  which  produce  by  their 
reaction  hydrocyanic  acid,  tannic  and  gallic  acids,  etc. 

Cascarilla. —  Cascarilla.  Cascarille,  Fr.  ;  Cascarille  Hinde,  Ger. 
The  bark  of  Croton  eleuteria  Bennett  (Nat.  Ord.  Euphorbiaceoe). 

PREPARATIONS. — Infusum  Cascarillce.  (Not  official.)  Infusion 
of  cascarilla  (  3  ss — Oj).  Dose,  f  ss —  §  j. 

COMPOSITION. — A  crystallizable  principle,  cascarillin,  tannic  acid, 
a  volatile  oil,  etc. 

Canella. — The  bark  of  Canella  alba.  This  remedy  has  been 
dropped  from  the  list  of  official  medicinal  agents.  As  it  is  indigenous 
(Florida),  and  as  recent  experiences  have  shown  that  it  is  possessed  of 
some  valuable  therapeutical  properties,  it  is  taken  up  now  as  a  mem- 
ber of  the  group  of  aromatic  bitters. 

COMPOSITION. — Canella  contains  a  volatile  oil  and  a  bitter  prin- 
ciple, but  the  latter  has  not  yet  been  isolated. 

Actions  and  Uses. — These  remedies  possess  the  quality  called  tonic  ; 
they  invigorate  digestion,  and  promote  constructive  metamorphosis. 
They  differ  from  the  simple  bitters  in  containing  aromatic  constituents, 
and  in  being  astringent  to  a  greater  or  less  degree,  owing  to  the  pres- 
ence of  tannic  and  gallic  acids.  They  are  indicated  in  the  same  kind 
of  cases  as,  and  under  similar  conditions  to,  the  simple  bitters  ;  but 


AROMATIC   BITTERS.  183. 

they  are  supposed  to  have,  in  addition,  some  specific  properties  derived 
from  their  volatile  and  odorous  constituents. 

Serpentaria  is  occasionally  used  as  a  stimulating  tonic  in  typhoid 
and  typho-malarial  fevers.  It  is  more  frequently  prescribed  as  a 
stimulant  expectorant  in  capillary  bronchitis  and  in  pneumonia  of 
low  grade,  when  carbonate  of  ammonia  is  combined  with  it.  For- 
merly it  was  used  locally  to  the  throat,  as  a  gargle  in  diphtheria,  and 
given  internally  as  a  stimulant,  but  it  is  now  very  rarely  employed  in 
such  cases. 

Wild-cherry  is  an  excellent  stomachic  tonic,  and  may  well  be  used 
as  a  substitute  for  calumba  in  the  class  of  cases  to  which  the  latter  is 
considered  specially  applicable.  It  has  long  been  held  in  great  esteem 
in  domestic  practice,  as  a  remedy  in  catarrhal  states  of  the  bron- 
chial mucous  membrane,  and  in  phthisis.  Owing  to  the  prussic  acid 
which  its  cold  infusion  contains — produced  by  the  reaction  between 
the  amygdalin  and  emulsin — it  exercises  some  influence  over  cough. 
That  it  has  any  special  virtues  in  the  treatment  of  phthisis  is  hard- 
ly to  be  credited.  The  sirup  is  much  used  as  an  ingredient  in  cough- 
mixtures. 

As  regards  canella,  there  has  been  no  proper  study  of  its  physio- 
logical actions.  The  success  which  has,  apparently,  attended  its  use  in 
certain  haemorrhagic  states  indicates  that  canella  has  properties  analo- 
gous to  erigeron  :  antiseptic,  vaso-motor,  stimulant,  etc.  Formerly,  it 
was  in  considerable  repute  as  a  remedy  for  certain  pelvic  disorders  in 
women,  and  was  much  prescribed  in  the  form  of  hiera  picra  (vulgarly 
hickery  pickery),  pulvis  aloes  cum  canella.  Recently,  Dr.  Cheron  has 
revived  its  use,  and  extols  it  much  as  a  remedy  for  menorrhagia  and 
metrorrhagia  of  chlorosis,  for  the  menorrhagia  occurring  during  preg- 
nancy in  weak,  lymphatic  women,  for  the  menorrhagia  of  cancer,  and 
for  the  persistent  bleeding  after  delivery,  due  to  the  inefficient  invo- 
lution of  the  uterus,  in  some  weak  subjects.  It  is  also  often  highly 
useful  in  the  dysmenorrhcea  of  congestion,  and  the  amenorrhcea  of 
similar  origin.  If  constipation  coexist,  the  combination  with  aloes 
acts  well. 

Authorities  referred  to  : 

CHERON,  DR.  J.     Revue  de  Therapeutique,  October  15,  1885,  p.  350. 
HUSEMAN,  DRS.  AUGUST  UND  THKODOR.     Die  Pflanzenstoffe,  op.  at. 
PORCHER,  DR.  FRANCIS  PEYRE.     Resources  of  the  Southern  Fields  and  Forests,  Charles- 
ton, 1869. 

OLEUM  ERIGERONTIS. — A  volatile  oil  distilled  from  the  fresh  flow- 
ering herb  of  Erigeron  canadense  Linne  (Nat.  Ord.  Composites). 

OLEUM  EBECHTHITES. — A  volatile  oil  obtained  from  Erechthites^ 
hieracifolius  (fireweed). 

I  am  informed  by  Prof.  J.  U.  Lloyd,  the  distinguished  pharmacist 


184  RESTORATIVE   AGENTS. 

of  Cincinnati,  that  the  oil  of  erigeron  is  much  adulterated  with  the 
oil  of  erechthites  (fire weed).  As  these  volatile  oils  have  similar 
properties  physiologically,  there  is  probably  no  great  harm  done  by 
the  substitution.  I  am  indebted  to  Prof.  Lloyd  for  pure  specimens 
of  each.  They  differ  in  odor  and  in  appearance.  Erigeron-oil  is 
reddish  yellow  in  color,  while  erecthites  is  pale  yellow,  or  nearly 
colorless. 

PROPERTIES. — These  oils  are  hot  and  somewhat  pungent  to  the 
taste,  and  give  off  a  characteristic  odor.  They  grow  darker  in  color, 
and  thicker  in  consistence,  by  age.  They  are  soluble  in  ether  and  in 
absolute  alcohol.  The  principal  constituent  is  a  terpene. 

The  ordinary  dose  is  five  drops,  or  from  three  to  ten  drops, 
and  the  best  mode  to  administer  the  oil  is  to  drop  the  dose  on 
a  lump  of  sugar,  and  swallow  with  a  large  draught  of  water,  or 
it  may  be  put  into  gelatine  capsules,  or  made  into  an  emulsion 
with  gum. 

ACTIONS. — Oil  of  erigeron  has  long  been  known  to  have  consider- 
able power  to  arrest  hemorrhage,  but  a  knowledge  of  this  fact  has 
been  confined  to  a  few  physicians  of  Philadelphia,  and  has  not  been 
acted  on  to  any  considerable  extent.  No  adequate  explanation  has 
been  offered  of  the  nature  of  this  property.  Some  recent  investiga- 
tions have  satisfied  me  that  the  physiological  actions  consist  in  stimu- 
lation of  the  vaso-motor  system,  and  at  the  same  time  of  the  inhibitory 
function  of  the  vagus  terminals.  In  consequence  of  these  effects  the 
amount  of  blood  passing  through  the  arterioles  in  a  given  time  is 
much  lessened. 

Erigeron-oil,  also,  stimulates  the  renal  functions,  and  promotes  the 
cutaneous  transpiration — both  effects  being  due,  probably,  to  contact 
with  these  organs  during  the  process  of  elimination. 

Oil  of  erigeron  has  considerable  antiseptic  power,  prevents  decom- 
position, and  is  destructive  of  microbes  to  some  extent.  There  are 
other  agents,  however,  more  powerful  as  germicides,  but  under  some 
circumstances  erigeron-oil  may  be  utilized  for  this  purpose. 

THERAPY. — Recent  experiences  have  confirmed  former  opinions 
that  erigeron-oil  has  a  distinct  antihaemorrhagic  property.  In  me- 
norrhagia  and  metrorrhagia  it  has  proved  very  effective  in  nu- 
merous instances,  but  it  sometimes  fails.  In  purpura  it  is  distinct- 
ly beneficial.  In  fact,  whenever  haemorrhage  is  more  especially 
venous  in  character,  in  what  site  soever  it  may  occur,  erigeron  is 
likely  to  do  good. 

The  author  has  ascertained,  also,  that  oil  of  erigeron  is,  in  a  high 
degree,  useful  in  the  chronic  forms  of  albuminuria.  It  lessens  the 
waste  of  albumen,  sometimes  remarkably,  and  at  the  same  time  im- 
proves the  general  condition  of  the  patient.  An  acute  congestion  of 
the  kidneys  is  probably  a  contraindication  to  its  use,  but  in  all  the 


EUCALYPTUS.  185 

really  chronic  cases,  united  by  the  common  symptom — albuminuria — 
it  may  be  expected  to  render  real  service. 

In  catarrh  of  the  genito-urinary  mucous  membrane,  pyelitis,  cys- 
titis, etc.,  it  has  acted  well,  probably,  because  of  coming  into  actual 
contact  with  the  mucous  membrane  in  the  process  of  elimination.  In 
small  doses  it  has  apparently  allayed  irritability  of  the  bladder,  as  it 
occurs  in  women,  and  the  author  has  seen  it  give  much  relief  in  cases 
of  prostatic  irritation. 

As  a  stimulant  expectorant,  erigeron-oil  is  entitled  to  much  con- 
sideration. It  is  nearly,  if  not  quite,  as  useful  in  chronic  bronchitis, 
winter  cough,  etc.,  as  is  terebene,  and  may  be  given  under  the  same 
conditions,  and  to  supply  the  same  indications.  Here,  again,  the  ex- 
planation of  its  utility  may  be  found  in  the  actual  contact  with  the 
diseased  surface  which  takes  place  in  the  process  of  elimination. 

Authorities  referred  to : 

BARTHOLOW,  DR.  R.     The  Physician  and  Surgeon,  Ann  Arbor,  April,  1 887. 

Eucalyptus. — Leaves  of  Eucalyptus  globulus  Labillardiere  (Nat. 
Ord.  Myrtacece). 

PREPARATIONS. — Tinctura  Eucalypti.  (Not  official.)  Tincture  of 
eucalyptus.  Dose,  3  ss —  3  ij. 

Extractum  Eucalypti  Fluidum. — Fluid  extract  of  eucalyptus. 
Dose,  TTI  x —  3  j. 

Oleum  Eucalypti. — Dose,  1T[  v —  3  ss.  Usually  prescribed  in  cap- 
sules, but  may  be  given  in  the  form  of  emulsion. 

COMPOSITION. — Eucalyptus  contains  a  peculiar  resin  composed  of 
three  different  resinous  bodies,  a  volatile  oil  consisting  of  eucalyptol, 
terpene,  and  cymol,  tannic  acid,  and  a  crystallizable  fatty  acid.  EUCA- 
LYPTOL is  the  most  important  of  the  constituents,  and  is  now  official. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alkalies,  the  mineral  acids, 
the  salts  of  iron,  mercury,  lead,  zinc,  etc.,  are  chemically  incompatible. 
All  agents  promoting  waste,  or  the  retrograde  metamorphosis  of  tis- 
sue, are  therapeutically  incompatible. 

SYNERGISTS. — The  simple  and  aromatic  bitters,  hydrastis,  cinchona, 
etc.,  camphor,  turpentine,  cubebs,  copaiba,  the  essential  oils  and  sub- 
stances containing  them,  are  synergistic  to  or  promote  the  therapeuti- 
cal actions  of  eucalyptus.  Any  of  these  remedies  may,  therefore,  be 
prescribed  in  the  same  formula  with  eucalyptus. 

PHYSIOLOGICAL  ACTIONS. — Eucalyptus  has  a  warm,  aromatic,  bitter, 
and  camphoraceous  taste,  resembling  somewhat  the  taste  of  cubebs. 
In  the  mouth  it  excites  the  flow  of  saliva,  and  leaves  a  hot,  pungent, 
and  rather  disagreeable  flavor.  In  the  stomach  it  causes  a  sensation 
of  warmth,  and  doubtless  promotes  the  flow  of  gastric  juice.  The 
appetite  and  digestive  power  are  increased  under  its  use.  Increased 
intestinal  secretion,  also,  is  one  result  of  its  administration,  and  hence 


186  RESTORATIVE   AGENTS. 

the  alvine  evacuations  are  rendered  somewhat  more  copious  and  easy. 
In  very  large  doses  it  causes  a  sense  of  weight  and  uneasiness  at  the 
epigastrium,  odorous  eructations  and  indigestion,  followed  by  diarrhoea, 
the  stools  having  the  characteristic  odor  of  eucalyptol.  The  essential 
oil  is  readily  diffusible  and  enters  the  blood  with  facility,  but  what 
changes,  if  any,  it  induces  in  the  blood  are  unknown.  It  increases  the 
action  of  the  heart,  lowers  the  arterial  tension,  and  induces  a  feverish 
state.  The  respiratory  movements  are  accelerated.  Wakefulness  is 
caused  by  it  in  those  of  full  health,  and  sleep  in  the  weak  and  anaemic. 
The  eucalyptol  is  eliminated  by  the  skin,  mucous  membrane  of  the 
bronchial  tubes,  and  by  the  kidneys,  the  secretions  of  these  organs 
being  increased  by  it,  and  they  are  impregnated  with  its  odor.  This 
is  especially  the  case  with  the  urine,  which,  after  some  days'  adminis- 
tration, becomes  most  strongly  odorous  by  the  presence  of  eucalyptol. 

The  vapor  of  eucalyptus,  inhaled  in  large  quantity,  produces  analo- 
gous effects  to  the  internal  administration,  besides  the  more  decided 
effects  on  the  bronchial  mucous  membrane. 

Eucalyptus  is  a  powerful  diaphoretic. 

THERAPY. — The  decoction  of  the  leaves  is  an  efficient  local  appli- 
cation in  the  various  forms  of  stomatitis,  angina  subacute  and  chronic, 
and  tonsillitis  after  the  subsidence  of  the  acute  stage. 

O 

Eucalyptus  is  one  of  the  most  useful  of  the  so-called  stomachics  in 
atonic  dyspepsia,  chronic  gastric  catarrh,  and  chronic  intestinal  ca- 
tarrh, but  its  use  is  contraindicated  in  inflammatory  states.  The  form 
of  vomiting  and  indigestion  dependent  on  the  presence  of  sarcina  is 
relieved  by  this  agent,  which  acts  by  destroying  the  vitality  of  this 
minute  organism.  That  condition  of  the  mucous  membrane  which 
favors  the  production  of  intestinal  parasites  is  removed  by  eucalyptus. 
In  the  case  of  ascarides  vermicular es,  the  remedy  should  be  used  by 
injection. 

Like  the  bitters,  eucalyptus  may  be  used  to  promote  constructive 
metamorphosis,  but  it  possesses  more  decided  stimulant  effects  than 
these  agents,  by  virtue  of  the  eucalyptol.  In  convalescence  from  acute 
disease,  in  debility  arising  from  defective  assimilation,  and  in  cachectic 
states  generally,  it  is  a  serviceable  tonic  and  stimulant.  When  the  ac- 
tion of  the  heart  is  weak,  it  may  be  strengthened  by  eucalyptus.  To 
women  at  the  change  of  life  who  suffer  from  flatulence,  palpitation  oj 
the  heart,  and  sudden  flushings  of  the  face,  it  affords  great  relief,  and 
often  permanently  removes  these  symptoms. 

Hysteria,  chorea,  asthma,  and  allied  nervous  states,  when  occurring 
in  debilitated  subjects,  and  cerebral  anaemia,  are  benefited  by  eucalyp- 
tus. In  asthma  eucalyptus  may  be  smoked  in  cigarettes  with  stramo- 
nium, belladonna,  tobacco,  etc.  Its  efficacy  in  the  form  of  fumes  is 
strongly  stated  by  Maclean. 

The  most  important  uses  of  this  agent  occur  in  the  treatment  of 


EUCALYPTUS.  187 

catarrhal  affections  of  the  broncho-pulmonary  mucous  membrane.  It 
is  not  adapted  to  acute  affections  or  to  recent  inflammation,  but  to 
chronic  cases  accompanied  by  free  muco-purulent  expectoration.  The 
author  is  able  to  confirm  the  observations  of  Gubler  in  reference  to  the 
great  utility  of  eucalyptus  in  bronchorrhoea.  It  is  an  interesting  fact, 
and  probably  explanatory  of  its  therapeutical  action,  that  eucalyptol  is 
in  part  eliminated  by  the  bronchial  mucous  membranes.  In  the  same 
way  eucalyptus  is  effective  in  the  treatment  of  catarrhal  states  of  the 
genito-urinary  organs.  Chronic  desquamative  nephritis,  granular  de- 
generation of  the  kidneys,  pyelonephritis,  and  hydronephrosis,  are  im- 
proved by  its  cautious  administration,  but  it  should  not  be  forgotten 
that,  used  too  freely,  or  for  too  great  a  length  of  time,  it  will  cause 
irritation  and  congestion  of  the  kidneys,  in  the  same  way  that  turpen- 
tine, copaiba,  and  cubebs  do. 

No  remedy  which  the  author  has  hitherto  used  has  seemed  to  him 
so  effective  in  chronic  catarrh  of  the  bladder  as  eucalyptus.  The  urine 
during  its  administration  acquires  a  strong  odor  of  eucalyptol,  and  to 
its  local  action  on  the  mucous  membrane  is  to  be  attributed  the  thera- 
peutical effect. 

Eucalyptus  has  been  much  praised  as  a  remedy  for  intermittent 
fever.  The  evidence  as  to  its  utility  is  contradictory.  As  the  result 
of  his  own  observations,  and  after  careful  examination  of  the  facts 
reported  by  others,  the  author  concludes  that  eucalyptus  is  far  inferior 
to  quinine.  It  is  certainly  very  serviceable  in  the  convalescence  from 
intermittent  and  remittent  fevers,  and  in  chronic  malarial  poisoning  it 
has  a  high  degree  of  utility.  It  can  not  take  the  place  of  quinine  for 
the  arrest  of  the  paroxysms,  or  to  prevent  relapses  at  the  septenary 
periods,  but  it  is  more  useful  than  quinine  to  reconstruct  the  damages 
in  the  organs  of  assimilation  caused  by  malarial  infection. 

Externally,  the  tincture  and  the  distilled  water  of  eucalyptus  are 
used  as  disinfectant  applications  to  foul-smelling  and  ill-conditioned 
ulcers  and  wounds  (Gimbert).  The  water  of  eucalyptus  is  recom- 
mended by  Gubler  as  a  vehicle  for  agents  used  by  the  hypodermatic 
method.  The  toxic  influence  of  eucalyptus  on  the  lower  forms  of  life 
— cryptogamic  and  infusorial  organisms — is  the  ground  of  its  applica- 
tion for  these  purposes.  As  respects  solutions  of  alkaloids  for  hypo- 
dermatic use,  the  water  of  eucalyptus  prevents  the  development  of  the 
penicillium,  which  grows  rapidly  and  at  the  expense  of  the  alkaloid 
in  solutions  prepared  with  simple  distilled  water. 

Authorities  referred  to  : 

BURDEL,  DR.  E.  Bulletin  de  Therapeutique,  tome  Ixxxiv,  p.  409,  et  ibid.,  tome  Ixxxv, 
p.  529. 

COSTAU,  M.  Gazette  Hebdomadaire,  1872,  No.  25.  Bulletin  de  Therapeutique,  tome 
Ixxxiii,  p.  237. 

GIMBERT,  M.  LE  DB.     Bulletin  de  Therapeutique,  tome  Ixxxi^  p.  422. 


188  RESTORATIVE   AGENTS. 

GUBLER,  DR.  A.     Bulletin  de  Therapcutique,  tome  Ixxxi,  pp.  145,  193. 

KELLER,  DR.     The  British  Medical  Journal,  May  11,  1872. 

LORINSER,  DR.     Wiener  medicinische  Wochenschrift,  1869,  xix,  43. 

MACLEAN,  DR.  M.  C.     The  Practitioner,  vol.  vii,  p.  268. 

SCHMIDT'S  Jahrbiicher  der  gesammten  Medicin,  vol.  cxlviii,  p.  11.  Ueber  Eucalyptus 
globulus  ;  nach  F.  W.  Lorinser  ;  C.  Haller  ;  Franz  Seitz  ;  L.  A.  Buchner  ;  C.  Paul  ;  A. 
Gubler. 

IBID.     Vol.  cl,  p.  121.     Ueber  den  Nutzen  des  Eucalyptus  gegen  Wechselfieber. 

flydrastis.  —  The  rhizoma  and  roots  of  Hydrastis  canadensis  Linn6 
(Nat.  Ord.  Ranunculacece).  Yellow  root. 

PREPARATIONS.  —  Extractum  Hydrastis  Fluidum.  Fluid  extract 
of  hydrastis.  Dose,  TUv  —  §  ss. 

Tinctura  Hydrastis.  —  Tincture  of  hydrastis.     Dose,  Tilx  —  3  j. 
Glyceritum  Hydrastis.  —  Glycerite  of  hydrastis.     Hydrastis,  1,000 
grm.  ;  glycerin,  alcohol,  and  water,  q.  s.  to  make  1,000  c.  c.     Dose, 


HydrastininaB  Hydrochloras.  —  Hydrastinine  hydrochlorate.  The 
hydrochlorate  of  an  artificial  alkaloid  derived  from  hydrastine,  the 
alkaloid  of  hydrastis.  It  occurs  in  light-yellow  amorphous  granules, 
or  a  pale-yellow  crystalline  powder,  odorless,  and  having  a  bitter  saline 
taste.  Soluble  at  59°  F.  in  0'3  part  of  water.  Dose,  gr.-  -fa  —  fa  —  J-. 

COMPOSITION.  —  Hydrastis  contains  a  peculiar  principle,  hydrastine 
or  hydrastina,  which  crystallizes  in  four-sided  prisms,  white  or  color- 
less when  pure,  and  having  but  little  taste.  Hydrastine,  the  alkaloid, 
should  not  be  confounded  with  the  eclectic  preparation,  "  hydrastin," 
which  is  composed  chiefly  of  berberine. 

ANTAGONISTS  AND  INCOMPATIBLES.  —  The  alkalies,  tannic  and  muri- 
atic acids,  are  chemically  incompatible  with  the  preparations  of  hy- 
drastis. Muriatic  acid  precipitates  berberine,  and  the  so-called  hy- 
drastine of  the  eclectic  practitioners  is  nothing  more  than  berberine 
muriate.  The  alkaloid  hydrastine  is  antagonized  by  chloral,  which  is, 
therefore,  the  appropriate  remedy  in  poisoning  by  this  agent. 

STNEEGISTS.  —  The  vegetable  tonics  in  general  are  synergistic  to 
hydrastis,  especially  berberis  vulgaris  and  calumba,  both  of  which  con- 
tain berberine,  and  the  group  of  excito-motors  favor  its  action. 

PHYSIOLOGICAL  ACTIONS.  —  The  preparations  of  hydrastis  have  a 
decidedly  bitter  taste,  and,  like  other  bitters,  promote  the  flow  of  saliva, 
and  probably,  also,  of  gastric  juice.  Increased  appetite  and  digestive 
power  result  from  its  administration.  It  is,  therefore,  a  stomachic 
tonic.  It  also  increases  secretion  of  the  intestinal  mucous  membrane. 

The  property  of  hydrastis  as  a  laxative  is  due  to  its  effects  on  the 
various  secretions  concerned  in  the  primary  assimilation,  whence  the 
stools  become  softer,  and  to  its  stimulant  action  on  the  muscular  fiber 
of  the  intestine,  whence  it  increases  peristalsis.  Until  the  author's  in- 
vestigations were  made  in  the  laboratory  of  Jefferson  Medical  College, 


HYDRASTIS.  189 

only  vague  impressions  existed  as  to  the  character  of  its  true  active 
principle — hydrastine. 

The  most  conspicuous  effect  of  the  alkaloid  is  the  stimulation  of 
the  nervous  system  of  animal  life,  and  this  power  is  exerted  on  cold- 
and  warm-blooded  animals,  and  on  man  in  a  uniform  manner.  Com- 
parative tests  demonstrated  that  the  alkaloid  and  the  fluid  extracts, 
colored  and  colorless,  acted  in  the  same  way — hence  it  follows  that 
hydrastine  is  the  true  active  principle,  and  that  berberine  contributes 
nothing  to  the  impression  made  on  the  nervous  system,  although  the 
stomachic  tonic  and  cholagogue  actions  must  be,  in  part,  certainly  re- 
ferred to  this  alkaloid. 

The  most  important  and  characteristic  effect  of  the  alkaloid — hy- 
drastine— is  that  which  it  exerts  on  the  nervous  system  of  animal  life  ; 
it  is  an  excito-motor  stimulant,  and  induces  such  a  degree  of  excita- 
bility of  the  reflexes  that  the  feeblest  peripheral  irritation  causes  gen- 
eral tonic  muscular  spasms,  passing  from  above  downward.  Presently 
these  tetanic  convulsions  occur  independently,  and  in  the  interval  be- 
tween them  more  or  less  muscular  trembling  and  paresis  occur.  This 
tetanizing  action  was  found  to  be  due  to  an  impression  on  the  spinal 
cord — is  centric  and  not  peripheral  in  seat.  When  very  large  doses 
are  administered,  the  irritability  of  the  motor  nerves  is  destroyed  and 
the  muscular  contractility  impaired  to  some  extent.  Death  ensues 
by  tetanic  fixation  of  the  respiratory  muscles,  and  hence  increasing 
cyanosis  and  carbonic-acid  narcosis  occur. 

In  medicinal  doses  (medium)  hydrastine  stimulates  the  vagus,  but 
lethal  doses  destroy  its  irritability,  and  the  heart's  action  is  arrested  in 
the  diastole,  the  cavities  distended.  It  is  then  found  that  the  cardiac 
muscular  tissue  will  no  longer  contract  on  electrical  stimulation.  In 
ordinary  medicinal  doses  hydrastine  stimulates  the  vase-motor  system 
causes  contraction  of  the  arterioles,  and  raises  the  arterial  tension  ac- 
cordingly, but  in  massive  or  lethal  doses  the  opposite  effects  obtain. 

Comparative  experiments  have  shown  that  hydrastine  not  only  has 
many  points  of  correspondence  in  its  physiological  actions  to  strych- 
nine, but  its  physiological  antagonists  are  the  same.  The  most  impor- 
tant of  the  antagonisms  is  that  between  hydrastine  and  chloral.  When 
the  tetanizing  action  of  the  former  is  well  advanced,  chloral  suspends 
the  spasms,  and  thus  prevents  the  tetanic  fixation  of  the  respiratory 
muscles,  which  is  the  mode  of  dying. 

The  elimination  of  hydrastine  is  effected  chiefly  by  the  kidneys,  and 
to  some  slight  extent,  probably,  by  the  intestinal  glands. 

THEKAPT. — Stomatitis,  both  mercurial  and  aphthous,  is  much  im- 
proved by  local  application  of  the  fluid  extract  of  hydrastis.  When 
this  preparation  causes  much  smarting,  it  may  be  diluted  with  water. 
Follicular pharyngitis,  chronic  coryza,  and  even  syphilitic  affections  of 
the  mouth,  throat,  and  nares,  may  be  much  benefited  or  even  cured  by 
the  same  application.  It  is  said  that  five  to  ten  drops  of  the  fluid  ex- 


19o  RESTORATIVE    AGENTS. 

tract,  taken  by  the  stomach,  will  act  favorably  in  the  removal  of  the 
very  troublesome  affections  named  above,  but  the  author  is  unable  to 
verify  these  observations. 

Hydrastis  is  very  useful  as  a  stomachic  tonic,  and  may  take  the 
place  of  calumba  in  the  treatment  of  atonic  dyspepsia.  A  few  drops 
of  the  tincture  or  fluid  extract  (five  to  fifteen)  taken  before  meals, 
daily,  for  some  time,  will  often  cure  chronic  gastric  catarrh,  and  re- 
move the  distressing  headache  which  frequently  accompanies  this  dis- 
ease. It  is  one  of  the  best  remedies  for  the  stomach  catarrh  of  chronic 
alcoholism,  and  is  probably  the  best  substitute,  if  given  in  sufficient 
doses,  for  the  alcoholic  stimulant  when  its  habitual  use  is  to  be  aban- 
doned. Catarrh  of  the  duodenum  is  in  a  similar  manner  relieved  by 
hydrastis,  but  this  agent  has  special  utility  in  duodenal  catarrh  when 
accompanied  by  catarrh  of  the  gall-ducts  and  jaundice.  Its  use  should, 
in  these  affections,  be  continued  for  some  time. 

These  statements  have  been  questioned  by  the  authors  of  a  dispen- 
satory, the  therapeutical  part  of  which  is  chiefly  remarkable  for  an 
elaborate  nihilism.  Quoting  one  of  the  foregoing  sentences,  the  medical 
skeptic  in  question  asserts  that  such  confidence  in  the  value  of  hydras- 
tis indicates  "  marvelous  virtues  "  in  the  remedy,  or  "  still  more  mar- 
velous faith  "  in  those  who  make  such  assertions.  It  is  unfortunate 
that  mere  library  therapeutists  should  have  the  opportunity  to  air  their 
crude  conceptions  and  parade  their  uninstructed  judgments  in  a  big 
volume  intended  for  the  perusal  of  students  and  young  physicians. 
The  alkaloid  hydrastine  having  the  power  to  stimulate  the  motor  cen- 
ters of  the  nervous  system,  while  it  also  acts  on  the  gastro-duodenal 
mucous  membrane,  is  peculiarly  fitted  to  relieve  that  complex  of  con- 
ditions included  in  the  term  chronic  alcoholism.  It  is  the  combina- 
tion of  these  powers  that  renders  it  a  valuable  restorative  when  the 
use  of  alcohol  is  discontinued. 

When  constipation  is  dependent  on  deficient  secretion,  and  the 
stools  are  dry  and  hard,  it  may  be  overcome  by  this  remedy,  but  tor- 
por of  the  muscular  layer  of  the  intestine  is  not  affected  by  it. 

Chronic  catarrh  of  the  intestine,  even  when  it  has  proceeded  to 
ulceration,  is  sometimes  remarkably  benefited  by  hydrastis.  When 
the  stools  are  very  frequent  and  there  is  much  pain,  it  is  advantageous 
to  combine  a  little  opium  with  it.  In  fissure  of  the  anus,  haemorrhage 
from  the  rectum,  and  ulceration  of  the  rectal  mucous  membrane,  appli- 
cations of  fluid  extract  of  hydrastis  to  the  affected  parts  promote  healing. 

As  a  remedy  for  intermittents,  hydrastine  ranks  far  below  quinine. 
In  chronic  malarial  poisoning  (paludal  cachexia),  hydrastine  may  be 
given  with  ferruginous  preparations,  as  quinine  is  so  frequently  em- 
ployed. Although  not  without  action,  it  is  inferior  to  quinine  in  the 
condition  of  enlarged  spleen  of  malarial  origin. 

Late  researches  have  shown  that  berberine  has  an  injurious  effect  on 
the  kidneys,  and  must  therefore  be  avoided ;  but  hydrastine  may  be  used 


CINCHONA.  191 

with  advantage  in  certain  affections  of  the  genito-urinary  organs.  In 
chronic  Brightis  disease  it  appears  to  lessen  the  excretion  of  albumen. 
It  diminishes  the  mucus  in  catarrh  of  the  bladder.  It  is  often  a  useful 
remedy  in  gonorrhoea  after  the  acute  stage  has  subsided,  and  in  gleet. 

Hydrastine  having  the  power  to  stimulate  the  excito-motor  func- 
tions of  the  spinal  eord,  may  be  expected  to  do  much  good  in  cases  of 
paresis  or  paralysis  of  motility  when  the  lesions  causing  them  are  not 
recent  in  origin.  Those  forms  of  paralysis  with  trophic  disturbances, 
which  succeed  to  fevers  and  other  acute  affections,  are  conditions  of 
disease  in  which  it  may  be  expected  to  do  good.  Reflex  neuroses 
having  their  origin  in  gastro-intestinal  catarrh,  respiratory  neuroses 
of  a  paretic  character,  and  similar  maladies  requiring  an  excito-motor, 
will  probably  be  successfully  treated  by  hydrastine. 

Prof.  Schatz  finds  hydrastis  a  valuable  remedy  in  the  haemorrhage 
of  uterine  myomata,  in  menorrhagia,  in  congestive  dysmenorrhwa, 
and  allied  states.  Its  power  to  stimulate  the  organic  nervous  system, 
and  thus  to  contract  the  blood-vessels,  is  Schatz's  explanation  of  its 
mode  of  action. 

The  lethal  quantity  of  hydrastine  not  having  been  determined,  the 
dose  can  not  be  closely  stated.  It  is  probable  that,  beginning  with  ^V 
gr.,  the  dose  may  be  increased  up  to  £th  or  even  \  grain. 

LOCAL  USES. —  Uterine  and  vaginal  leucorrhoza,  ulcerations,  and 
erosions  of  the  cervix  uteri,  are  quickly  improved  by  the  topical  ap- 
plication of  the  fluid  extract  of  hydrastis,  which  may  be  used  in  an 
undiluted  state. 

Unhealthy  and  sloughing  sores,  chancroid,  old  ulcers  of  the  leg, 
are  improved  in  character  by  the  local  use  of  this  remedy. 

Authorities  referred  to  : 

BARTHOLOW,  DR.  R.     Lloyd's  Drugs  and  Medicines  of  North  America,  vol.  i. 
FILEHNE,  DR.     Quoted  in  London  Medical  Record,  November  15,  1884. 
PORCHER,  DR.  F.  PEYRE.     Resources  of  the  Southern  Fields  and  Forests,  Charleston, 
1869,  p.  15. 

SCHATZ,  PROF.     Centralblatt  fur  gesammte  Therapie,  Band  ii,  p.  82. 
SCLAVATINSKT,  DR.     London  Medical  Record,  supra. 


CINCHONA   AND   ITS   PREPARATIONS. 

Cinchona.  —  Cinchona.  The  bark  of  Cinchona  calisaya  Wed- 
dell,  Cinchona  officinalis  Linne,  and  of  hybrids  of  these  and  of  other 
species  of  Cinchona  (Nat.  Ord.  Rubiacece)  containing  not  less  than  5 
per  cent  of  its  peculiar  alkaloids,  at  least  one  half  of  which  should  be 
quinine. 

Cinchona  Rubra. — Red  cinchona.  The  bark  of  Cinchona  succi- 
rubra  Pavon  (Nat.  Ord.  Rubiacece)  containing  not  less  than  5  per 
cent  of  its  peculiar  alkaloids. 

PREPARATIONS  OF  CINCHONA. — Infusum  Cinchonae. — Infusion  of 


192  RESTORATIVE   AGENTS. 

cinchona  (cinchona,  No.  40  powder,  60  grm. ;  aromatic  sulphuric  acid, 
10  c.  c.;  water  to  make  up  to  1,000  c.  c.     Dose,  S  ss—  §  j. 

Exiractum  Cinchonce. — Extract  of  cinchona.     Dose,  gr.  j — gr.  x. 

Extraction  Cinchonce  Fluidum. — Fluid  extract  of  cinchona.    Dose, 

m  x— 3  j. 

Tinctura  Cinchonce. — Tincture  of  cinchona.     Dose,  3  ss —  §  ss. 

Tinctura  Cinchonce  Composita. — Compound  tincture  of  cinchona 
(red  cinchona,  bitter  orange-peel,  serpentaria,  glycerin,  alcohol,  and 
water).  Dose,  3  ss  —  3  ss. 

ALKALOIDS  OF  CINCHONA  AND  THEIR  SALTS. —  Cinchonina. — Cin- 
chonine.  An  alkaloid  extracted  from  various  species  of  cinchona. 

Cinchonince  Sulphas. — Cinchonine  sulphate  ;  occurs  in  hard,  white, 
lustrous,  prismatic  crystals,  without  odor,  and  having  a  very  bitter 
taste.  It  is  soluble  at  59°  F.  (15°  C.)  in  sixty-six  parts  of  water  and 
ten  parts  of  alcohol.  Dose,  gr.  v  —  3  ss. 

Cinchonidince  Sulphas. — Cinchonidine  sulphate.  The  neutral  sul- 
phate of  an  alkaloid  extracted  from  the  bark  of  various  species  of  cin- 
chona ;  occurs  in  white,  silky,  acicular  crystals,  and  is  soluble  at  59° 
F.  in  seventy  parts  of  water.  Dose,  gr.  v  —  3  ss. 

Quinina. — Quinine.  An  alkaloid  obtained  from  the  bark  of  vari- 
ous species  of  cinchona.  A  white,  flaky,  amorphous  or  crystalline 
powder,  odorless,  and  having  a  very  bitter  taste.  It  is  but  slightly 
soluble  in  water — in  1,670  parts  only.  It  is  given  in  the  form  of  vari- 
ous salts  named  below. 

Quinince  Sulphas. — Quinine  sulphate.  Occurs  in  white,  silky, 
light,  and  fine  needle-shaped  crystals.  Soluble  in  740  parts  of  water 
at  59°  F.  Dose,  gr.  j— 3j. 

Quinince  Bisulphas. — Quinine  bisulphate.  Occurs  in  colorless,  trans- 
parent or  whitish  orthorhombic  crystals,  or  in  small  needles  ;  odorless, 
and  having  a  very  bitter  taste  ;  soluble  at  59°  F.  (15°  C.)  in  ten  parts 
of  water  and  in  thirty-two  parts  of  alcohol.  The  aqueous  solution 
has  a  strong  acid  reaction  and  a  blue  fluorescence.  Dose,  gr.  v —  3  ss. 

Quinines  Hydrochloras. — Quinine  hydrochlorate.  Occurs  in  white, 
silky,  light,  and  fine  needle-shaped  crystals  ;  odorless,  and  having  a 
very  bitter  taste.  It  is  soluble  in  thirty-four  parts  of  water  at  59°  F. 
(15°  C.),  and  in  three  parts  of  alcohol.  Dose,  gr.  j — 3  j. 

Quinince  Hydrobromas. — Quinine  hydrobromate.  Similar  in  phys- 
ical qualities  to  the  hydrochlorate,  but  is  soluble  in  fifty-four  parts  of 
water  at  59°  F.  (15°  C.).  Dose,  gr.  j— 3  j. 

Quinines  Vaferianas. — Quinine  valerianate.  Occurs  in  white  or 
nearly  white,  pearly,  lustrous,  triclinic  crystals,  having  a  slight  odor  of 
valerianic  acid  and  a  bitter  taste.  Soluble  at  59°  F.  (15°  C.)  in  one 
hundred  parts  of  water  and  in  five  parts  of  alcohol.  Dose,  gr.  j — 3  j. 

COMPOSITION. — Cinchona  is  remarkable  for  the  number  and  variety 
of  the  principles  obtained  from  it,  viz.,  five  alkaloids,  two  simple  acids, 


CINCHONA.  193 

two  tannic  acids,  and  a  resinoid  substance.  The  most  important  alka- 
loid is  quinine,  which  exists  in  all  varieties  of  bark,  but  is  most  abun- 
dant in  the  yellow  or  calisaya  bark.  It  occurs  in  combination  with 
kinic  and  kino-tannic  acids.  Quinidine  is  an  alkaloid  isomeric  with 
quinine,  and  may  be  used  as  a  substitute  for  the  latter  in  the  same 
dose.  It  is  less  bitter  than  quinine,  and  its  sulphate  is  more  soluble  in 
water.  Cinchonine  is  found  in  greatest  quantity  in  the  pale  barks. 
It  unites  with  acids  to  form  salts,  of  which  the  sulphate  is  most  fre- 
quently used.  Therapeutically  considered,  cinchonine  has  about  half 
the  strength  of  quinine.  Cinchonidine  is  an  alkaloid  isomeric  with 
cinchonine,  as  quinidine  is  with  quinine.  Aricine,  which  has  close  anal- 
ogies with  cinchonine,  has  been  found  in  the  Arica  or  Cuzco  bark. 

The  alkaloids  are  combined  in  bark  with  the  acids  kinic  and  kino- 
vie,  chiefly  with  the  former.  There  are  also  two  kinds  of  tannic  acid, 
kino-tannic  and  kinovi-tannic,  and  a  resinoid  substance,  kinovin. 
None  of  these  have  thus  far  been  applied  to  therapeutical  purposes, 
except  kinic  acid,  which  has  been  utilized  to  form  a  kinate  of  quinine, 
under  the  belief  that  a  combination  of  quinine  in  its  natural  state  would 
be  more  efficient  as  a  remedy  than  as  combined  with  a  mineral  acid. 

When  the  mother-liquor,  left  after  the  crystallization  of  the  alka- 
loids, is  evaporated,  a  black  residue  is  obtained,  which  is  called  chino- 
idin.  This  contains  amorphous  quinine  and  cinchonine,  and  probably 
also  quinidine  and  cinchonidine.  It  is  found  in  cylindrical  sticks,  is 
very  bitter  to  the  taste,  brittle  when  cold,  but  plastic  when  warm  ;  is 
but  slightly  soluble  in  water.  Dose,  gr.  v —  3  j. 

With  regard  to  the  quantity  of  the  alkaloids  contained  in  the  barks, 
respectively,  it  may  be  stated  that  the  three  varieties — pale,  yellow, 
and  red — differ  only  in  the  relative  proportions  of  their  constituents. 
The  pale  bark  contains  most  cinchonine,  the  yellow  most  quinine,  and 
the  red  an  equal  proportion  of  each. 

ADMINISTRATION. — The  alkaloids  of  bark  are  intensely  bitter.  Qui- 
nine being  insoluble  in  the  saliva,  is  less  objectionable  than  its  salts. 
The  sweet  principle  of  licorice  covers  the  taste  of  the  cinchona  alka- 
loids. A  sufficient  dose  of  quinine  may  easily  be  inclosed  in  a  chocolate 
caramel.  The  sugar-coated  pill,  when  freshly  prepared  and  by  a  repu- 
table maker,  is  a  convenient  and  suitable  form  for  administration  ;  but 
by  keeping  it  becomes  hard  and  insoluble.  The  most  active  form  is  a 
solution,  the  quinine  being  dissolved  by  the  aid  of  sufficient  dilute  acid. 

ANTAGONISTS  AND  INCOMPATIBLES. — Substances  containing  tannic 
acid  in  a  free  state  should  not  be  administered  with  the  infusum  or 
decoctum  cinchonce.  The  preparations  of  iodine  (tincture  and  com- 
pound solution)  are  also  incompatible,  for  they  form  insoluble  com- 
pounds with  the  cinchona  alkaloids.  The  alkalies,  alkaline  carbonates, 
and  alkaline  earths  should  not  be  administered  with  the  solutions  of 
the  alkaloids,  because  the  latter  will  be  precipitated. 

As  an  agent  promoting  constructive  metamorphosis,  cinchona  and 


194  RESTORATIVE   AGENTS. 

its  alkaloids  are  therapeutically  antagonized  by  mercury,  the  iodides, 
the  salts  of  copper,  zinc,  and  lead. 

As  Gubler  has  shown,  morphine  and  quinine  are  antagonists  in  re- 
spect to  their  effects  on  the  brain.  As  regards  their  action  on  the 
sympathetic  system,  on  the  heart,  and  on  the  temperature,  quinine,  and 
belladonna  and  its  alkaloid,  are  antagonistic. 

SYXERGISTS. — All  those  agents  which  promote  constructive  meta- 
morphosis, as  the  bitters,  the  ferruginous  preparations,  arsenic,  and 
the  acids,  are  synergistic  to  cinchona. 

PHYSIOLOGICAL  ACTIONS. — The  preparations  of  cinchona  are  known 
as  "  astringent  bitters  "  :  they  contain,  in  addition  to  bitter  principles, 
two  tannic  acids.  As  bitters  they  act  as  stomachic  tonics ;  that  is, 
promote  appetite,  the  flow  of  gastric  juice,  and  the  digestive  power. 
Long  continued,  as  is  the  case  with  all  the  other  bitters,  they  set  up  a 
gastric  catarrh,  and  digestion  becomes  painful  and  labored.  They 
differ  from  the  simple  bitters  in  exercising  an  astringent  action  on  the 
intestinal  mucous  membrane,  and  cause  constipation.  The  red  bark 
is  more  decidedly  astringent  than  the  yellow  or  pale  bark. 

Since  the  time  of  Sir  John  Pringle,  who  made  the  first  experiments 
on  this  point,  cinchona  has  been  known  to  possess  antiseptic  properties. 
The  powdered  bark,  applied  to  unhealthy  wounds,  arrests  putrefactive 
decomposition,  and  promotes  healing.  The  alkaloids  are  destructive 
of  the  minute  organisms,  on  the  presence  of  which  fermentative 
changes  depend,  and  hence,  when  added  to  milk,  urine,  and  other  ani- 
mal fluids,  will  prevent  decomposition  (Binz,  Herbst,  Baxter,  etc.). 
Quinine,  the  most  active  of  the  alkaloids,  is  not  equally  destructive  of 
all  minute  organisms  :  some,  it  merely  inhibits  ;  others,  it  kills.  The 
bacteria  of  septic  fluids  resist  its  toxic  action  to  a  great  extent,  and 
are  only  inhibited  by  the  largest  quantity. 

When  the  crude  bark  is  introduced  into  the  stomach,  the  alkaloids 
are  dissolved  out  by  the  acid  gastric  juice,  in  which  they  are  freely 
soluble.  Any  portion  of  the  bark,  or  of  the  alkaloids,  escaping  solu- 
tion in  the  gastric  juice,  probably,  passes  out  with  the  other  unabsorbed 
contents  of  the  intestine.  The  alkaline  reaction  of  the  intestinal 
juices  will  cause  precipitation  of  the  alkaloids,  which,  forming  insol- 
uble combinations  with  the  bile-acids,  will  not  be  absorbed.  From 
the  stomach  the  alkaloids  diffuse  into  the  blood  with  facility.  In  the 
alkaline  blood,  it  is  probable  that  the  alkaloids  are  held  in  solution  by 
the  carbonic  acid  (Kerner).  No  changes  visible  by  the  unassisted 
eye  are  discernible  in  the  blood,  for,  notwithstanding  the  observations 
of  the  older  writers,  who  affirm  that  the  blood  was  dark  and  unco- 
agulable,  the  moderns  deny  the  existence  of  such  alterations  (Briquet, 
Schwalbe).  Quinine  acts  in  a  definite  manner  on  certain  constituents 
of  the  blood — on  the  haemoglobin,  impairing  its  power  to  transport 
active  oxygen  or  ozone,  into  which  the  ordinary  oxygen  of  the  air  is 


CINCHONA.  195 

converted.  This  is  demonstrated  in  the  following  manner  :  Mix  with 
old  turpentine,  that  is,  turpentine  long  exposed  to  the  air,  and  there- 
fore holding  ozone,  some  tincture  of  guaiacum  ;  if,  now,  some  haemo- 
globin or  a  drop  of  blood  be  added  to  the  mixture,  the  tincture  of 
guaiacum  assumes  a  blue  color,  the  change  of  color  being  due  to  the 
oxidation  of  the  guaiacum  by  the  active  oxygen  or  ozone  contained  in 
the  haemoglobin  (Hermann).  The  addition  of  certain  substances,  no- 
tably of  quinine,  prevents  the  reaction  ;  in  other  words,  destroys  the 
ozonizing  action  of  the  blood.  Binz  has  shown  that  so  small  a  quan- 
tity of  quinine  as  one  part  to  twenty  thousand  exerts  this  action  to  a 
considerable  extent.  As  soon  as  the  blood  is  withdrawn  from  the 
peculiar  influence  exerted  by  the  walls  of  the  blood-vessels,  as  was 
some  time  ago  shown  by  Pfliiger  and  Zuntz,  its  alkalinity  begins  to 
decline,  and  presently  it  exhibits  an  acid  reaction.  Correspondingly 
with  the  progress  of  this  acidification,  A.  Schmidt  has  shown  that  the 
quantity  of  contained  oxygen  diminishes  and  the  carbonic  acid  in- 
creases. These  changes,  leading  finally  to  the  death  of  the  blood,  are 
greatly  retarded  by  the  addition  of  quinine  (Schulte,  Binz,  Ransone, 
Kerner).  From  these  observations  we  draw  the  conclusion  that  qui- 
nine lessens  the  oxidizing  or  ozonizing  function  of  the  blood. 

Binz  and  his  pupils  have  shown  that  quinine  inhibits  or  lessens  the 
activity  of  the  white  blood-corpuscles,  and  indeed  destroys  them,  or 
arrests  their  production  ;  for,  in  cats  poisoned  by  this  agent,  the  num- 
ber of  white  corpuscles  was  found  to  be  considerably  less  than  in  un- 
poisoned  animals  (Scharrenbroich,  Martin,  Jerusalimsky,  Geltowsky). 
By  all  the  observers  just  named,  by  Baxter,  who  made  a  series  of  very 
carefully  conducted  experiments,  and  by  Cutter,  it  has  been  estab- 
lished that  quinine  inhibits  the  amoeboid  movements  of  the  white  cor- 
puscles. These  bodies,  as  other  masses  of  protoplasm,  are  in  con- 
stant motion,  changing  their  form  and  appropriating  the  materials 
of  their  nutrition.  Such  movements  are  called  amoeboid,  and  they  are 
arrested  by  quinine,  even  in  so  small  a  quantity  as  one  part  to  four 
thousand  ;  hence  it  is  called  a  protoplasmic  poison.  Quinine  has  also 
the  power  to  prevent  or  arrest  the  migration  of  the  white  corpuscles 
from  the  vessels.  This  Binz  was  the  first  to  demonstrate,  using  the 
method  employed  by  Cohnheim  for  exhibiting  the  phenomena.  This 
is  now  generally  conceded,  although  denied  by  Schwalbe  ;  but,  as  the 
observations  of  Geltowsky  show,  the  quantity  of  quinine  necessary  to 
produce  the  result  varies  with  the  animal  experimented  on,  and  ranges 
from  one  part  in  four  thousand  to  one  part  in  eight  hundred,  outside 
of  the  body  (Appert).  No  amount,  short  of  a  fatal  dose,  can  affect 
the  movements  of  the  white  corpuscles  in  the  living  warm-blooded 
animal,  according  to  Geltowsky,  who,  therefore,  holds  to  the  same  view 
as  Schwalbe  on  this  point.  In  opposition  to  the  views  of  Binz  must  also 
be  placed  Schtschepotjaw,  who  has  studied  the  effects  of  small  quantities. 
15 


19G  RESTORATIVE   AGENTS. 

Quinine  also  affects  the  rate  of  movement  of  the  heart.  An  impor- 
tant distinction  exists  between  the  action  of  small  and  large  doses.  It 
is  a  matter  of  daily  observation  that  ordinary  medicinal  doses  of  qui- 
nine (from  two  to  five  grains)  increase  the  action  of  the  heart,  while 
experiments  with  large  doses  have  demonstrated  that  this  agent  de- 
presses the  circulation.  Observations  on  the  intra-cranial  circulation, 
as  seen  through  the  retina  and  drum  membrane,  have  demonstrated 
that  an  artificial  hypersemia  results  from  the  administration  of  medi- 
cinal doses.  On  the  other  hand,  as  Favier  was  the  first  to  observe, 
quinine  in  large  doses  depresses  the  heart,  arrests  it  in  the  diastole 
without  impairing  its  contractility,  and  lowers  the  arterial  tension 
(Chirone,  Briquet).  Quinine  acts  on  the  cardiac  motor  ganglia,  and 
hence  occur  the  feebleness  of  the  heart's  movements  and  in  part  the  gen- 
eral lowering  of  the  vascular  tension  (Lewizky).  Besides  these  effects, 
it  unquestionably  depresses  the  vaso-motor  system,  after  a  short  pre- 
liminary stimulation,  probably  (Jerusalimsky,  Lewizky,  Briquet).  This 
depression  of  the  heart  from  large  doses  occurs  after  the  vagi  are 
divided  (Briquet,  Schlockow,  Kohler,  Lewizky),  and  is  more  conspicu- 
ous when  the  agent  is  introduced  into  the  jugular  vein,  indicating  that 
the  impression  made  on  the  heart  is  not  through  an  increase  of  inhibi- 
tion, but  on  the  cardiac  ganglia.  Immersion  of  the  heart  in  a  quinine 
solution  quickly  arrests  its  movements. 

In  the  normal  condition  of  the  human  subject,  quinine  does  not 
appreciably  affect  the  temperature.  In  the  course  of  some  carefully 
conducted  experiments  a  few  years  ago,  I  found  that  the  maximum 
doses  caused  not  more  than  a  half -degree  decline  in  a  healthy  adult. 
In  fever,  however,  the  influence  of  antipyretic  doses  is  prompt  and 
decided.  This  result  may  be  attributed  to  several  factors  :  to  the  de- 
pression of  the  heart  and  arterial  tension,  to  the  suspension  of  the 
oxidizing  power  of  the  blood,  and  to  the  inhibition  of  the  white  cor- 
puscles. JUrgensen  was  the  first  to  observe  that  quinine  prevented 
the  rise  of  temperature  produced  by  certain  physiological  acts,  as,  for 
example,  active  exercise,  but  Kerner  has  more  particularly  developed 
the  experimental  evidence  proving  this  fact.  By  active  gymnastics, 
the  temperature  was  found  to  be  elevated  two  to  three  degrees  Centi- 
grade ;  but  the  previous  exhibition  of  a  full  dose  of  quinine  prevented 
this  rise  of  the  body-heat.  Kerner  also  ascertained  that  the  increased 
cutaneous  secretion,  the  result  of  active  exercise,  was  prevented  by 
the  administration  of  sufficient  quinine.  From  all  of  these  facts,  it 
seems  evident  that  the  lowering  of  the  temperature  by  this  agent  de« 
pends  on  diminished  production  of  heat  rather  than  increased  radia- 
tion and  loss  by  cooling  of  the  skin.  This  statement  seems  confirmed 
by  the  experiment  of  Lewizky,  made  in  Bering's  laboratory,  by  wrap- 
ping a  rabbit  in  protective  envelopes  to  prevent  loss  of  heat  by  cool- 
ing, and  then  practicing  the  intra-venous  injection  of  quinine  ;  the  re- 


CINCHONA.  197 

suit  was  a  depression  of  temperature  as  in  animals  not  so  enveloped. 
To  such  experiments,  the  author  opposes  the  insuperable  objection 
that  the  temperature  in  rabbits  kept  at  rest  declines,  and  to  a  remark- 
able extent,  without  the  administration  of  any  medicament.  Never- 
theless, the  fact  of  the  reduction  of  temperature  by  quinine  is  un- 
doubted. By  Popow,  who  admits  the  diminution  of  temperature,  the 
influence  of  quinine  over  the  body-heat  is  referred  to  some  unknown 
biological  process. 

In  small  doses  quinine  exerts  a  distinct  stimulant  effect  on  the 
cerebrum,  increases  the  mental  activity,  and  even  exhilarates  in  some 
mobile  constitutions.  As  some  hypersemia  is  caused  by  it,  the  result- 
ing cerebral  stimulation  is  probably  secondary  to  this  change  in  the 
vascular  condition.  In  full  medicinal  doses,  as  the  quinine  accumu- 
lates in  the  brain,  a  sense  of  fullness  in  the  head,  constriction  of  the 
forehead,  tinnitus  aurium,  more  or  less  giddiness,  even  decided  ver- 
tigo, may  be  produced.  Dullness  of  hearing  results  from  considerable 
doses,  and  deafness  has  in  rare  cases  been  permanent.  In  a  long  ex- 
perience of  its  use  and  extended  observation,  no  case  has  come  under 
my  notice  of  permanently  impaired  hearing,  although  the  temporary 
condition  is  usual.  According  to  Knapp,  Moos,  and  others,  amaurosis 
is  produced  by  very  large  doses.  White  atrophy  of  the  optic  disks 
occurs,  and  most  of  the  vessels  disappear  from  the  field.  This  must  be 
due  to  strong  contraction  of  the  vessels,  since  this  condition  is  quite 
curable,  the  ordinary  appearance  of  the  retina  being  restored  in  most 
of  the  cases.  Permanent  atrophy  of  the  optic  nerve  is,  however,  an 
occasional  result.  Amblyopia  is  frequently  produced  by  the  use  of 
considerable  doses  kept  up  for  some  time.  It  is  recovered  from  readily 
by  suspending  the  administration  of  the  remedy  and  taking  the  neces- 
sary steps  to  improve  the  intraocular  circulation.  In  actually  toxic 
doses  all  of  the  above  symptoms  have  been  intensified.  There  are  in- 
tense headache  with  constriction  of  the  forehead,  dimness  of  vision  or 
complete  blindness,  deafness,  delirium  or  coma,  dilated  pupils,  weak, 
fluttering  pulse,  irregular  and  shallow  respiration,  convulsions,  and 
finally  collapse  and  death.  It  is  excessively  rare  to  encounter  such 
severe  cerebral  symptoms. 

The  influence  of  quinine  over  the  functions  of  the  spinal  cord  is 
yet  subjudice.  Chaperon  some  time  ago  demonstrated  that  quinine 
lessened  and  ultimately  abolished  the  reflex  function  of  the  spinal 
cord.  This  result  he  decided  was  due  not  to  immediate  action  on  the 
spinal  cord,  but  to  stimulation  of  Setschenow's  center  of  inhibition  of 
reflex  movements.  Brunton,  who  has  repeated  Chaperon's  experi- 
ments, has  found  them  to  be  correct.  The  observation  of  Schlockow, 
that  the  first  effect  of  quinine  is  to  increase  the  sensibility  of  the  re- 
flex function  of  the  spinal  cord,  has  much  probability  in  its  favor. 
Heubach  has  also,  after  moderate  doses,  observed  some  evidences  of 


193  RESTORATIVE   AGENTS. 

the  existence  of  reflex  irritability,  but  the  experiments  of  Brunton 
show  that  these  reflex  effects  decline  with  the  increasing  stimulation 
of  the  inhibiting  center.  Brunton's  experiments  were  also  directed 
to  ascertain  whether  .the  sulphuric  acid  in  combination  with  the  qui- 
nine was  responsible  for  the  effects  observed,  but  the  result  proved 
that  quinine  is  the  active  agent  in  stimulating  Setschenow's  inhibiting 
center. 

As  quinine  depresses  the  functions  of  the  sympathetic  system,  its 
action  is  opposed  to  that  of  agents  which  have  the  power  to  promote 
uterine  contractions,  hence,  a  priori,  it  would  not  seem  to  be  aborti- 
facient.  Very  numerous  and  conflicting  statements  have  been  put 
forth,  because  there  are  no  exact  data.  The  few  cases  in  which  uter- 
ine action  followed  the  administration  of  quinine  were,  doubtless,  due 
to  malarial  intoxication  or  to  other  causes,  and  hence  the  association 
of  uterine  action  with  the  effects  of  quinine  was  accidental.  The  in- 
numerable instances  in  which  quinine  has  been  given  during  the  exist- 
ence of  pregnancy,  without  initiating  contractions  of  the  womb,  are 
certainly  conclusive  against  the  view  of  its  abortifacient  power. 
"While  it  is  not  a  special  uterine  stimulant,  it  may  exert  such  an  ac- 
tion indirectly.  When  uterine  inertia  is  due  to  depression  of  the  vital 
forces,  quinine,  in  moderate  doses,  then  becomes  a  valuable  stimulant, 
and  is  utilized  for  this  purpose  in  obstetric  practice. 

The  diffusibility  of  quinine  and  its  rate  and  mode  of  elimination 
have  been  studied  by  Bence  Jones,  Ciotti  and  Albertoni,  and  Kerner. 
Jones  in  his  researches  availed  himself  of  the  fluorescent  property  of 
animal  tissues,  possessed  also  in  a  high  degree  by  the  alkaloids  of  cin- 
chona, especially  quinine.  To  this  substance,  as  it  appears  in  animal 
tissues,  Jones  gave  the  name  "  animal  chinoidin,"  but  he  was  not  aware 
that  fluorescence  is  a  property  possessed  by  large  numbers  of  animal 
and  vegetable  bodies.  Nevertheless,  he  recognized  the  fact  that  the 
diffusibility  of  quinine  could  be  estimated  by  the  increase  in  the  fluo- 
rescence of  animal  textures,  and  he  thus  ascertained  that  in  a  half- 
hour  after  the  administration  of  quinine  a  positive  gain  in  fluorescence 
of  the  crystalline  lens  is  observed.  It  is  probable  that  under  some 
circumstances — a  catarrhal  state  of  the  mucous  membrane,  for  exam- 
ple— a  portion  of  the  quinine  taken  fails  to  be  absorbed,  and  is  conse- 
quently excreted  by  the  intestines  (Byasson).  The  effect  of  this 
agent  on  the  secondary  assimilation  is  involved  in  more  or  less  doubt. 
Opposing  opinions  have  arisen  from  the  different  points  of  view  taken. 
In  the  normal  condition  quinine,  in  small  quantity,  stimulates  the  nu- 
trition, and  increases  the  excretion  of  waste  products — urea,  uric  acid, 
creatinin,  extractives,  etc.  ;  but,  in  considerable  doses,  the  opposite 
condition  obtains — the  decrease  in  the  quantity  of  uric  acid  is  espe- 
cially well  marked  (Ranke,  Kerner) — and  when  administered  in  mala- 
rial fevers  all  the  products  of  waste  are  greatly  increased.  The  con- 


CINCHONA.  199 

ditions  attending  the  use  of  the  remedy,  therefore,  influence  the  re- 
sult. Considerable  doses  in  the  normal  state  diminish  the  excretion 
of  urea,  uric  acid,  creatinin,  and  phosphoric  and  sulphuric  acids 
(Kerner).  Strassburg,  however,  failed  to  find  any  change  in  the  car- 
bonic acid.  According  to  the  observations  of  Cutler  and  Bradford, 
quinine  has  an  obvious  effect  on  the  globular  richness  of  the  blood, 
increasing  the  relative  proportion  of  the  white,  and  diminishing  the 
red  globules.  The  action  of  quinine  en  the  spleen  is  still  sub  judice. 
Piorry  was  the  first  to  note  a  reduction  in  the  size  of  the  organ  pro- 
duced by  quinine,  but  he  had  an  exaggerated  notion  of  the  nicety  by 
which  a  difference  in  the  size  of  an  organ  could  be  made  out  by  the  ples- 
simeter  and  hammer.  Kiichenmeister  examined  the  subject  experi- 
mentally in  1851,  with  negative  results,  but  afterward,  operating 
with  larger  doses,  obtained  confirmation  of  Piorry's  view.  Mosler,  after 
dividing  all  the  nerves  of  the  spleen,  ascertained  that  quinine  in  large 
doses  still  acted  on  the  contractile  elements,  and  reduced  the  size  of 
the  organ.  Jerusalimsky,  in  an  elaborate  research,  has  established 
the  same  fact.  That  the  enlarged  spleen  of  malarial  infection  is  re- 
duced by  quinine  is  an  undoubted  clinical  fact.  From  these  positive 
observations  it  must  be  concluded  that  quinine  does  act  on  the  spleen, 
notwithstanding  there  are  numerous  negative  statements.  It  follows, 
hence,  that  the  diminution  in  the  red  and  increase  of  the  white  cor- 
puscles may  be  due  to  this  action. 

Quinine  diffuses  out  of  the  blood  into  the  urine,  chiefly,  but  also 
into  the  sweat,  saliva,  milk,  and  pathological  exudations  (Kerner, 
Briquet,  Binz).  Jtirgensen  found  quinine  in  the  urine  in  ten  minutes 
after  the  hypodermatic  injection.  Thau  had  evidence  of  its  presence 
in  the  urine  in  a  half -hour  after  the  ingestion  of  a  half -drachm  dose 
each  by  two  persons,  and  he  holds  that  the  maximum  elimination  takes 
place  in  about  eight  hours,  but  the  excretion  is  not  completed  until 
two  days  after  the  administration.  According  to  De  Renzi,  quinine 
remains  in  the  organism  a  variable  number  of  days,  and  may  indeed 
be  discovered  in  the  urine  on  the  third  day  ;  in  a  special  case,  as  late 
as  seven  days.  Binz  also  finds  that  the  elimination  of  quinine 'is  vari- 
able and  rather  slow,  the  maximum  being  excreted  within  forty-eight 
hours.  From  the  time  the  agent  appears  in  the  urine,  the  systemic 
action  is  manifest,  and  the  maximum  effect  of  any  given  dose  must 
be  experienced  in  advance  of  the  period  of  maximum  elimination, 
which  Thau  places  at  eight  hours.  According  to  Kerner,  quinine  ap- 
pears in  the  urine  in  a  somewhat  modified  form. 

The  action  of  quinine  has  occasionally  been  attended  by  the  ap- 
pearance of  an  eruption  on  the  skin.  Sometimes  the  exanthem  has 
been  in  the  form  of  an  erythema,  sometimes  it  has  assumed  the  ap- 
pearance of  urticaria  ;  again,  it  has  seemed  to  be  herpetic.  There  is, 
in  fact,  no  constant  and  invariable  eruption,  and  many  of  the  reported 


200  RESTORATIVE  AGENTS. 

cases  are  open  to  the  suspicion  that  the  appearances  on  the  skin  are 
merely  accidental,  and  not  causative. 

THERAPY. — A  solution  of  quinine  will  sometimes,  when  applied  to 
the  nares,  arrest  an  attack  of  summer  catarrh,  a  malady  which  appears 
to  be  produced  by  the  pollen  of  plants.  The  preparation  most  suitable 
for  this  purpose  is  an  aqueous  solution  of  the  hydrochlorate  (gr.  iv — 
jrr-  viij —  g  j).  This  should  be  applied  by  a  large  camel's-hair  brush, 
or  spray-producer,  to  the  nares  and  fauces.  The  utility  of  quinine  in 
this  peculiar  disease  will  be  determined  by  the  extent  to  which  the 
local  trouble  has  proceeded  ;  it  can  be  useful  only  when  the  irritation 
is  confined  to  the  nares  and  fauces. 

The  aphthous  tdceration  (niuguet)  which  succeeds  to  an  exhausting 
entero-colitis,  or  which  occurs  in  cachectic  infants,  is  much  improved  by 
quinine — a  grain  or  two  every  three  hours.  An  attack  of  acute  tonsillitis 
may  sometimes  be  aborted  by  a  full  dose  of  quinine  (ten  to  fifteen  grains). 
This  practice  is  especially  indicated  in  those  cases  which  proceed  to 
suppuration,  but  the  quinine  must  be  administered  before  pus  forms. 

The  preparations  of  cinchona  are  much  used  as  stomachic  tonics. 
In  atonic  dyspepsia  they  are  employed,  like  the  simple  bitters,  to  pro- 
mote the  flow  of  gastric  juice.  In  gastric  catarrh  they  relieve  that 
morbid  state  of  the  mucous  membrane  on  which  the  increased  produc- 
tion of  mucus  depends.  For  these  purposes  they  may  be  combined 
with  the  mineral  acids.  The  best  preparation  is  the  infusion  ;  the  de- 
coction, although  official,  is  inelegant  and  faulty.  The  alkaloid  quinine 
is  frequently  used  for  the  same  purposes,  and  notably  in  the  gastric 
catarrh  of  drunkards,  combined  with  acids.  When  vomiting  of  yeast- 
like  material  is  due  to  the  presence  of  sarcina,  quinine  may  be  used 
in  virtue  of  its  power  as  a  poison  to  these  minute  organisms,  and  as 
an  anti-ferment.  In  these  stomach-disorders  other  and  less  expensive 
drugs  may  be  used  with  equal  advantage.  (See  HYDEASTIS.)  When 
there  is  a  relaxed  state  of  the  gastro-intestinal  mucous  membrane, 
manifested  by  catarrh,  diarrhoaa,  etc.,  but  without  inflammation,  the 
preparations  of  red  bark  are  more  particularly  indicated  in  virtue  of 
the  tannins  which  they  contain.  The  reader  need  hardly  be  reminded 
that  the  preparations  of  cinchona  are  contraindicated  in  all  inflam- 
matory states  of  the  intestinal  mucous  membrane.  Furthermore,  if 
too  long  continued,  they  will  set  up  an  irritation,  and  perpetuate  the 
troubles  which  they  were  prescribed  to  remove. 

Sometimes  it  happens  that  the  entero-colitis  of  children  (cholera 
infantum),  which  resists  every  possible  combination  of  astringent  and 
laxative,  will  yield  readily  to  quinine.  The  author  has  seen  quinine 
give  prompt  relief  in  the  following  :  A  child  suffers  with  tenesmus, 
and  after  much  straining  voids  a  transparent  mucus  streaked  with 
blood,  but  there  is  no  fever  nor  other  disturbance  of  the  bowels,  and 
the  stools  when  passed  are  natural. 


CINCHONA.  201 

The  preparations  of  cinchona  and  quinine  are  very  serviceable  in 
that  state  of  the  mucous  membrane  which  favors  the  development  of 
ascarides.  After  the  expulsion  of  the  parasites,  these  remedies  remove 
the  saburral  state  of  the  mucous  membrane.  A  combination  of  purga- 
tives and  bitters  will  correct  the  following  condition  of  things  as  they 
occur  in  children  :  A  foul  breath,  coated  tongue,  capricious  appetite, 
tumid  belly,  and  constipation  alternating  with  diarrhoea. 

The  use  of  quinine  as  a  restorative  tonic  in  cases  of  debility  is  al- 
most universal.  Given  in  moderate  doses — six  to  twelve  grains  a  day 
• — it  promotes  constructive  metamorphosis.  Its  utility  is  due  not  to 
any  direct  action  on  the  blood,  but  to  its  stimulant  effect  on  the 
digestive  function,  and  the  retardation  of  the  combustion  process. 
When  cinchona  or  quinine  proves  irritant  to  the  intestinal  mucous 
membrane,  this  beneficial  restorative  action  ceases.  Iron  and  arsenic 
increase  the  power  of  quinine  to  promote  construction  of  tissue  and  to 
retard  waste. 

There  can  be  no  doubt  in  regard  to  the  power  of  quinine  to  arrest 
the  inflammatory  process  in  its  formative  stages.  Its  utility,  given 
with  this  view,  ceases  when  the  migration  of  the  white  corpuscles  and 
the  proliferation  of  the  cellular  elements  of  the  inflamed  parts  have 
taken  place,  for  it  possesses  no  power  to  cause  disintegration  and  ab- 
sorption of  inflammation  products.  Administered  at  the  critical  mo- 
ment, a  commencing  fibrinous  pneumonia,  a  pleuritis,  an  endocarditis, 
may  be  suppressed  by  a  full  dose  (twenty  to  forty  grains).  Its  power 
in  this  respect  is  much  increased  by  combination  with  morphine.  If  the 
time  have  passed  for  the  use  of  quinine  in  this  way,  it  is  employed  with 
advantage  as  a  restorative  tonic  in  the  various  inflammatory  affec- 
tions of  low  type,  small  doses  (two  to  four  grains)  being  given  fre- 
quently. 

In  septic  diseases  quinine  has  very  important  uses.  Although  the 
observations  of  Binz,  showing  the  influence  of  quinine  over  septic  pro- 
cesses, may  not  be  applicable  to  the  full  extent  for  which  he  proposes 
them,  there  can  be  no  doubt  of  the  good  effects  in  practice  of  quinine 
in  septicaemia,  pyaemia,  erysipelas,  and  puerperal  fever.  In  these  dis- 
eases, only  large  doses — five  to  twenty  grains — every  four  hours,  are 
useful. 

The  author's  experience  in  the  treatment  of  acute  rheumatism  does 
not  justify  the  use  of  large  doses  of  quinine,  as  now  employed  by  Bri- 
quet and  his  followers  in  France.  In  the  hyperpyrexia  of  acute  rheu- 
matism, it  is  true,  large  doses  of  quinine  will  depress  the  temperature, 
but  we  have  less  distressing  and  more  effective  means  for  accomplish- 
ing this  object  in  the  wet-pack  and  the  cold  bath.  When  the  acuter 
symptoms  have  subsided,  and  the  skin  is  cool  and  perspiring,  and  the 
pulse  weak,  quinine  in  moderate  doses — two  to  five  grains — is  very  ser- 
viceable. 


202  RESTORATIVE  AGENTS. 

A  careful  examination  of  the  large  number  of  facts  which  have 
now  been  accumulated,  and  considerable  personal  experience  and  ob- 
servation, have  satisfied  the  writer  of  the  inutility  of  quinine  as  a 
means  of  aborting  or  shortening  the  duration  of  typhus  and  typhoid 
fevers.  Not  only  has  this  remedy  little  or  no  influence  over  the 
course  and  duration  of  these  affections,  but  its  irritant  effects  upon 
the  gastro-intestinal  mucous  membrane,  and  its  inhibitive  influence, 
exerted  through  the  organic  nervous  system,  upon  the  heart  and  lungs, 
may,  in  some  cases,  render  it  positively  injurious  in  large  doses.  As 
a  rule,  the  dryness  of  the  tongue,  the  diarrhosa,  the  subsultus,  and  the 
delirium  of  typhoid  fever,  are  increased  by  it.  In  certain  parts  of  the 
United  States,  the  prevalence  of  a  mixed  type — typho-malarial — re- 
quires, under  certain  conditions,  the  use  of  quinine  in  continued  fevers. 
But  it  becomes  less  and  less  effective  as  the  typh-element  predominates. 
When  there  are  evidently  true  remissions — and  not  merely  the  rhyth- 
mical morning  remission  and  evening  exacerbation  characteristic  of 
typhoid — quinine  is  indicated,  and  it  is  most  effective  when  adminis- 
tered in  an  occasional  large  dose  during  the  remission.  When  there 
is  a  condition  of  hyperpyrexia,  or  of  continuously  elevated  tempera- 
ture, which  endangers  life  by  parenchymatous  degeneration  and  car- 
diac or  cerebral  paralysis,  quinine  in  antipyretic  doses  renders  an 
incontestable  service.  This  opinion  of  the  author  is  fully  confirmed 
by  the  committee  of  the  Clinical  Society  of  London,  who  find  that 
large  doses  of  quinine  have  a  marked  effect  in  reducing  the  temperature 
in  pyrexia,  and  that,  although,  with  the  exception,  perhaps,  of  certain 
cases  of  rheumatic  fever  in  which  the  temperature  is  high,  no  decided 
evidence  has  been  obtained  to  show  that  quinine  has  any  influence  in 
shortening  the  attack  of  a  specific  disease  such  as  typhus  or  scarlet 
fever,  yet  from  the  marked  effect  on  the  temperature  and  pulse  there 
is  reason  to  believe  that  at  the  critical  stage  of  acute  disease,  when 
pulse  and  temperature  are  high,  a  large  dose  of  quinine  may  be  em- 
ployed with  benefit.  Jtirgensen,  Ringer,  Liebermeister,  and  other 
authorities,  and  a  vast  clinical  experience  in  all  civilized  countries,  are 
now  agreed  in  respect  to  the  fever-reducing  power  of  quinine  and  to 
the  absence  of  ill  results  from  large  doses  (especially  Liebermeister). 
Liebermeister,  indeed,  says,  if  he  were  restricted  in  his  choice  to  one 
antipyretic,  he  would  select  quinine.  The  quantity  necessary  to  effect 
a  decided  reduction  of  the  body-heat  in  fevers  is  determined  by  the 
age,  the  amount  of  disturbance,  and  the  individual  susceptibility  to 
its  action.  In  general,  it  may  be  stated  that  from  twenty  to  sixty 
grains  will  be  required.  The  antipyretic  effect  is  more  decided  if  it 
is  given  toward  the  close  of  the  exacerbation  or  during  the  remission 
in  typhoid  or  other  fevers.  The  duration  of  the  effect  is  "  from  one 
to  forty-eight  hours  "  ;  consequently,  a  repetition  of  the  dose  will  be 
necessary,  if  it  is  desired  to  maintain  the  reduction  of  the  temperature. 


CINCHONA.  203 

A  few  large  doses  at  short  intervals  until  the  necessary  quantity  is 
reached,  or  a  single  maximum  dose  if  the  stomach  is  tolerant,  should 
be  prescribed,  rather  than  a  succession  of  smaller  doses.  The  rapidity 
with  which  elimination  takes  place  is  a  sufficient  reason  for  adopting 
the  former  mode  of  administration.  The  effect  of  quinine  is  not  less 
happy  in  the  fevers  of  childhood,  and  comparatively  large  doses  are 
well  borne  at  this  period,  as  Jacobi,  especially,  has  shown  us.  The  same 
rule  should  be  followed  as  in  the  case  of  adults  :  to  give  the  amount 
required  in  several  doses  within  a  brief  period — an  hour,  according  to 
Liebermeister — or  at  one  time.  The  antipyretic  use  of  quinine  should 
not  be  confounded  with  its  tonic  or  supporting  qualities.  In  the  treat- 
ment of  fevers,  the  typhoid  state,  or  the  condition  of  adynamia  super- 
vening daring  the  course  of  fever,  small  doses  (two,  three,  or  four 
grains),  at  short  intervals,  are  employed  for  the  stimulating  effects 
which  they  have  on  the  organs  of  circulation,  respiration,  and  diges- 
tion. Large  doses,  as  has  been  set  forth,  depress  these  functions. 

In  cerebro-spinal  meningitis,  doubtless  a  continued  fever  with  cere- 
bro-spinal  lesions,  quinine  is  indicated  under  the  conditions  already 
defined  for  the  treatment  of  other  inflammations,  viz.,  in  the  begin- 
ning of  the  disease,  when  the  alterations  of  cutaneous  sensibility  first 
occur,  and  before  the  febrile  movement  has  developed.  If  a  few  large 
doses — twenty  to  thirty  grains — do  not  produce  a  good  result,  it  is 
useless  to  repeat  them,  or  to  pursue  a  tentative  plan  with  small  doses. 

In  the  treatment  of  the  eruptive  fevers,  variola,  scarlatina,  rubeola, 
quinine  has  an  important  place.  It  is  used  in  small  doses,  frequently 
repeated  in  adynamic  states,  and  in  large  doses  at  longer  intervals  to 
reduce  hyperpyrexia.  In  scarlet  fever,  Dr.  Hood  especially  urges  the 
use  systematically  of  quinine  from  the  earliest  stage  of  the  disease, 
preceded  by  an  emetic  and  purgative,  and  he  states  as  the  result  of 
this  practice  that  since  he  has  adopted  it  he  has  not  lost  a  single  case 
of  this  disease  treated  by  him  from  the  beginning.  In  measles,  large 
doses  of  quinine  have  an  unquestionable  utility  in  relieving  the  ca- 
tarrhal  pneumonia,  and  in  preventing  those  changes  in  the  exudation 
products  which  end  in  caseation. 

The  treatment  of  malarial  diseases  by  quinine  is  the  most  success- 
ful contribution  ever  made  to  practical  therapeutics.  No  adequate 
explanation  of  its  action  had  been  offered  before  Binz  suggested  that 
its  germicide  power  was  the  real  source  of  its  therapeutical  activity. 
It  was  not,  however,  until  Laveran  discovered  the  flagellate  organism 
and  pigmented  bodies  which  develop  in  the  blood  of  those  infected 
with  malarial  poison,  that  Binz's  theory  received  support  of  a  satis- 
factory kind.  Laveran's  discovery,  made  in  1881  in  Algiers,  has  since 
been  confirmed  by  Italian,  French,  and  American  pathologists,  so  that 
the  long-sought  cause  of  malarial  infection  may  now  be  regarded  as  a 
known  fact.  The  parasite  consists  of  a  pigmented  body  in  the  interior 


204  RESTORATIVE  AGENTS. 

of  the  red  blood-corpuscles — pigmented  granules  of  various  shapes  free, 
and  flagellate  organisms,  both  having  amoeboid  movements,  the  fila- 
ments of  which  engage  in  active  vibration. 

The  alkaloids  of  cinchona  are  employed  as  prophylactics  against 
malarial  infection.  The  experience  of  the  English  naval  service,  of 
crews  engaged  on  the  coast  of  Africa  in  the  suppression  of  the  slave- 
trade,  of  the  expeditionary  force  into  Ashantee  under  Lord  Napier,  and 
of  our  late  civil  war,  has  abundantly  shown  that  quinine  is  in  a  high 
degree  prophylactic.  The  first  public  reference  to  this  property  seems 
to  be  that  of  Dr.  Bryon  in  1854,  who  called  attention  to  the  success 
which  attended  its  use  among  the  crews  of  the  British  vessels  serving 
on  the  coast  of  Africa.  Since  that  time,  for  several  years  the  statistical 
reports  of  the  British  naval  medical  service  have  contained  conclusive 
evidence  on  this  point.  Dr.  Joseph  Jones  has  published  since  the  close 
of  the  civil  war  some  valuable  statistical  data,  showing  the  efficiency 
of  quinine  as  a  prophylactic.  The  troops  who  were  the  subjects  of  ex- 
periment were  stationed  in  a  highly  malarious  locality.  Of  the  num- 
ber, 230,  who  took  no  quinine,  134  had  fever.  Of  those  who  took  qui- 
nine irregularly,  246  in  number,  96  had  fever.  Of  the  506  who  took 
quinine  regularly,  98  had  fever.  The  proportion  of  cases  of  fever  was, 
therefore;  1  to  5 '66  men.  On  the  coast  of  Africa,  the  proportion  has 
varied  from  1  in  8  to  1  in  20.  Of  the  unprotected,  more  than  one  half 
— on  the  coast  of  Africa,  three  fourths — were  attacked  by  malarial 
disease  in  some  form.  As  the  quantity  of  quinine  daily  taken  has 
been  usually  three  to  five  grains,  it  is  probable  that  the  results  would 
be  even  more  favorable  if  a  larger  quantity  of  the  prophylactic  were 
given.  "When  the  poison  is  not  intense,  this  amount  may  be  sufficient, 
but  if  concentrated  and  active,  and  the  conditions  are  otherwise  un- 
favorable, twice  as  much  should  be  administered  daily.  An  enor- 
mous experience  has  now  shown  that  quinine  is  entirely  free  from  in- 
jurious effects  when  taken  as  a  prophylactic.  It  is  probable  that  the 
influence  slowly  decreases,  and  that  some  addition  to  the  daily  quantity 
may  be  necessary  after  a  time.  The  prophylactic  dose  should  be  ad- 
ministered on  rising  in  the  morning,  and  may  be  usefully  prescribed 
in  a  cup  of  black  coffee,  or  in  pill-form.  The  practice  adopted  in  the 
civil  war,  of  giving  whisky  as  the  vehicle,  is  not  to  be  commended. 
If  the  quinine  administered  fail  to  prevent  the  disease,  those  attacked 
will  suffer  far  less  severely  than  the  unprotected.  Experience  has 
shown  that,  to  be  entirely  efficient,  the  quinine  must  be  administered 
for  some  time,  at  least  ten  days,  after  exposure  to  the  causes  of  fever 
(Jones). 

The  mode  of  using  quinine  for  the  cure  of  intennittents  may  be 
formulated  as  follows  : 

The  antipyretic  is  nearly  equally  effective  whether  administered  in 
;the  interval  or  during  the  seizure. 


CINCHONA.  205 

If  time  is  an  element  of  importance,  no  delay  is  necessary  in  order 
to  give  the  remedy  in  the  stage  of  apyrexia. 

To  save  the  suffering  and  exhaustion  of  the  febrile  movement,  the 
attack  should  be  anticipated,  and,  if  possible,  prevented. 

As  the  maximum  effect  of  the  quinine  is  attained  in  about  five 
hours  after  being  taken,  it  should  be  administered  this  period  of  time, 
at  least,  before  the  expected  paroxysm. 

As  the  elimination  of  quinine  takes  place  with  considerable  rapid- 
ity, the  maximum  curative  effect  is  obtained  by  the  administration  of 
the  whole  amount  required  in  a  single  dose,  rather  than  by  a  succes- 
sion of  small  doses  (Prize  Essay). 

An  intermittent  may  be  successfully  treated  by  giving,  during  the 
interval,  a  number  of  small  doses  frequently  repeated.  The  author  is 
convinced  by  extended  observation  that  a  full  dose  of  quinine  (ten 
grains)  in  the  sweating  stage,  and  the  same  quantity  five  hours  before 
the  time  of  the  next  paroxysm,  is  the  more  effective  method.  The 
anti-periodic  property  of  quinine  is  increased,  and  the  cerebral  effects 
of  large  doses  diminished,  by  combination  with  morphine.  It  is  well 
known  that  intermittents,  arrested  by  quinine  or  other  anti-periodics, 
manifest  a  tendency  to  recur  about  the  septenary  periods  ;  therefore, 
ten  to  fifteen  grains  of  quinine  should  be  administered  in  anticipation  of 
these  recurrent  paroxysms,  until  the  third  septenary  period  has  passed. 
Meanwhile,  the  organs  damaged  by  the  malarial  infection — intestinal 
canal,  liver,  spleen,  kidneys,  etc. — require  appropriate  treatment.  The 
action  of  quinine  is  much  assisted  by  the  continuous  administration  of 
arsenic  during  the  intermissions,  and  until  the  third  septenary  period 
has  passed.  The  unpleasant  cerebral  effects  of  quinine  are  lessened  or 
prevented  by  the  simultaneous  administration  of  diluted  hydrobromic 
acid  :  $  Quininse  sulph.,  3  j  ;  acid,  hydrobromic.  dil.,  3  ij  ;  aquse, 
3  xiv.  M.  Sig.  :  One  or  two  teaspoonfuls  at  a  dose. 

In  the  treatment  of  remittent  fever  two  modes  of  using  quinine  are 
employed  :  first,  by  emetics,  purgatives,  baths,  diaphoretics,  etc.,  to 
secure  a  distinct  remission  when  the  remedy  is  administered  ;  second, 
to  give  it  in  sufficient  dose  immediately,  relying  on  its  apyretic  effect. 
The  author  is  convinced  that  the  latter  plan  is  preferable :  from  twenty 
to  thirty  grains  in  a  single  dose  once  or  twice  each  day  until  the  tem- 
perature is  reduced  to  normal.  This  use  of  the  remedy  need  not  inter- 
fere with  other  appropriate  medication. 

In  the  so-called  pernicious  fever,  it  is  agreed  on  all  hands  that  the 
safety  of  the  patient  is  secured  only  by  the  prompt  use  of  large  doses 
(twenty  to  sixty  grains),  and  administration  by  the  stomach,  rectum, 
and  skin  may  be  in  turn  or  simultaneously  resorted  to. 

In  chronic  malarial  infection,  important  changes  have  been  pro- 
duced in  the  intestinal  canal,  liver,  spleen,  kidneys,  cerebro-spinalaxis; 
the  paroxysms  of  fever  occur  irregularly  ;  various  abnormal  manifes- 


OQ6  RESTORATIVE   AGENTS. 

tations  of  the  infection  take  place  (dumb  ague,  enlarged  spleen,  etc.). 
Under  these  circumstances,  quinine  is  less  curative  than  when  the  infec- 
tion is  recent,  and  the  paroxysms  will  recur  from  time  to  time  notwith- 
standing its  use,  unless  these  structural  alterations  are  corrected.  In 
chronic  malarial  disease,  salicylate  of  quinine  and  salicylate  of  cincho- 
nidine  are  especially  effective.  I£  Cinchonidinae  salicylat.,  3  ij  ;  acidi 
arseniosi,  gr.  j ;  ferri  sulph.  exsic.,  3  j.  M.  Ft.  pulv.  (wafers)  no.  xx. 
Sig. :  One  three  times  a  day.  Also:  $  Chinoidin.,  3  ij;  quininae  salicy- 
lat., 3  j;  ferri  sulph.  exsic.,  3j.  M.  Ft.  pil.  no.  Ixxx.  Sig.:  Two  pills 
three  times  a  day.  IJ,  Quininae  sulph.,  chinoidinae,  aa  3  j ;  res.  podo- 
phylli,  gr.  v;  ferri  sulph.  exsic.,  3  ss.  M.  Ft.  pil.  no.  Ix.  Sig.:  Two 
pills  three  times  a  day. 

In  periodical  affections  of  malarial  origin,  quinine  is  equally  as  ef- 
fective as  in  the  periodical  febrile  diseases,  but  somewhat  larger  doses 
are  necessary.  A  difficulty  of  diagnosis  often  arises  in  these  diseases, 
for  the  reason  that  the  neuroses  are  irregularly  periodical  in  their 
manifestations,  when  not  malarial  in  origin.  The  existence  of  a  ma- 
larial cachexia,  and  the  more  uniform  periodicity  in  the  recurrence  of 
the  paroxysms,  will  enable  the  practitioner  to  distinguish  the  neuroses 
of  malarial  origin  from  the  other  functional  disorders  of  the  nervous 
system.  The  following  group  contains  the  disorders  of  the  sensory 
nervous  system  caused  by  malaria :  tic-douloureux,  cephalalgia,  cer- 
vico-brachial  neuralgia,  cervico-occipital  neuralgia,  dorso-intercostal 
neuralgia,  lumbo-abdominal  neuralgia,  mammary  neuralgia,  crural  neu- 
ralgia, gastralgia,  enteralgia,  hepatalgia,  nephralgia,  hysteralgia,  ova- 
ralgia,  sciatica,  angina  pectoris.  The  following  motor  disorders,  also, 
are  produced  by  malarial  influences  :  epilepsy,  chorea,  stricture  of 
urethra,  hiccough,  laryngismus  stridulus,  asthma,  summer  catarrh. 
These  neuroses  may  occur  as  an  expression  of  malarial  infection, 
being  substituted  for  the  ordinary  chill,  fever,  and  sweat,  or  they  may 
assume  the  orderly  periodical  character  in  consequence  of  having 
occurred  in  an  organism  already  under  the  influence  of  the  malarial 
cachexia.  If  they  are  of  malarial  origin,  the  specific  action  of  quinine 
will  speedily  prevail  against  them.  These  malarial  neuroses  require 
large  doses  of  quinine,  and  the  same  fact  is  true  of  all  irregular  mani- 
festations of  malarial  infection.  Ten  to  twenty  grains,  according  to 
the  severity  of  the  attacks  and  the  obstinacy  with  which  they  recur, 
are  necessary,  and  the  paroxysms  should  be  anticipated  by  the  exhi- 
bition of  the  remedy  from  three  to  five  hours  before  the  expected  time. 
In  cases  of  malarial  neuralgia,  the  curative  effect  of  quinine  is  enhanced 
by  combination  with  morphine,  either  in  the  same  prescription  or  by 
simultaneous  administration  of  the  latter  subcutaneously. 

Diarrhoea,  dysentery ,  jaundice,  and  hypertrophy  of  the  spleen  oc- 
casionally occur  in  the  periodical  form,  or  are  due  to  the  immediate 
influence  of  paludal  miasm.  Under  these  circumstances  quinine  af- 


CINCHONA.  207 

fords  relief  without  the  use  of  any  other  remedy.  Very  frequently  the 
diarrhoea,  dysentery,  and  jaundice  are  results  of  structural  alterations 
in  the  liver  and  the  glandular  apparatus  of  the  intestine,  and  are  not 
merely  functional  disorders  which  quinine  may  remove.  In  malarial 
enlargement  of  the  spleen,  quinine  is  supposed  to  be  especially  effec- 
tive ;  but  quinine  exhibits  a  curative  power  only  in  cases  of  simple 
enlargement,  and  does  not  affect  that  condition  known  as  "  fleshy 
spleen,"  or  chronic  splenitis,  of  inflammatory  origin. 

Hcematuria,  when  distinctly  intermittent  and  arising  from  malarial 
infection,  is  cured  by  quinine,  but  large  doses  are  necessary.  Accord- 
ing to  Karamitsas,  sometimes  hsematuria  is  caused  by  this  agent. 

Cases  of  cerebral  disease,  occurring  in  weak  and  anaemic  subjects, 
are  sometimes  much  improved  by  small  doses  of  quinine.  The  author 
has  observed  great  relief  by  the  use  of  this  remedy  in  the  following 
group  of  symptoms,  occurring  in  men  advanced  in  life  :  Headache, 
vertigo,  failure  of  memory,  and  despondency,  associated  with  a  slow 
pulse,  an  atheromatous  degeneration  of  the  vessels,  puffiness  of  the 
eyelids,  and  dilatation  of  the  superficial  veins  of  the  head.  From 
three  to  ten  grains  daily  may  be  given  with  advantage,  the  effect  being 
to  remove  that  sluggishness  of  the  intra-cranial  circulation  on  which 
these  symptoms  depend.  In  insanity,  especially  the  puerperal  form, 
when  there  is  much  weakness,  and  the  skin  is  cold  and  sweating,  qui- 
nine is  very  useful.  When  there  is  a  condition  of  adynamia — the  usual 
state — in  delirium  tremens,  small  doses  of  quinine  assist  materially  in 
tranquillizing  the  patient.  In  that  preliminary  stage  known  as  "  hor- 
rors," characterized  by  restlessness,  tremor,  nausea,  and  anorexia,  qui- 
nine, with  a  mineral  acid,  renders  important  service  by  restoring  the 
digestive  function,  and  by  giving  steadiness  to  the  cerebral  motor 
centers. 

Although  headache  (hemicrania)  and  neuralgia  of  malarial  origin 
are  cured  by  quinine,  by  no  means  equally  successful  results  follow 
the  use  of  this  remedy  in  ordinary  headache  and  neuralgia.  Quinine 
is  largely  employed,  it  is  true,  in  these  affections  when  not  caused  by 
malaria,  but  it  is  useful  only  when  anaemia  is  present  and  is  causative. 
The  same  remark  is  true  of  epilepsy  and  chorea. 

An  attack  of  acute  catarrh  may  often  be  entirely  aborted  by  a 
full  dose  (ten  grains)  of  quinine  and  morphine  (one  half  a  grain),  if 
given  at  the  incipiency  of  the  attack.  After  the  acute  symptoms  have 
subsided,  quinine  is  very  serviceable  in  hay-asthma.  Diphtheria  being 
an  adynamic  disease,  quinine  is  used  by  the  stomach  with  a  view  to 
its  restorative  action,  and  in  the  form  of  spray  to  arrest  the  spread  of 
the  exudation  in  the  fauces.  The  power  of  quinine  to  kill  bacteria 
and  micrococci  renders  its  local  use  a  rational  measure  in  a  disease 
characterized  by  an  enormous  multiplication  and  diffusion  of  micro- 
eocci. 


208  RESTORATIVE   AGENTS. 

Laryngismus  stridulus,  a  reflex  spasm  of  the  muscles  of  the  larynx 
occurring  in  rickety,  ill-fed,  and  anaemic  children,  may  be  prevented 
recurring  by  the  use  of  quinine  in  the  intervals  between  the  attacks. 
Quinine  is  one  of  the  remedies  which  is  used  in  membranous  croup,, 
but  the  reported  successes  were  probably  cases  of  spasmodic  croup. 
There  can  be  no  doubt  regarding  the  good  effects  of  quinine  in  asth- 
ma, after  the  severity  of  the  paroxysms  has  somewhat  abated,  as  an. 
apyretic  in  the  fever  which  succeeds,  and  as  a  restorative  tonic.  It  is 
also  the  most  useful  tonic  which  can  be  employed  in  chronic  bron- 
chitis, with  profuse  expectoration  (bronchiectasis).  The  hectic  fever 
and  sweats  of  phthisis  are  prevented  by  large  doses  (fifteen  to  twenty 
grains)  of  quinine,  but  this  remedy  really  has  no  influence  over  the 
course  and  progress  of  the  disease. 

In  skin-diseases,  when  there  is  present  a  lowered  condition  of  the 
vital  forces,  quinine  is  indicated.  It  is  the  most  valuable  remedy  in, 
erysipelas  and  erythema  nodosum.  It  is  a  curious  fact  that  in  many 
subjects  a  full  dose  of  quinine  will  cause  an  erythema,  with  dilated 
pupils,  phenomena  closely  analogous  to  those  produced  by  belladonna. 
Ecthyma  and  impetigo,  usually  arising  in  a  feeble  state  of  the  assimi- 
lative functions,  are  cured  by  quinine. 

Quinine  is  largely  employed  in  surgical  affections,  to  sustain  the 
powers  of  life  during  protracted  suppuration,  and  to  check  the  forma- 
tion of  pus.  It  is  the  most  generally  prescribed  remedy  for  surgical 
fever.  A  full  dose  of  quinine,  given  before  the  operation,  may  pre- 
vent the  chill  and  fever  which  succeed  in  some  subjects  to  the  opera- 
tion of  catheterization. 

SUBCUTANEOUS  AND  LOCAL  USES  OF  QUININE. — The  increasing  use 
of  quinine  hypodennatically  requires  further  consideration  of  this  sub- 
ject. In  pernicious  intermittents  and  remittents,  when  life  is  put  in 
imminent  danger,  the  most  speedy  and  effectual  way  of  introducing 
the  remedy  must  be  employed.  Besides  the  hazards  due  to  the  inten- 
sity of  the  poison,  an  irritable  stomach  and  rectum  prevent  the  intro- 
duction of  the  remedy  by  either  of  those  channels.  The  subcutaneous 
method  then  becomes  most  important.  Again,  in  obstinate  and  re- 
peatedly relapsing  intermittents,  the  introduction  of  the  remedy  by 
the  skin  imparts  to  it  greater  curative  power.  In  enlarged  spleen 
(ague-cake),  malarial  jaundice,  with  great  irritability  of  the  stomach, 
and  a  catarrhal  state  of  the  gastro-intestinal  mucous  membrane,  the 
subcutaneous  method  becomes  necessary,  or,  if  not  essential,  is  much 
more  effective.  Quinine  and  the  sulphate  simply  suspended  are  not 
adapted  to  subcutaneous  use.  Several  cases  of  tetanus  have  been 
reported  from  New  Orleans  (Sale),  and  two  cases  occurred  in  one 
regiment  of  the  British  Indian  Army  from  their  use  in  this  way. 
The  salt  employed  for  hypodermatic,  use  should  be  sufficiently  solu- 
ble that  no  undissolved  particles  be  thrown  under  the  skin.  Various 


CINCHONA.  209 

solutions  have  been  proposed.  The  muriate  is  more  soluble  than  the 
sulphate  —  dissolves  in  twenty-four  parts  of  cold  water,  and  about 
three  parts  of  alcohol.  One  grain  will  dissolve  in  about  fifteen  min- 
ims of  hot  water,  and  in  a  much  less  quantity  of  alcohol-and- water, 
but  alcohol  is  irritating.  Lente's  solution,  which  is  much  employed 
in  New  York,  is  prepared  as  follows  :  I£  Quininae  disulph.,  grs.  1  ;. 
acid,  sulphuric,  dil.,  m  c  ;  aquae  font.,  f  j  ;  acid,  carbolic,  liq.,  in  v. 
Solve.  This  contains  six  grains  to  the  drachm.  Dr.  Lente  directs  that 
the  quinine  and  water  be  heated  to  the  boiling-point  when  the  acid  i& 
added.  The  solution  is  then  filtered  into  a  bottle  and  the  carbolic  acid 
added.  Below  50°  Fahr.  it  must  be  warmed  before  using.  A  solution 
of  kinate  of  quinine  is  much  used  at  Guy's  Hospital  at  the  strength 
of  one  to  four.  The  kinate  is  obtained  by  decomposing  sulphate  of 
quinine  with  the  kinate  of  barium.  The  mode  of  preparing  the  solu- 
tion is  as  follows  :  Put  into  a  beaker  3  vj  of  distilled  water  and  3  ij  of 
kinate  of  quinine,  and  heat  until  the  salt  dissolves,  which  it  does  al- 
most immediately,  and  then  add  enough  distilled  water  to  make  up  to 
§  j.  The  disadvantage  of  so  concentrated  a  solution  is  the  incrusta- 
tion, by  evaporation,  of  the  bottle  and  syringe  with  the  solid  kinate. 
The  sulpho-vinate  of  quinine  is  very  soluble — one  part  in  three  of 
water  at  60°  Fahr. — and  is  readily  prepared  by  double  decomposition 
between  the  alcoholic  solutions  of  sulpho-vinate  of  sodium  and  sul- 
phate of  quinine.  Gubler  advocates  the  hydrobromate,  as  follows  : 
$  Quininas  hydrobromat.,  grs.  xlviij ;  aquae  destil.,  f  f  j.  M.  Dis- 
solve by  heat  if  necessary.  Ten  minims  contain  one  grain. 

Recently  a  new  compound  salt  of  urea  and  quinine  has  been  pro- 
posed, and  it  seems  to  possess  distinct  advantages  over  every  other 
preparation  :  it  is  designated  quinia  bimuriatica  carbamidata,  and  is 
formed  by  Drygin  from  a  combination  of  twenty  parts  of  muriate  of 
quinine,  twelve  parts  of  muriatic  acid,  and  three  parts  of  urea.  The 
resulting  salt  is  soluble  in  equal  parts  of  water.  The  utility  of  this 
compound  is  not  entirely  theoretical.  Practical  trials  made  at  Ham- 
burg have  demonstrated  its  fitness  for  hypodermatic  use.  A  fifty-per- 
cent solution  has  usually  been  employed,  and  a  half  to  three  syringefuls 
(TH,  xv  to  3  jss)  injected.  The  local  irritation  is  represented  as  slight. 
Very  favorable  reports  have  been  published  in  respect  to  the  utility  of 
the  hydrobromate  brought  forward  by  Gubler.  In  the  hands  of  Ray- 
mond, Soulez,  and  others,  intermittents  are  said  to  have  ceased  after 
two  injections  of  three  grains  each  of  this  salt.  The  usual  method 
pursued  was  to  inject  one  and  a  half  grain  of  the  hydrobromate  twice 
morning  and  evening,  and,  although  six  to  twelve  grains  were  usually 
successful,  in  one  case  thirty  grains  were  required.  It  has  also  been 
employed  in  the  treatment  of  acute  rheumatism. 

Quinine  in  solution  is  applied  in  various  affections  of  the  fauces  by 
atomization.  In  diphtheria  especially  have  good  results  been  produced. 


KESTORATIVE   AGENTS. 

A  saturated  solution  of  the  muriate  or  of  the  bromide  may  be  thus 
employed.  There  can  be  no  doubt  that  a  solution  of  quinine  ap- 
plied to  the  nares  may  be  very  beneficial  at  the  onset  of  hay-asthma, 
as  first  shown  by  Helmholtz.  The  author  has  seen  several  cases 
benefited  greatly  ;  but  to  achieve  success  the  applications  must  be 
thorough  and  timely.  The  secret  of  any  good  effects  it  has,  is 
afforded  by  its  toxic  action  on  germs,  and  possibly  on  the  pollen  of 
certain  grasses,  to  the  presence  of  which  the  irritation  of  the  air- 
passages  is  ascribed. 

The  author  is  indebted  to  Dr.  W.  R.  Gray,  of  Orange,  New  Jersey, 
for  a  private  communication  in  which  he  states  that  he  has  successfully 
used  quinine  by  inunction— 3  j  of  quinine  to  3  j  of  lard — in  the  case 
of  children  especially.  The  ointment  should  be  thoroughly  rubbed  in 
over  the  abdomen  and  at  the  flexures  of  the  joints. 

Orexine. — When  first  employed  as  a  stomachic  tonic  it  was  ad- 
ministered in  the  form  of  the  hydrochlorate.  This  proved  so  un- 
pleasant in  its  effect  on  the  stomach,  and  vomiting  was  so  often 
induced  by  it,  that  it  fell  into  discredit.  It  was  then  ascertained 
by  Prof.  F.  Penzoldt  that  if  given  in  the  basic  form — that  is,  un- 
combined — it  could  be  readily  taken  without  any  unpleasant  after 
effects. 

As phenyldihydroquinazoline,  it  occurs  as  a  white  powder,  which 
is  soluble  in  hot  water.  It  may  be  placed  on  the  tongue  and  swal- 
lowed with  water  without  giving  rise  to  any  pungent  sensation  or 
causing  nausea.  It  may  be  given  in  wafer,  or  capsule,  or  in  an  ordi- 
nary pill  mass,  the  dose  ranging  from  two  to  five  grains,  an  hour  or 
two  before  meals. 

Orexine  is  a  stomachic  tonic,  in  regard  to  which  there  is  remark- 
able unanimity  of  opinion.  It  promotes  appetite,  occurring  as  a  symp- 
tom in  a  great  variety  of  affections.  It  appears  to  be  contraindicated 
in  stomach  ulcer.  It  has  proved  useful  in  the  anorexia  of  nervous 
subjects,  in  hysteria,  in  neurasthenia,  and  allied  states.  The  author 
has  found  it  most  beneficial  as  a  stomachic  tonic  in  many  neurasthenic 
subjects,  otherwise  difficult  of  management.  The  reports  as  to  its 
utility  in  the  vomiting  of  pregnancy  have  also  been  highly  favorable. 

While  orexine  is  thus  useful  as  a  stomachic  tonic,  in  the  direct 
sense,  it  has  proved  beneficial,  indirectly,  as  a  means  of  improving  the 
nutrition  in  various  wasting  diseases,  as  in  tuberculosis,  chronic  gastro. 
intestinal  catarrh,  and  similar  maladies.  It  may,  therefore,  be  admin- 
istered when  it  is  desirable  to  promote  constructive  tissue  metamor- 
phosis, when  from  impaired  appetite  the  requisite  amount  of  aliment 
can  not  be  taken,  and  it  can  be  used  also  when  the  stomach  is  func- 
tionally deranged  by  a  reflex  impression,  as  in  the  case  of  the  vomit- 


ALKALIES.  211 

ing  of  pregnancy.     The  range  of  its  utility  is  therefore  wide  and 
varied. 

Orexine  Tannate  has  been  proposed  as  a  substitute  for  the  basic 
orexine  and  for  the  hydrochlorate.  Its  chemical  designation  is  phenyl- 
dihydroquinazoline  tannate.  It  has  the  advantage  of  being  an  odor- 
less and  tasteless  yellowish- white  powder.  It  has  been  used  with 
much  advantage  in  promoting  appetite  and  improving  nutrition  in 
various  diseases — in  phthisis,  cardiac  affections,  after  surgical  proced- 
ures, and  the  vomiting  of  pregnancy.  This  preparation  is  contraindi- 
cated  in  the  same  conditions  as  the  basic  orexine  when  there  is  exces- 
sive acidity,  and  in  ulcer. 

Quinine  and  Urethan. — It  has  been  lately  ascertained  that  the 
hydrochlorate  of  quinine  and  urethan  (ethylic),  triturated  together 
with  a  small  amount  of  water,  make  a  transparent,  permanent  solu- 
tion, which  may  be  utilized  for  the  stomachal  and  subcutaneous  ad- 
ministration of  quinine.  The  following  formula  should  be  used : 
5  Quininse  bydrochlorat,  3  j  ;  urethan  (ethylic),  3  ss.  ;  aquae  destil., 
3  j.  M.  Sig.  :  Dose,  from  ten  minims  upward.  This  solution  is  free 
from  irritant  qualities,  and  the  urethan,  by  its  sedative  effect  on  the 
nerve  centers,  moderates  the  unpleasant  effects  of  the  quinine.  The 
chief  advantage  of  this  combination  exists  in  the  facility  with  which 
quinine  may  be  administered  hypodermatically.  It  is  necessary  to 
note  that  it  is  only  the  hydrochlorate  of  quinine  that  urethan  will  act 
on  as  a  solvent,  and  it  is  in  about  the  proportion  given  above  that  a 
perfect  solution  is  effected. 


AGENTS    PROMOTING    DESTRUCTIVE    METAMOR- 
PHOSIS OR  INCREASING  WASTE. 

ALKALIES. 

Potassium. — PREPARATIONS:  Potassa. — Potassa ; potasse, Fr. ;  Kali 
hydricum,  Ger.  Caustic  potash.  Occurs  in  cylindrical  rods,  is  very 
deliquescent,  and  dissolves  in  water  and  in  alcohol. 

Potassa  cum  Calce. — Equal  parts  of  potassa  and  lime.    Escharotic. 

Potassii  Acetas. — Potassium  acetate.  A  white,  deliquescent  salt, 
wholly  soluble  in  water  (100  in  35)  and  in  alcohol  (proof  spirit  1  in 
2).  Dose,  gr.  v — 3j. 

Potassii  Bicarbonas. — Potassium  bicarbonate.  In  white  crystals, 
permanent  in  the  air,  wholly  soluble  in  water  (1  in  3),  and  having  a 
slightly  alkaline  taste.  Dose,  gr.  v — 3j. 

Potassii   Carbonas. — Potassium  carbonate.      A  deliquescent  salt, 
wholly  soluble  in  water  (100  in  75).     Dose,  gr.  ij — gr.  x. 
16 


212  AGENTS  INCREASING  WASTE. 

Liquor  Potassii    Citratis.— Solution  of  potassium  citrate.    Dose, 

3  j—  5  j- 

Potassii  Citras.— Potassium  citrate.  A  whitish,  granular,  deli- 
quescent salt,  wholly  soluble  in  water  (10  in  6).  Dose,  gr.  v—  3  ss. 

Potassii  Citras  Effervescens.  —  Effervescent  potassium  citrate. 
Citric  acid,  63  grm.  ;  potassium  bicarbonate,  93  grm.  ;  sugar,  47  grm. 
Dose,  a  teaspoonful  or  two. 

Potassii  et  Sodii  Tartras. — Potassium  and  sodium  tartrate  ;  Ro- 
chelle  salt.  In  colorless,  transparent  crystals,  which  effloresce  slightly 
in  dry  air,  and  are  wholly  and  readily  soluble  in  five  times  their  weight 
of  boiling  water.  Soluble  in  cold  water,  1  in  2. 

Liquor  Potasses,. — Solution  of  potassa.  A  colorless  liquid,  having 
an  extremely  acrid  taste  and  a  strong  alkaline  reaction.  Dose,  in,  ij 
—HI,  xx.  It  should  be  taken  well  diluted  with  water. 

Potassii  Chloras. — Chlorate  of  potassium.  In  colorless,  lustrous, 
monoclinic  prisms  or  plates,  or  a  white  powder,  wholly  soluble  in  dis- 
tilled water  (in  cold  water,  1  in  16'5  ;  in  boiling  water,  1  in  2).  Dose, 
gr.  v — gr.  xv. 

Trochisci  Potassii  Chloratis. — Potassium  chlorate  troches. 

Potassii  Nitras. — Potassium  nitrate.  In  colorless,  prismatic  crys- 
tals, unalterable  in  the  air  and  wholly  soluble  in  water  (in  cold  water, 
1  in  4  ;  in  boiling  water,  1  in  2£).  Dose,  gr.  ij — gr.  x. 

Potassii  Bichromas. — Potassium  bichromate.  In  orange-red,  an- 
hydrous, tabular  crystals,  soluble  in  ten  parts  of  cold  and  in  much 
less  of  boiling  water,  forming  a  solution  having  an  acid  reaction. 
Dose,  gr.  4 — gr.  ss. 

Potassii  Bitartras. — Potassium  bitartrate ;  cream  of  tartar.  Is 
sparingly  dissolved  in  cold  water  (1  in  210),  more  freely  in  boiling 
water  (1  in  15).  Dose,  3j —  §  ss. 

Potash  salts  not  included  in  this  list  are  considered  elsewhere,  in 
accordance  with  their  physiological  relations. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  alkalies  and  their  carbon- 
ates are  incompatible  with  the  acids  and  with  metallic  salts.  The 
caustic  alkalies  decompose  the  alkaloids  of  belladonna,  stramonium, 
hyoscyamus,  duboisia,  etc.  In  case  of  poisoning,  the  antidotes  to  be 
employed  are — acetic,  citric,  or  tartaric  acids,  in  the  form  of  vinegar, 
cider,  lemon- juice,  etc. 

SYNEBGISTS. — The  alkalies  assist  each  other's  action.  All  agents 
promoting  waste — for  example,  mercury,  the  iodides,  etc. — increase 
the  therapeutical  activity  of  the  alkalies. 

PHYSIOLOGICAL  ACTION  OF  THE  POTASH  SALTS. — The  most  recent 
experiments  having  shown  that  potash  has  quite  distinct  properties 
from  the  other  alkalies  of  the  group,  each  member  of  the  group  is  con- 
sidered separately.  As  an  alkali,  potash  combines  with  acids  to  form 
salts,  and  with  fats  to  form  soaps.  As  it  has  a  great  affinity  for  moist- 


ALKALIES.  213 

ure,  and  dissolves  albumen,  and  is  a  very  diffusible  substance,  it  exerts 
a  destructive  action  on  the  animal  tissues.  These  chemical  facts  ex- 
plain the  active  caustic  properties  of  potassa  f usa.  In  the  stomach  the 
salts  of  potash  obey  chemical  laws,  neutralize  the  free  acid,  and  sapon- 
ify oily  or  fatty  matters.  Given  when  the  stomach  is  empty,  potash, 
as  do  the  alkalies  in  general,  promotes  the  acidity  of  the  gastric  juice, 
by  increasing  the  diffusion  of  those  constituents  of  the  blood  from 
which  the  acid  of  the  stomach  is  elaborated  ;  but,  as  a  large  amount 
of  alkali  will  neutralize  a  corresponding  proportion  of  acid,  it  is  obvi- 
ous that,  to  obtain  an  increased  quantity  of  acid  gastric  juice,  the 
amount  of  alkali  administered  must  be  small  and  rightly  timed. 

When  a  toxic  dose  of  potassa,  of  the  carbonate,  nitrate,  or  chlorate, 
is  taken,  violent  local  inflammation  results.  The  action  and  the  ap- 
pearances are  somewhat  different  as  regards  potassa  and  its  salts. 
The  former  liquefies  the  tissues,  and  extends  its  escharotic  action 
widely  and  deeply,  the  sloughs  being  surrounded  by  a  zone  of  inflam- 
mation. The  salts,  according  to  their  activity  and  the  quantity  taken, 
set  up  a  high  degree  of  inflammation,  cause  intense  burning  pain  about 
the  epigastrium,  nausea,  vomiting,  sometimes  of  bloody  mucus,  purg- 
ing, the  stools  being  watery  and  profuse,  or  they  may  be  dysenteric. 
In  the  case  of  caustic  potash,  marks  of  corrosive  action,  sloughs  of  the 
mucous  membrane,  bloody  oozing,  may  be  seen  about  the  lips,  mouth, 
and  fauces,  and  shreds  of  bloody  and  sloughing  tissues  vomited.  In 
case  of  toxic  action  of  potassa  and  its  salts,  the  local  destruction,  pain, 
and  inflammation  are  accompanied  by  the  usual  systemic  symptoms — 
great  depression  of  the  powers  of  life,  a  weak,  rapid  pulse,  shrunken 
countenance,  cold  surface,  followed  by  coma  and  insensibility.  In  a 
small  proportion  of  cases  the  local  mischief  is  not  great,  but  the  effects 
of  the  poison  are  expended  on  the  nervous  system,  and  assume  the 
form  of  muscular  weakness,  paralysis  of  the  inferior  extremities,  weak 
action  of  the  heart,  and  coma,  and  a  very  large  dose  may  cause  death 
suddenly  by  paralysis  of  the  heart  before  the  local  inflammation  has 
time  to  develop.  The  nitrate  and  chlorate  are  the  most  active  of  the 
salts,  but  all  potash  bases  have  more  or  less  power  in  the  same  direc- 
tion. The  well-known  case  of  Dr.  Fountain,  of  Iowa,  illustrates  some 
points  in  the  action  of  chlorate  of  potassa.  Entertaining  some  theo- 
retical notion  of  the  curative  power  of  this  remedy  when  administered 
in  considerable  doses,  he  took  an  ounce  to  demonstrate  its  innocuous- 
ness.  Violent  gastro-enteritis  was  produced  ;  at  first  there  was  free 
diuresis,  but  urinary  suppression  followed,  and  death  ensued  in  seven 
days  after  the  ingestion  of  the  poison.  "When  recovery  takes  place 
after  poisoning  by  caustic  potash,  deformity  of  the  mouth,  stenoses  of 
the  O3sophagus,  cardia  and  pylorus,  may  remain,  and  then,  after  a  par- 
tial improvement,  the  mechanical  interference  with  the  functions  of 
these  organs  causes  a  more  or  less  rapid  marasmus. 


214  AGENTS   INCREASING   WASTE. 

When  the  alkaline  bicarbonates  are  taken  on  an  empty  stomach 
they  diffuse  quickly  into  the  blood,  where,  meeting  the  neutral  phos- 
phate of  sodium,  they  are  decomposed,  acid  phosphate  of  sodium  being 
formed,  and  this  compound,  diffusing  out  of  the  blood  into  the  urine, 
increases  the  acidity  of  that  excretion  (Rolfe).  The  result  is  different 
when  bicarbonate  of  potassium  is  taken  during  digestion,  for  then,  the 
reaction  of  the  gastric  juice  being  strongly  acid,  this  salt  is  decomposed, 
carbonic  acid  is  given  off,  and  the  alkaline  base  lessens  the  acidity  of 
the  stomach,  increases  the  alkalinity  of  the  blood,  and  diminishes  the 
acidity  of  the  urine.  The  salts  of  potash  formed  with  vegetable  acids 
undergo  conversion  into  alkaline  carbonates  in  their  passage  through 
the  organism,  and  are  eliminated  in  this  form,  thus  causing  an  alkaline 
condition  of  the  urine.  The  period  of  administration  unquestionably 
influences  the  result  to  a  large  degree,  as  has  just  been  stated.  The 
increased  alkalinity  of  the  blood,  produced  by  the  administration  of 
the  potash  salts,  promotes  its  oxidizing  function  (Buchheim,  Basham, 
Kohler,  and  others).  The  relative  quantity  of  uric  acid  is  diminished, 
and  of  urea  increased.  Basham,  instructed  by  the  observations  of 
Schunck,  that  oxalurate  of  ammonia  is  a  product  of  the  oxidation  of 
uric  acid,  and  that  the  former  is  readily  converted  into  urea  and  oxalic 
acid,  holds  that  the  same  process  takes  place  in  the  organism  when 
uric  acid  is  subjected  to  the  action  of  the  potash  salts.  The  urine  of 
patients  suffering  from  uric-acid  deposits  was  carefully  examined  » 
after  a  course  of  the  citrate  or  carbonate  of  potassium,  and  it  was 
found,  after  an  interval  of  about  three  days,  that  the  urea  was  in  one 
case  trebled  in  amount,  and  in  others  more  than  doubled,  while  the  uric 
acid  was  reduced  to  a  fractional  part  of  what  had  existed  (Basham). 
The  facts,  then,  are  conclusive  in  regard  to  the  increase  in  the  oxida- 
tion processes,  caused  by  the  administration  of  potash,  and  its  salts 
formed  by  combination  with  carbonic  and  the  vegetable  acids.  The 
changes  in  the  fatty  constituents  of  the  blood  consist,  probably,  in  a 
process  of  saponification  and  excretion.  Nitrate  and  chlorate  of  po- 
tassium produce  very  different  effects  on  the  blood.  Xot  parting  with 
their  oxygen  in  the  system,  and  excreted  undecomposed,  the  effects 
noted  in  the  blood  must  be  due  to  their  action  as  a  whole.  The 
changes  made  by  the  chlorate  in  the  composition  of  the  blood  have 
been  studied  recently  by  Marchand,  in  cases  of  poisoning  in  man  and 
by  experiments  on  animals.  The  blood  assumes  a  dark,  brownish,  or 
chocolate  color,  and  can  no  longer  take  up  oxygen  ;  the  haemoglobin 
is  decomposed,  and  the  injured  blood-corpuscles  accumulate  in  the 
spleen  ;  the  kidneys  are  brownish  in  color,  and  the  tubules  are  choked 
with  the  broken-down  materials  of  the  red  globules.  The  peculiar 
brownish  color  of  the  blood  is  found,  by  spectroscopic  analysis,  to 
be  due  to  a  substance  identical  with  Hoppe-Seyler's  methaemoglobin. 
These  effects  separate  the  chlorate,  nitrate,  and  other  compounds  of 


ALKALIES.  215 

potassa  very  distinctly  from  the  compounds  with  vegetable  acids, 
while  the  latter  also  differ  distinctly  from  the  former  in  the  power  to 
alkalinize  the  blood  and  urine. 

A  very  considerable  reduction  of  temperature  is  produced  by  large 
doses  of  the  potash  salts  (Podcopaew,  Guttmann,  Traube).  This  effect, 
due  especially  to  chlorate  and  nitrate  of  potassium,  may  be  readily  ex- 
plained by  the  changes  in  the  haemoglobin,  which  impair  its  function 
as  a  carrier  of  oxygen.  Ordinary  doses  do  not  affect  temperature  de- 
cidedly, probably  because  they  do  not  have  the  power  to  change  the 
properties  of  haemoglobin.  The  alterations  produced  in  the  composi- 
tion of  the  blood  by  the  salts  of  potash  necessarily  affect  the  nutritive 
functions.  The  increased  elimination  of  urea,  the  waste  of  the  fatty 
constituents  of  the  blood  and  of  the  tissues,  the  more  rapid  process  of 
oxidation,  results  of  the  action  of  the  potash  salts,  necessarily  place 
these  remedies  among  the  list  of  those  promoting  destructive  meta- 
morphosis. 

Drs.  Ringer  and  Murrell  find  chloride  of  potassium  to  be  a  proto- 
plasmic poison,  and  to  this  effect  they  refer  its  action  on  the  brain  and 
nervous  system  and  on  the  heart.  That  potash  is  a  poison  to  the  heart 
has  long  been  known.  The  experiments  of  Podcopaew,  repeated  sub- 
sequently by  Guttmann,  confirm  this.  Whether  introduced  directly 
into  the  circulation,  by  injection  into  the  jugular  vein  or  subcutane- 
ously,  the  paralysis  of  the  heart  follows — more  speedily,  when  the 
poison  reaches  the  heart  more  directly.  The  arrest  of  the  heart  takes 
place  in  the  diastole,  and  occurs  after  division  of  the  pneumogastric, 
whence  it  must  be  concluded  that  the  effect  on  the  heart  is  not  exerted 
through  increase  of  the  inhibition.  As,  when  a  large  dose  is  suddenly 
precipitated  on  the  heart,  its  movements  are  speedily  arrested,  and  the 
muscle  of  the  heart  does  not  then  respond  to  electrical  excitation,  the 
effects  of  the  poison  must  be  expended  chiefly  on  the  muscular  tissue 
(Traube),  but  not  wholly  so,  since,  before  the  electro-contractility  is 
entirely  abolished,  all  motion  may  be  arrested.  The  cardiac  ganglia 
must  therefore  participate  in  the  changes  wrought  by  the  poison.  The 
effect  of  potash  on  the  tension  of  the  vessels — on  the  blood-pressure — 
is  much  influenced  by  the  quantity  and  mode  of  administration.  A 
large  quantity  by  intra-venous  injection  quickly  poisons  the  heart  and 
lowers  the  pressure  in  the  arterial  system.  On  the  other  hand,  small 
doses  increase  the  tension  (Hummel,  Traube).  As  elimination  takes 
place  very  rapidly,  it  is  not  surprising  to  find  that  the  normal  pressure 
is  quickly  restored.  This  difference  in  the  result,  due  to  the  size  of 
the  dose,  is  largely  responsible  for  the  conflicting  statements  which 
have  been  put  forward. 

It  has  been  ascertained  by  Ringer  and  Murrell,  and  by  Guttmann, 
that  the  contractility  of  the  muscles  and  the  irritability  of  the  motor 
nerves  persist  after  complete  paralysis  induced  by  the  potash  salts. 


oio  AGENTS   INCREASING   WASTE. 

The  paralyzing  action  must,  therefore,  be  exerted  on  the  spinal  cord. 
In  fact,  as  Ringer  and  Murrell  have  shown,  potash,  being  a  protoplas- 
mic poison,  affects  most  injuriously  the  most  highly  specialized  struct' 
ures  ;  hence  the  brain  and  spinal  cord  suffer  earlier  and  more  severely 
than  do  other  tissues.  We  owe  to  Dr.  Ringer  some  important  discov- 
eries as  to  the  action  of  the  alkalies  on  the  frog's  heart.  As  these 
observations  are  confirmed  for  the  most  part  by  clinical  and  experi- 
mental studies  in  man,  they  may  be  accepted  as  a  close  approximation 
to  the  actual  facts.  Potash,  soda,  and  ammonia,  in  small  quantity, 
increase  the  tonicity  of  the  muscular  walls  of  the  heart,  but  in  large 
quantity  they  manifest  a  paralyzing  action,  and  this  is  especially  true  of 
potash,  which  is  much  more  powerful  than  any  of  the  alkalies.  If  the 
ordinary  saline  solution  is  made  with  river-water,  when  passed  through 
the  heart,  the  ventricular  contractions  are  much  prolonged ;  but,  if  a 
minute  quantity  of  potash  is  added,  the  heart-beats  assume  the  normal 
character.  This  result  is  probably  due  to  the  lime  present  in  the 
river-water,  for  when  a  trace  of  a  lime-salt  is  added  to  distilled  water 
the  same  lengthening  of  the  ventricular  contraction  takes  place. 

The  elimination  of  the  potash  salts  takes  place  by  various  channels, 
chiefly  by  the  kidneys,  but  they  also  appear  in  the  saliva,  sweat,  milk, 
and  other  secretions.  The  effect  of  these  salts  on  the  reaction  of  the 
urine  and  the  differences  in  result  due  to  the  period  of  administration 
have  been  pointed  out.  The  state  of  acidity  of  the  stomach  greatly 
affects  the  reactions  of  the  urine  produced  by  the  carbonates  of  po- 
tassa  (Ralfe).  The  salts  of  vegetable  acids  undergo  decomposition  in 
their  passage  through  the  system  ;  they  render  the  urine  alkaline,  and 
greatly  increase  the  excretion  of  free  carbonic  acid  (Parkes).  The 
after-condition  of  the  urine  is  that  of  increased  acidity  (Ralfe).  The 
nitrate  and  chlorate  of  potassa  are  eliminated  unchanged,  and  do  not 
affect  the  reaction  of  the  urine  (Laborde).  The  notion  entertained  in 
some  quarters  that  chlorate  of  potassa  parts  with  its  oxygen,  is  en- 
tirely erroneous.  These  salts  increase  the  amount  of  urinary  water, 
and,  in  common  with  the  other  members  of  the  family,  promote  oxi- 
dation and  the  excretion  of  urea.  While  the  acetate  increases  the 
discharge  of  urinary  water,  it  actually  lessens  the  quantity  of  solids 
excreted  (Parkes).  The  production  of  saliva  is  much  increased  by  the 
chlorate,  which  is  freely  eliminated  by  the  salivary  glands  (Laborde). 
It  is  a  very  important  fact,  which  we  owe  to  Dr.  Jacobi,  of  New  York, 
that  chlorate  of  potassa  irritates  the  kidneys,  and  if  continued  a  suffi- 
cient time  sets  up  a  chronic  nephritis.  Others  have  made  similar  ob- 
servations, so  that  the  popular  use  of  this  supposed  harmless  agent 
should  be  discouraged  by  the  medical  profession. 

THERAPY  OF  THE  POTASH  SALTS. — Chlorate  of  potash  is  in  almost 
universal  use  as  a  remedy  for  catarrhal  inflammation  of  the  mouth 
and  fauces,  for  acute  tonsillitis,  aphthous  ulcerations  of  the  mouth* 


ALKALIES.  217 

stomatitis  materna,  or  nursing  sore  mouth,  and  mercurial  stomatitis. 
As  above  stated,  the  domestic  use  of  this  remedy  for  sore  mouth  and 
sore  throat  has  become  an  evil  which  should  be  discouraged.  For  or- 
dinary purposes  this  remedy  should  not  be  employed.  The  utility  of 
the  chlorate  is,  however,  so  decided  in  the  case  of  stomatitis  materna, 
that  all  other  considerations  are  merely  secondary.  In  this  malady 
large  doses  (fifteen  grains  to  3  j  three  or  four  times  a  day)  are  neces- 
sary, and  a  less  amount  will  fail  to  effect  a  cure.  In  mercurial  stoma- 
titis, ulcerative  tonsillitis,  diphtheritic  angina,  etc.,  the  following  for- 
mula may  be  applied  locally  :  IJ  Potassii  chlorat.,  3  j  ;  acid,  carbolic., 
3  ss  ;  glycerini,  §j;  aquae,  §  iij.  M.  Sig. :  Lotion. 

The  potash  salts  are  used  with  great  advantage  in  many  stomach- 
disorders.  It  is  an  undoubted  chemical  fact  that  an  excess  of  acid  is 
relieved  by  an  alkali,  but  the  result  is  not  permanent,  and  the  cause  of 
the  acidity  is  not  removed.  Small  doses  of  an  alkali,  given  with  a 
bitter  before  meals,  promote  the  flow  of  gastric  juice,  and  are  a  ser- 
viceable combination  in  atonic  dyspepsia.  IJ  Inf.  calumbae,  §  iv  ; 
liq.  potassae,  3  ss.  M.  Sig. :  A  dessert  to  a  tablespoonf  ul  three  times 
a  day  before  meals.  Administered  after  meals,  the  alkalies  will  relieve 
the  acidity  due  to  an  excessive  production  of  acid,  or  to  the  acid  fer- 
mentation of  the  starch,  sugar,  and  fat,  in  the  food.  An  acid  given 
before  meals  is  the  proper  remedy  for  the  excessive  formation  of  the 
acid  of  the  gastric  juice.  Alkalies  render  an  important  service  in  case 
of  indigestion  of  fats.  Not  only  do  they  prevent  the  formation  of 
butyric  acid,  but  they  assist  in  the  process  of  emulsionizing  the  fats 
and  help  their  absorption.  In  diseases  of  the  liver,  and  when  from 
any  cause  the  flow  of  bile  into  the  intestine  is  prevented,  alkalies  assist 
in  the  digestion  and  absorption  of  fats.  The  indigestion  of  obese  sub- 
jects, and  of  the  gouty  and  rheumatic,  is  usually  cured  or  alleviated 
by  alkalies.  The  lithia  salts  are  generally  to  be  preferred  in  gouty 
and  rheumatic  subjects  ;  but,  generally  speaking,  the  bicarbonate  of 
potassium  is  the  most  useful  of  the  alkali  remedies  in  the  above-men- 
tioned maladies. 

The  salts  of  the  alkalies,  especially  the  citrates,  tartrates,  and  car- 
bonates of  potassium,  are  useful  in  inflammatory  diseases  to  lessen  heat, 
and  to  promote  excretion  of  the  products  of  inflammation.  When 
oxidation  is  deficient,  as  represented  in  an  excess  of  uric  acid  in  the 
urine,  a  coated  tongue,  hebetude  of  mind — the  so-called  "  bilious  state  " 
— relief  is  afforded  by  the  use  of  the  alkalies  and  their  laxative  salts. 
The  alkaline  treatment  of  acute  rheumatism  is  based  on  these  prin- 
ciples. Although  this  plan  of  treatment  may  not  be  adapted  to  all 
cases,  there  can  be  no  doubt  of  its  utility  in  respect  to  a  considerable 
proportion.  It  must  be  borne  in  mind,  as  Dr.  Fuller,  the  most  influ- 
ential advocate  of  the  method,  informs  us,  that  the  alkaline  treatment 
consists  in  a  plan,  made  up  in  part  of  the  use  of  bicarbonate  of  potas- 


218  AGENTS   INCREASING  WASTE. 

slum,  and  in  part  of  certain  adjuvants,  notably  quinine.  The  main 
point  in  the  treatment  consists  in  the  administration  of  remedies  to 
induce  an  alkalinization  of  the  system  as  quickly  as  possible,  for  when 
this  is  accomplished  further  joint  and  heart  complications  are  not  like- 
ly to  occur.  Fuller  gives  not  less  than  an  ounce  and  a  half  of  bicarbon- 
ate of  potassium,  largely  diluted  with  water,  in  the  first  twenty-four 
hours  of  the  treatment.  Sometimes  this  salt  is  given  in  effervescence 
with  lemon- juice — in  the  proportion  of  two  drachms  to  an  ounce  of 
lemon-juice — every  three  or  four  hours,  or  with  citric-acid  solution.  If 
the  bowels  are  torpid,  one  or  more  compound  cathartic  pills  are  pre- 
scribed in  addition.  As  soon  as  the  urine  ceases  to  exhibit  an  acid 
reaction — usually  at  the  expiration  of  twenty-four  hours — the  quantity 
of  potassic  carbonate  is  reduced  one  half.  If  the  urine  continues  alka- 
line at  the  expiration  of  another  period  of  twenty-four  hours,  the  alkali 
is  further  reduced  one  half,  and,  on  the  fourth  day,  the  same  conditions 
continuing,  the  treatment  ceases  to  be  exclusively  alkaline.  Then  the 
alkali  is  reduced  to  the  amount  necessary  merely  to  keep  the  urine 
neutral — about  a  half -drachm  of  the  bicarbonate  three  times  a  day, 
and  quinine  is  given.  In  Dr.  Fuller's  words,  three  grains  of  quinine,  dis- 
solved in  lemon-juice,  is  given  three  times  a  day  in  effervescence  with 
half  a  drachm  of  bicarbonate  of  potash.  In  ninety-four  cases  of  acute 
rheumatism  thus  treated,  the  average  duration,  from  the  beginning  of 
treatment,  was  eleven  days.  This  method  is  adapted  to  the  treat- 
ment of  the  plethoric,  obese,  and  muscular  subjects,  and  in  the  experi- 
ence of  the  author  is  not  well  suited  to  the  pale,  delicate,  and  anemic 
rheumatic. 

In  irritation  of  the  urinary  organs  due  to  an  excess  of  acid,  the 
combinations  of  potash  with  the  vegetable  acids  possess  a  high  degree 
of  utility.  The  liquor  potassse  is  much  prescribed  under  these  circum- 
stances, but,  as  it  is  very  irritating  to  the  stomach,  the  salts  are  prefer- 
able, and  they  are  equally  effective.  The  liquor  potassii  citratis  is  an 
excellent  form  for  this  purpose.  There  is  no  doubt  that  the  long-con- 
tinued use  of  alkalies  (citrate,  acetate,  and  carbonate  of  potassa)  will 
effect  the  solution  of  renal  calculi,  which  are  usually  composed  of  uric 
acid.  As  the  urate  of  soda  is  often  the  nucleus  of  these  formations,  the 
soda  alkalies  should  not  be  used.  Small  doses  taken  daily  for  length- 
ened periods  are  necessary.  Such  alkaline  waters  as  the  Vichy  may 
be  used  if  more  agreeable  to  the  patient,  but  the  best  results  are  ob- 
tained by  the  administration  of  the  citrates  and  tartrates  in  a  large 
quantity  of  distilled  water.  When  the  urine  is  acid  in  any  of  the  forms 
of  cystic  irritation — from  stone,  cystitis,  stricture,  enlarged  prostate, 
etc. — great  relief  is  experienced  from  the  use  of  alkalies,  notably  the 
liquor  potassse,  the  citrates,  acetates,  and  carbonates  of  potassium. 
When  the  urine  is  alkaline  in  reaction,  no  benefit  can  be  derived  from 
the  use  of  these  remedies. 


ALKALIES.  219 

The  bitartrate  and  the  acetate  of  potassium  are  very  certain  diu- 
retics, especially  the  first  named.  They  are  most  effective  when  given 
largely  diluted  with  water.  A  pleasant  form  in  which  to  administer 
cream  of  tartar  is  the  familiar  "  cream-of -tartar  lemonade,"  made  as 
follows  :  A  sufficient  quantity  of  the  remedy  is  dissolved  in  hot  water ; 
when  cold  the  clear  solution  is  poured  off  ;  some  lemons  are  cut  up  and 
put  in  it,  and  it  is  sweetened  to  the  taste.  This  solution  may  be  drunk 
ad  libitum.  Considerable  stomach  and  intestinal  distress  often  follows 
the  free  use  of  dilute  solutions  of  these  potash  salts,  in  consequence  of 
the  abundant  production  of  carbonic-acid  gas.  The  potash  salts  are 
indicated  as  diuretics  in  desquamative  nephritis,  and  in  general  dropsy 
from  valvular  disease  of  the  heart.  By  determining  a  free  urinary 
discharge  in  the  one  case,  they  assist  in  washing  out  the  obstructing 
epithelium  in  the  tubules  ;  in  the  other,  they  relieve  the  tension  of  the 
venous  system.  Very  little  is  accomplished  by  the  use  of  alkaline 
diuretics  in  dropsical  accumulations  in  the  various  cavities. 

Sodium. — Soda. — Soda  ;  Natrium,  Ger.  ;  soude,  Fr.  Dry,  white, 
translucent  pencils,  or  fused  masses.  Is  soluble  in  water  and  in  alcohol. 

Liquor  Sodce. — Solution  of  soda.  A  colorless  liquid,  having  an  ex- 
tremely acrid  taste  and  a  strong  alkaline  reaction.  Dose,  m,  ij — -n\,  x. 

/Sodii  Acetas. — Sodium  acetate.  In  white  or  colorless  crystals, 
which  effloresce  in  dry  air  and  are  wholly  soluble  in  water.  Dose, 
gr.  v—  3  j. 

Sodii  Bicarbonas. — Sodium  bicarbonate.  A  white,  opaque  pow- 
der, wholly  soluble  in  water  (1  in  12).  Dose,  gr.  v —  3  j. 

Sodii  Boras.  —  Sodium  borate.  ;  borax.  In  colorless  crystals, 
which  slightly  effloresce  in  dry  air  and  are  wholly  soluble  in  water. 
Dose,  gr.  ij — 3j. 

Sodii  Carbonas  Exsiccatus. — Dried  sodium  carbonate.  A  white, 
hygroscopic  powder,  having  the  same  properties  as  the  carbonate. 
Dose,  gr.  ij — gr.  x. 

Sodii  Carbonas. — Sodium  carbonate.  Large,  monoclinic  crystals,, 
rapidly  efflorescing  in  dry  air  and  falling  into  a  white  powder  ;  alka- 
line taste  and  reaction.  Soluble  in  T6  water  at  60°  Fahr.,  and  nearly 
twice  as  soluble  in  hot  water.  Dose,  gr.  v — 3j. 

Sodii  Nitras. — Sodium  nitrate.  Colorless,  transparent,  rhombo- 
hedral  crystals,  slightly  deliquescent  in  damp  air,  having  a  cooling, 
slightly  bitter  taste,  and  a  neutral  reaction.  Soluble  in  1'3  water  at 
60°  Fahr.,  and  in  0'6  boiling  water.  Dose,  3  j —  3  j- 

Sodii  Sulphas.  —  Sodium   sulphate  ;   Glauber's  salts.     Dose,  §  ss- 

§  j- 
Sodii  Chloras. — Sodium  chlorate.     Colorless,  transparent  crystals, 

or  a  crystalline  powder,  odorless,  and  having  a  cooling,  saline  taste. 
Soluble  at  59°  Fahr.,  in  M  part  of  water.     Dose,  gr.  j — gr.  xv. 


220  AGENTS   INCREASING  WASTE. 

Piilvis  Effervescens  Compositus. — Compound  effervescing  powder. 
Seidlitz  powder.  Each  powder  contains  forty  grains  of  bicarbonate 
of  sodium  and  one  hundred  and  twenty  grains  of  tartrate  of  potassium 
and  sodium  (Rochelle  salt)  in  one  paper,  and  thirty-five  grains  of  tar- 
taric  acid  in  the  other  paper. 

ANTAGONISTS,  INCOMPATIBLES,  AND  SYNERGISTS,  are  the  same  as 
those  given  under  potassium. 

PHYSIOLOGICAL  ACTIONS  OF  THE  SALTS  OF  SODIUM. — In  respect 
to  the  merely  alkaline  properties,  there  is  a  close  correspondence  be- 
tween potassium  and  sodium,  but  as  regards  other  properties  there  is 
a  wide  divergence.  The  salts  of  soda  are  alkaline,  and  hence  neutral- 
ize the  acid  of  the  gastric  juice.  They  are  readily  diffusible.  Like 
the  potash  salts,  they  increase  the  alkalinity  of  the  blood,  and  under 
suitable  conditions  determine  a  change  in  the  urine  from  acid  to  alka- 
line. The  same  results  follow  the  administration  during  or  between 
the  intervals  of  digestion,  as  in  the  case  of  the  potash  salts.  The  alka- 
linity of  the  urine  induced  by  soda  salts  ceases  on  the  day  following 
their  administration,  and  the  acidity  is  then  increased.  Soda  has  but 
little  toxic  action  besides  the  local  caustic  effects.  Caustic  soda,  like 
caustic  potash,  dissolves  albumen,  forms  soaps  with  fats,  and  destroys 
the  tissues  widely  and  deeply.  It  is,  however,  less  active  than  caustic 
potash.  The  composition  of  the  blood  does  not  appear  to  be  altered 
by  the  salts  of  soda  in  any  reasonable  quantity.  Laborde,  in  some 
comparative  experiments  between  chlorate  of  potassa  and  chlorate  of 
soda,  finds  that  the  latter,  in  treble  the  quantity  of  the  former,  has  but 
a  transient  effect,  depressing  the  temperature  half  a  degree,  and  caus- 
ing a  slight  salivation,  but  producing  none  of  the  paralytic  symptoms 
which  follow  the  administration  of  the  potash  salts.  Guttmann  had 
previously  demonstrated  the  same  facts,  and  Schonlein,  in  some  stud- 
ies with  the  carbonate,  finds  that  even  in  large  doses  in  frogs  it  rarely 
arrests  the  heart's  movements,  only  slowing  and  lengthening  the  con- 
tractions. Chloride  of  sodium  has,  unquestionably,  an  important  office 
in  the  economy.  It  forms  the  principal  part  of  the  soluble  constitu- 
ents of  the  ash  of  all  animal  substances.  Albumen  owes  its  solubil- 
ity in  part  to  the  chloride  of  sodium  ;  it  dissolves  pure  casein,  and 
impedes  the  coagulation  of  the  fibrin  of  the  blood.  In  one  thousand 
parts  of  blood  there  are  about  four  parts  of  this  salt.  It  is  very  abun- 
dant in  various  normal  secretions  and  pathological  products.  The 
gastric  juice  is  very  rich  in  chloride  of  sodium,  and  it  probably  is  the 
source  of  the  hydrochloric  acid  of  the  stomach  (Lehmann).  In  the 
course  of  an  inflammation,  notably  of  pneumonia,  the  chloride  of  so- 
dium of  the  system  accumulates  in  the  inflamed  area,  and  disappears 
from  the  urine.  Its  return  to  the  urine  is  in  the  nature  of  a  critical 
phenomenon,  and  marks  the  subsidence  of  the  inflammation.  The  im- 
portance of  this  salt  in  the  animal  economy  is  doubtless  the  cause  of 


ALKALIES.  221 

the  universal  taste  ;  all  in  excess  of  the  needs  of  the  body  is  excreted, 
chiefly  by  the  kidneys,  and  with  such  facility  that  no  accumulation 
takes  place.  While  a  necessary  amount  is  of  high  importance  and 
excess  is  readily  disposed  of,  it  is  probable  that  long  and  habitual  in- 
dulgence in  a  considerable  excess  increases  waste  and  lowers  the  vital 
forces. 

THERAPY  or  SODIUM  SALTS. — One  of  the  important  salts  of  soda — 
the  phosphate  —  has  been  considered  under  the  head  of  phosphates. 
The  soda  salts  are  to  be  preferred  in  the  alkaline  treatment  of  stomach- 
diseases,  but  the  potash  salts  when  it  is  desired  to  promote  oxidation 
in  the  system,  or  to  alkalinize  the  urine.  The  urate  of  soda  is  insol- 
uble. In  case  of  excess  of  acid  or  acid  indigestion,  the  use  of  soda 
after  meals  is  very  effective  ;  but,  while  the  immediate  result  is  good, 
the  after-effect  is  to  increase  the  production  of  acid.  Those  who 
habitually  take  sodium  bicarbonate  for  acid  indigestion  suffer  severely 
from  acidity.  Taken  before  meals,  or  on  an  empty  stomach,  soda 
bicarbonate  is  useful  in  atonic  dyspepsia,  to  increase  the  acid  of  the 
gastric  juice.  Acute  indigestion,  with  vomiting,  especially  if  the  vom- 
ited matters  are  very  acid,  and  there  is  burning  at  the  epigastrium,  may 
be  quickly  relieved  by  the  effervescing  powder.  The  acid  diarrhoea 
of  children  is  relieved  by  the  bicarbonate  of  sodium.  This  salt  may  be 
utilized  as  an  emetic  in  narcotic  stupor  when  other  emetics  fail  to  act. 
The  author  has  known  this  method  to  succeed  in  opium  narcosis.  A 
half  to  a  drachm  of  bicarbonate  in  solution  in  water  is  swallowed  or 
thrown  into  the  stomach  by  the  pump,  and  this  is  followed  imme- 
diately by  a  similar  quantity  of  tartaric  acid.  Brisk  effervescence 
ensues,  and  the  contents  of  the  stomach  are  evacuated.  In  intussus- 
ception, the  same  expedient  has  been  practiced  with  success.  The 
solution  of  bicarbonate  of  sodium  is  thrown  into  the  rectum,  and  is 
followed  by  the  acid.  Strong  pressure  must  be  made  on  the  anus  ;  the 
gas  forces  the  bowel  back  through  the  ileo-csecal  valve  and  thus  re- 
lieves. A  stomach  or  bowel  much  softened  by  inflammation,  or  weak- 
ened by  ulceration,  is  a  contraindication  of  such  an  expedient. 

In  the  treatment  of  the  febrile  state,  and  to  lessen  the  acidity  of 
the  urine,  the  soda  salts  have  been  proposed  as  substitutes  for  the  pot- 
ash salts.  The  researches  of  Laborde,  Guttmann,  Podcopaew,  and 
others,  have  shown  that  the  former  do  not  have  the  same  powers  as 
the  latter,  and  that  therefore  the  substitution  can  not  be  made  suc- 
cessfully, although  the  difference  is  one  of  degree,  rather  than  of 
kind. 

Calcium. —  Calx. — Lime  ;  Kalk,  Ger.  ;  chaux,  Fr. 
Calcii   Carbonas  Prcecipitatus. —  Precipitated  calcium  carbonate. 
A  fine,  white  powder,  insoluble  in  water.     Dose,  gr.  v — 3  j. 
Greta  Prceparata. — Prepared  chalk.     Dose,  gr.  v — 3  j. 


222  AGENTS   INCREASING   WASTE. 

Liquor  Golds. — Lime-water.  A  saturated  solution  of  lime  in 
water. 

Liquor  Calcis  Saccharatus. — Dose,  3  ss —  3  ij-     (Unofficial.) 

Mistura  Cretce. — Chalk  mixture.     Dose,  3  j —  1  ss. 

Syrupus  Calcis. — Sirup  of  lime  (lime  65  grm.  to  1,000  c.  c.  of 
sirup  and  water).  Dose,  a  teaspoonful  or  more. 

Calcii  Chloridum. — Calcium  chloride.  A  colorless  or  whitish  salt, 
sometimes  translucent,  very  deliquescent.  It  is  soluble  in  two  parts 
of  water,  and  also  in  alcohol.  Dose,  gr.  v — 3j,  and  is  preferably 
administered  in  milk.  This  should  not  be  confounded  with  chlorinated 
lime.  (Other  salts  of  calcium  are  included  under  phosphates,  hypo- 
phosphites,  sulphides,  and  bromides.) 

ANTAGONISTS  AND  INCOMPATIBLES,  AND  SYNERGISTS,  the  same  as 
for  potassium. 

PHYSIOLOGICAL  EFFECTS  OF  CALCIUM  SALTS. — The  important  po- 
sition of  phosphate  of  lime  in  the  organism  has  been  already  set  forth 
under  the  appropriate  head.  It  is  only  necessary  to  state  in  this  con- 
nection that  the  lime  salts  are  antacid,  or  alkaline,  and  as  such  they 
neutralize  the  acid  of  the  gastric  juice.  They  act  locally  as  sedatives 
to  the  mucous  membrane.  Some  of  them  have  a  local  action  merely, 
but  the  chloride  is  very  diffusible,  and  the  carbonate  feebly  so.  En- 
tering the  blood  in  small  quantity,  they  promote  constructive  meta- 
morphosis ;  but  the  habitual  use  of  large  quantities  hastens  waste,  or 
the  retrograde  metamorphosis  of  the  tissues. 

Administered  in  the  ordinary  way,  however,  the  lime  salts  furnish 
materials  needed  by  the  organism  in  its  growth.  The  carbonate  of 
lime  is  taken  up  in  limited  quantity  by  the  stomach-juices  and  re-en- 
forces the  same  constituent  in  the  blood.  The  chloride  of  calcium  has 
a  different  office  in  the  economy.  It  acts  in  a  similar  manner  to  the 
other  chlorides,  and  has  close  relationship  to  the  iodides.  Clinical 
experience  has  shown  that  it  possesses  the  ill-defined  property  known 
as  alterative,  removes  certain  toxic  or  morbific  materials,  and  secures 
their  excretion  by  the  organs  of  elimination.  The  recent  studies  of 
the  therapeutical  actions  of  chloride  of  calcium  have  shown  it  to  pos- 
sess the  remarkable  property  of  an  antagonist  or  antidote  to  the  stru- 
mous  constitution.  No  mere  physiological  investigation  could  have 
demonstrated  this  power  ;  it  is  an  empirical  fact  which  we  can  not 
explain  as  yet  by  physiological  methods.  It  has  been  shown,  how- 
ever, that  under  its  use  enlarged  and  cheesy  lymphatics  gradually 
resume  their  normal  condition,  tubercular  deposits  undergo  a  process 
of  calcification,  and  ulcerating  cavities  discharge  their  contents  and 
cicatrize.  It  can  not,  of  course,  be  asserted  that  such  surprising 
changes  frequently  occur,  but,  that  they  do  sometimes  take  place, 
clinical  experience  has  proved.  From  this  point  of  view,  then,  chlo- 
ride of  calcium  assumes  a  high  degree  of  importance. 


ALKALIES.  223 

THERAPY  or  THE  CALCIUM  SALTS. — No  remedy  is  more  frequently 
prescribed  for  vomiting  than  lime-water.  It  is  given  very  often  with 
milk,  one  half,  one  fourth,  as  may  be,  and  the  combination  is  effective 
in  arresting  vomiting  due  to  acute  troubles  of  the  abdominal  organs, 
and  also  useful  in  vomiting  of  cerebral  and  reflex  origin.  When  the 
milk-cure  is  prescribed,  lime-water  is  frequently  added  to  enhance  the 
digestibility  of  the  milk.  Carbonate  of  lime  is  a  useful  restorative 
and  antacid  in  the  acid  indigestion,  and  in  the  diarrhoea  of  strumous 
children.  By  Dr.  Warburton  Begbie  and  by  Dr.  Coghill  the  chloride 
of  calcium  is  strongly  urged,  as  the  most  efficient  remedy  in  the  feeble 
digestion  and  disordered  secretions  of  strumous  children.  The  latter 
especially  commends  the  use  of  the  chloride  in  "  children  when  the 
sleep  becomes  restless  and  troubled,  the  breath  fetid,  the  tongue  foul 
and  coated,  the  tonsils  enlarged,  the  evacuations  irregular  and  offen- 
sive, with  deficient  secretion  of  bile."  In  the  cottiquative  diarrhcea 
of  the  strumous,  it  is  said  to  be  curative,  even  when  accompanied  by 
enlargement  of  the  mesenteric  glands.  According  to  the  published 
observations  of  Begbie,  Coghill,  and  Bell,  we  possess  no  agent  so  val- 
uable in  the  wasting  diseases  of  children  of  strumous  origin,  in  glan- 
dular enlargements,  etc.  The  testimony  which  has  been  lately  pub- 
lished in  respect  to  the  curative  power  of  chloride  of  calcium  in 
consumption  is  certainly  very  striking. 

Lithium. — Lithium. 

Lithii  Carbonas. — Lithium  carbonate.  A  white  powder,  soluble 
in  water  (1  in  80,  but  more  soluble  in  water  saturated  with  carbon 
dioxide).  Dose,  gr.  ij — gr.  x. 

Lithii  Citras. — Lithium  citrate.  A  white  powder,  deliquescent 
and  soluble  in  twenty-five  parts  of  water. 

Lithii  Citras  Effervescens. — Effervescent  lithium  citrate.  Com- 
posed of  lithium  carbonate,  sodium  bicarbonate,  citric  acid,  and  sugar. 
Dose,  gr.  v —  3  ss. 

Lithii  Salicylas. — Lithium  salicylate.  A  white  powder,  deliques- 
cent on  exposure  to  air,  having  a  sweetish  taste  and  a  faintly  acid  reac- 
tion. It  is  freely  soluble  in  water  and  in  alcohol.  Dose,  gr.  v — 3j. 

Lithii  Benzoas. — Lithium  benzoate.  A  white  powder,  or  small 
shining  scales,  permanent  in  the  air,  having  a  cooling,  sweetish  taste 
and  a  faintly  acid  reaction.  Soluble  in  four  parts  of  water  and  twelve 
parts  of  alcohol  at  60°  Fahr.  Dose,  gr.  ij — gr.  xv. 

ANTAGONISTS  AND  INCOMPATIBLES,  AND  STNEBGISTS,  are  the  same 
as  for  the  other  alkalies. 

PHYSIOLOGICAL  ACTIONS  or  THE  LITHIUM  SALTS. — These  remedies 
have  strong  alkaline  and  basic  properties,  and  act  on  the  organism  of 
man  in  the  same  manner  as  the  other  members  of  the  group.  The 
compound  of  uric  acid  and  lithium  is  readily  soluble,  differing  in  this 


224  AGENTS  INCREASING   WASTE. 

respect  from  the  urate  of  soda.     It  is  said  that  the  lithium  salts  alka- 
linize  the  urine  more  decidedly  than  even  the  potash  salts. 

THERAPY  OF  THE  LITHIUM  SALTS. — Garrod  first  introduced  these 
remedies  into  medical  practice  for  the  treatment  of  rheumatism,  and  in 
his  recent  Lumleian  lectures  has  demonstrated  anew  their  exceptional 
value.  Recently  the  compound  of  lithium  and  salicylic  acid  has  been 
brought  forward  as  a  more  effective  remedy  in  the  rheumatic  diseases. 
The  subacute  and  chronic  cases,  and  the  so-called  rheumatic  gout,  are 
the  forms  of  the  disease  in  which  the  lithium  salts  are  most  serviceable. 
In  the  so-called  uric-acid  diathesis,  in  renal  calculi  composed  of  uric 
acid,  and  in  irritable  bladder  from  an  excess  of  acid  in  the  urine,  the 
salts  of  lithium  are  useful.  In  the  case  of  a  renal  calculus  a  very  pro- 
tracted use  of  a  well-diluted  solution  is  necessary.  The  carbonate  of 
lithium,  in  carbonic-acid  water  and  arseniate  of  soda  dissolved  in  the 
same  solution,  has  been  highly  extolled  of  late  as  a  cure  for  diabetes. 
Dr.  Martineau,  the  author  of  the  plan,  directs  three  grains  of  the  lithium 
salt  and  ^  grain  of  arseniate  of  soda  to  be  dissolved  by  pressure  in 
two  pints  of  carbonic-acid  water — quantity  sufficient  for  three  doses. 

EXTERNAL  APPLICATIONS  OF  THE  ALKALIES. — A  solution  of  com- 
mon soda  (impure  bicarbonate)  freely  applied  will  often  remove  the 
fetid  sweat  of  the  feet,  and  the  odorous  emanations  which  in  some 
subjects  escape  from  the  axillary  glands.  Acne  occurring  in  persons 
with  a  greasy  skin,  and  prominent  and  black  sebaceous  follicles,  may 
sometimes  be  cured  by  alkaline  lotions.  ]J  I^q-  potassae,  3  j  ;  aquae 
rosae,  §  iv.  M.  Sig.  :  Apply  with  a  soft  sponge  twice  a  day.  For 
acute  eczema  where  there  is  much  serous  discharge,  no  applications  are 
more  efficient  than  solutions  of  the  alkalies.  $  Sodii  carbonat.,  3  ss  ; 
aquae,  Oj.  M.  Sig.  :  The  eruption  to  be  covered  with  lint  soaked  in 
this  solution.  Stronger  solutions  can  be  used  in  old  cases  where  the 
skin  is  much  thickened.  As  alkalies,  by  absorbing  the  moisture  and 
combining  with  the  fat  of  the  sebaceous  matter,  make  the  skin  dry 
and  harsh,  it  is  useful  to  apply  some  form  of  oil  after  these  alkaline 
applications,  certainly  after  the  stronger  solutions.  Mutton-suet  is  one 
of  the  best  fats  for  this  purpose. 

In  prurigo  great  relief  is  often  obtained  by  an  alkaline  warm  bath 
at  bedtime.  A  solution  of  carbonate  of  potassium  ( 3  iij —  §  iv)  is- 
recommended  by  Trousseau  as  a  remedy  for  that  obstinate  affection — 
pruritus  vulvce.  In  freckles,  sunburn,  and  tan,  the  following  lotion  is 
useful :  IJ,  Potassii  carbonat.,  3  iij  ;  sodii  chloridi,  3  ij  ;  aquae  rosae, 
|  viij ;  aquae  aurantii  flor.,  f  ij.  M.  Sig.  :  Lotion. 

To  cleanse  the  scalp  from  dandruff  (pityriasis),  there  is  no  more 
suitable  application  than  a  saturated  solution  of  borate  of  soda.  Pow- 
dered borax,  mixed  with  sugar,  is  a  domestic  remedy  for  aphthae  of 
children  ;  it  is  simply  placed  on  the  tongue.  A  saturated  solution  of 


ALKALIES.  225 

borax  in  rose-water  is  a  useful  application  to  remove  freckles,  and  to 
allay  pruritus  vagince. 

For  the  cure  of  corns  no  application  is  so  certain,  prompt,  and  ef- 
fective as  liquor  potassae.  It  should  be  applied  by  means  of  a  glass 
rod  or  pine-wood  splinter  to  the  summit  of  the  corn,  and  the  tissue 
softened  by  it  scraped  off.  By  successive  applications  the  callosity  is 
removed  without  pain  or  discomfort. 

The  so-called  ingrowing  toe-nail  may  be  cured  by  the  application 
to  the  irritable  granulation,  at  the  margin  of  the  nail,  of  a  solution  of 
liquor  potassae  (  3  ij —  §  j).  This  solution  is  to  be  applied  on  cotton- 
wool, to  the  margin  of  the  nail  and  to  the  ulcerated  surface  of  the  toe, 
until  the  nail  is  so  far  softened  that  it  can  be  cut  away  without  pain. 

Unhealthy  and  sloughing  ulcers  may  be  destroyed  by  potassa  fusa, 
and  a  healthy  granulating  surface  be  left.  No  more  efficient  escharotic 
can  be  used  in  hospital  gangrene.  As  it  penetrates  deeply  and  widely, 
great  care  must  be  used  to  limit  its  application  to  the  affected  parts, 
and,  as  soon  as  the  destruction  is  sufficient,  to  check  the  further  exten- 
sion of  the  caustic  by  washing  with  a  dilute  acid.  Vienna  paste — which 
is  a  mixture  of  equal  parts  of  potassa  and  lime  made  into  a  paste  with 
alcohol — is  milder  in  operation,  and  therefore  usually  preferred.  Caus- 
tic potash  was  formerly  much  employed  to  make  issues,  to  open  ab- 
scesses and  carbuncles,  but  these  applications  are  now  quite  obsolete. 
Induration  of  the  cervix  uteri  and  chronic  metritis  (hyperplasia  of  the 
connective  tissue)  are,  it  is  said  (Dr.  Bennet),  very  effectively  treated 
by  application  of  caustic  potassa  and  potassa  cumcalce;  but  such  pow- 
erful means  must  be  used  with  great  caution,  if  at  all.  In  carcinoma, 
when  the  disease  is  limited  to  the  neck  of  the  uterus  and  not  too  far 
advanced,  caustic  potassa  may  be  used  with  advantage  to  destroy  the 
diseased  surface.  This  caustic  is  quite  as  efficient  as  any,  probably, 
for  the  escharotic  treatment  of  cancer  when  this  method  of  treatment 
is  employed. 

A  solution  of  the  bichromate  of  potassium  (gr.  j — grs:  x  —  §  iv)  is 
an  excellent  local  application  in  the  treatment  of  the  catarrhal  state  of 
the  nasal,  buccal,  or  vaginal  mucous  membrane.  A  saturated  solution 
of  this  salt  may  be  used  as  a  caustic  in  place  of  chromic  acid. 

Carbonate  of  soda  in  saturated  solution  has  been  used  lately  with 
signal  success  in  the  treatment  of  burns:  it  allays  the  pain,  checks 
suppuration,  and  favors  healing  (McClellan,  Pring,  etc.).  Cloths 
dipped  in  a  saturated  solution,  and  covered  with  oiled  silk,  are  kept 
on  the  part,  the  solution  being  renewed  as  rapidly  as  may  be  neces- 
sary. Dr.  Duckworth  reports  that  toothache  may  be  quickly  allayed 
by  holding  a  solution  of  carbonate  of  soda  in  the  mouth.  Recently 
chlorate  of  potash  has  been  used  with  success  in  the  treatment  of  epi- 
thelioma.  This  practice  was  first  suggested  by  Yidal  in  the  treatment 
of  chancroid,  and  has  since  been  successfully  employed  in  the  treat 


2-26  AGENTS  INCREASING   WASTE. 

ment  of  obstinate  ulcers,  epithelioma  and  cancer  (Fereol,  Leveque).  In 
the  simpler  cases  a  saturated  solution  may  be  kept  on,  but  in  epithe- 
lioma and  cancer  the  powdered  chlorate  is  thickly  applied  over  the  sore. 
It  is  said  to  allay  pain,  remove  fetor,  and  promote  cicatrization  when 
so  applied.  The  internal  use  of  the  salt  is  recommended  in  conjunc- 
tion with  the  topical  application  in  cancer,  epithelioma,  and  lupus. 

Authorities  referred  to  : 

BASHAM,  DR.  W.  R.     The  Practitioner,  vol.  v,  p.  257. 

BEGBIE,  DR.  J.  WARBURTON.     The  Edinburgh  Medical  Journal,  July,  18*70,  p.  48. 

BELL,  DR.  ROBERT.     The  Lancet,  August,  1877,  p.  275. 

BINZ,  DR.  C.  Archiv  fur  experiment.  Pathologic  und  Pharmacologie,  vol.  x,  p.  153. 
Ueber  Reduction  des  chlorsauren  Kalis. 

BUCHHEIM,  PROF.  DR.  R.  Archiv  fur  experiment.  Pathol.  und  Pharmacol.,  Band  iii,  p. 
252.  Ueber  die  Wirkung  der  Kaliumsalze. 

COGHILL,  DR.  J.  G.  SINCLAIR.  The  Practitioner,  vol.  xix,  p.  247.  Therapeutic  Notes 
on  the  Chloride  of  Calcium. 

DUCKWORTH,  DR.  DYCE.     The  Practitioner,  April,  1875,  p.  250. 

FULLER,  DR.  H.  W.  The  Practitioner,  vol.  ii,  p.  129.  The  Alkaline  Method  in  the 
Treatment  of  Rheumatism. 

GUTTMANN,  DE.  P.  Virchow's  Archiv,  Band  xxxv,  p.  450.  Wirkung  der  Kali  und 
Natromalze. 

HUMMEL,  MEINRAD.  Allg.  Wiener  med.  Zeit.,  23-26,  1878.  Ueber  das  Kalium  Ohio- 
ricum. 

ISAMBERT,  DR.  Gaz.  Med.  de  Paris,  1874,  Nos.  17,  35,  41,  and  43.  Nouvelles  expe- 
riences sur  V action  physiologique,  toxique  et  therapeutique  du  chlorate  depotasse. 

KOHLER,  PROF.  DR.  H.  Centralblatt  f.  d.  med.  Wiss.,  1877,  No.  38,  p.  673.  Zur 
Wirkung  der  Kaliumsalze  auf  WarmbliUer, 

LABORDE,  DR.  J.  V.  Bull.  Gen.  de  Therap.,  1874,  pp.  247,  319,  and  354.  £tude  com- 
parative  de  faction  physiologique  des  chlorates  de  potasse  et  de  soda,  etc. 

MARCHAND.  DR.  F.  Virchow's  Archiv,  Band  Ixxvii,  p.  455.  Ueber  die  Intoxication 
durch  Chlorsaure  Sake. 

McCLELLAN,  DR.  ELY.  Louisville  Medical  News,  1878.  On  Relief  of  Burns  by  a  Satu- 
rated Solution  of  the  Carbonate  of  Soda. 

PARKES.     On  the  Urine,  p.  158. 

PERL,  DR.  LEOPOLD.  Virchoufs  Archiv,  vol.  Ixxiv,  p.  54.  Ueber  die  Resorption  der 
Kalksalze. 

PODCOPAEW,  DR.  Virchovfs  Archiv,  Band  xxxiii,  p.  505.  Vergleichende  Untcrsuchungen 
iiber  die  Wirkung  des  Chlorkalium  und  Chlornatrium  auf  den  thierchen  Organismus. 

PRING,  DR.  E.  J.  Philadelphia  Medical  Times,  March  16,  1878,  p.  273.  Note  on  the 
Use  of  Bicarbonate  of  Soda  in  Burns. 

RABUTEAC,  DR.  Gazette  Hebdom.,  xliii,  1868,  p.  617.  Recherches  sur  I 'elimination  et 
sur  proprietes  osmotiques  du  sulfate  de  sodium. 

RALFE,  DR.  C.  Lancet,  November,  1878,  p.  651.  Observations  in  Urinary  Pathology 
and  Therapeutics. 

RINGER  AND  MURRELL.  Journal  of  Physiology,  vol.  xii,  p.  5.  Influence  of  the  Chloride 
of  Potassium  on  the  Nervous  System  of  Frogs. 

SCHONLEIN,  K.  Arch.  f.  d.  ges.  Physiol.,  vol.  xviii,  p.  26.  Versuche  iiber  einige  physi- 
ologische  Wirkungen  des  Natriumcarbonats. 

VALENTIN,  DR.  Zeit.  fur  Biol.,  vol.  xiv,  p.  320.  Die  Giftioirkungen  welche  Salzbader 
auf  Frosche  ausiiben.  Virchow  u.  Hirsctts  Jahreibericht. 


ALKALINE   SPRINGS.  227 

ALKALINE    MINERAL    SPRINGS. 
1.  NORTH  AMERICA. 

Bladon  Springs,  Choctaw  County,  Alabama.  A  rolling,  pine-woods 
region. 

They  contain  carbonate  of  soda,  carbonate  of  magnesia,  carbonate 
of  iron,  carbonate  of  lime,  sulphate  of  lime,  carbonic-acid  gas,  sul- 
phureted  hydrogen  (traces),  and  chlorine. 

Congress  Springs,  Santa  Clara  County,  California.  In  the  Coast 
Range  of  mountains. 

They  contain  carbonate  of  soda  (15*418  grains  to  the  pint?),  car- 
bonate of  iron,  carbonate  of  lime,  chloride  of  sodium  (14*894  grains  to 
the  pint),  sulphate  of  soda,  etc.  They  are  highly  charged  with  car- 
bonic-acid gas. 

California  Seltzer  Springs,  Mendocino  County,  California. 

They  contain  carbonate  of  soda,  carbonate  of  magnesia,  carbonate 
of  lime,  carbonate  of  iron  (a  trace),  and  chloride  of  sodium.  They 
are  also  highly  charged  with  carbonic-acid  gas. 

Perry  Springs,  Pike  County,  Illinois. 

They  contain  carbonate  of  potassa,  carbonate  of  magnesia,  carbo- 
nate of  iron,  carbonate  of  lime,  sulphate  of  soda,  silicates  of  soda  and 
potassa.  Temperature  of  the  water  is  from  48°  to  50°  Fahr. 

St.  Louis  Spring,  Gratiot  County,  Michigan. 

This  water  contains  carbonate  of  soda  (7*684  grains  to  the  pint), 
carbonate  of  magnesia,  carbonate  of  iron,  carbonate  of  lime  (5*019 
grains  to  a  pint),  sulphate  of  lime  (6*925  grains  to  a  pint),  silicate  of 
lime,  and  silica.  This  is  one  of  the  so-called  "  magnetic  springs  " — • 
the  magnetic  property  being  due  not  to  the  water,  but  produced  by 
the  magnetization  with  terrestrial  currents  of  the  vertical  iron  tube 
through  which  the  water  flows.  It  is  unfortunate  that  this  part  of 
the  peninsula  of  Michigan,  in  which  the  numerous  alkaline  and  saline 
springs  abound,  is  very  decidedly  malarious. 

Buffalo  Lithia  Spring,  of  Virginia.  Contains  well-defined  traces  of 
lithia,  and  is  alkaline.  This  has  been  used  with  great  advantage  in 
gouty,  rheumatic,  and  renal  affections. 

The  Hot  Springs,  Bath  County,  Virginia,  contain  carbonates  of  lime 
and  magnesia,  sulphates  of  lime,  magnesia,  and  soda,  and  chlorides  of 
sodium,  calcium,  and  magnesium.  The  temperature  of  the  water 
ranges  from  100°  to  106°  Fahr. 

The  Warm  Springs,  Bath  County,  Virginia,  have  a  composition 
similar  to  the  hot  springs,  but  the  temperature  of  the  water  is  some- 
what less.  At  these  springs,  extensive  bathing-pools  have  been  con- 
structed. The  best  results  have  been  obtained  from  the  bathing,  con- 
joined with  the  internal  use  of  the  water. 

Berkeley  Springs  are  also  situated  in  Bath  County.     The  waters 

17 


228  AGENTS  INCREASING   WASTE. 

are  alkaline,  of  a  constant  temperature  of  72°  to  74°  Fahr.,  and  are 
employed  by  bath  and  internally. 

Rockbridge  Baths,  Rockbridge  County,  Virginia.  A  mountainous 
region. 

They  contain  magnesia  and  iron,  with  a  small  quantity  of  iodine. 
Temperature,  74°  Fahr.  Used  chiefly  in  the  form  of  baths. 

Capon  Springs,  Hampshire  County,  West  Virginia. 

This  water  contains  carbonate  of  soda,  carbonate  of  magnesia,  and 
traces  of  iodine  and  bromine.  The  temperature  of  the  water  is  66° 
Fahr.  These  springs  are  situated  in  a  romantic  mountain-region. 

Besides  the  above,  there  are  numerous  weakly-alkaline  waters,  such 
as  Bethesda  and  others  of  the  Waukesha  region  of  Wisconsin,  in  South- 
ern Michigan,  and  in  many  parts  of  the  United  States.  It  is  impos- 
sible to  mention  all  of  them,  and  especially  to  set  forth  the  rather  pre- 
tentious claims,  or  recognize  the  apocryphal  cures,  so  persistently  and 
profusely  published  by  their  owners.  Unquestionably  good  results 
have  been  wrought  by  these  waters.  Besides  the  positive  there  are 
negative  virtues  in  these  numerous  mineral  springs  :  they  take  the 
place  of  the  indiscriminate  drug  administration  which  is  one  of  the 
evils  of  the  time. 

2.  EUROPEAN. 

Vichy,  Central  France. 

There  are  several  springs —  Grande  Grille,  Putts  Carre,  Hbpttal,  fc 
Celestins,  De  Mesdames,  and  others.  The  waters  contain  carbonates 
of  soda,  of  potassa,  magnesia,  and  lime,  sulphate  of  soda  and  chloride 
of  sodium,  phosphate  of  soda,  arseniate  of  soda  (a  trace),  carbon- 
ates of  strontia  and  iron.  The  gas,  which  is  abundant,  is  carbonic 
acid. 

In  the  Vichy  region  there  are  numerous  alkaline  springs  having 
similar  properties.  The  temperature  of  the  waters  varies  from  58° 
Fahr.  ( Celestins)  to  178°  Fahr.  ( Chaudes  Aigues). 

Mont  Dor6,  valley  of  the  Dordogne,  France. 

The  waters  are  weak  alkaline,  and  have  a  temperature  from  90°  to 
104°  Fahr.  Their  principal  constituent  is  carbonate  of  soda.  These 
springs  lie  among  the  volcanic  mountains  of  Auvergne,  at  an  eleva- 
tion of  3,300  feet. 

Vals,  Ardeche,  France. 

The  waters  of  these  cold  springs  are  remarkable  for  the  quantity  .of 
carbonate  of  soda  which  they  contain.  They  are  abundantly  charged 
with  carbonic-acid  gas. 

Ems,  on  the  Lahn,  Germany. 

These  waters  contain,  according  to  the  analysis  of  Fresenius,  14  to 
15  parts  of  bicarbonate  of  soda,  7  parts  of  chloride  of  sodium,  and  1'7 
part  each  of  bicarbonate  of  lime  and  bicarbonate  of  magnesia,  with 
sulphates  of  soda  and  potash,  and  bicarbonates  of  iron,  manganese. 


ALKALINE   SPRINGS.  229 

baryta,  strontia,  and  alumina  in  small  quantity,  to  the  pint.  The  gas 
is  carbonic  acid,  from  6  to  8  cubic  inches  to  the  pint. 

Neuenahr,  valley  of  the  Ahr,  between  Bonn  and  Coblentz,  Ger- 
many. 

The  waters  of  these  springs  have  a  composition  similar  to  those  of 
Ems,  but  have  about  half  as  much  soda  and  very  little  salt. 

Salzbrunn,  upper  Silesia,  near  Freiburg,  Germany. 

These  waters  are  very  rich  in  carbonate  of  soda. 

Gleichenberg,  near  Gratz,  Styria,  Austria. 

These  springs  are  much  more  alkaline  than  Ems.  The  waters  con- 
tain from  20  to  27  parts  of  carbonate  of  sodium,  19'5  of  chloride  of 
sodium,  and  7*8  of  carbonate  of  magnesium.  The  water  is  highly 
charged  with  carbonic- acid  gas. 

Therapeutical  Uses  of  the  Alkaline  Mineral  Waters.— As  we  have 
seen  that  alkalies  taken  before  meals  increase  the  production  of  acid 
gastric  juice,  the  alkaline  mineral  waters  are  serviceable  in  atonic  dys- 
pepsia. They  are  especially  useful  in  catarrh  of  the  duodenum  and 
of  the  bile-ducts,  and  in  the  jaundice  dependent  on  this  state  of  the 
mucous  membrane.  In  incipient  cirrhosis,  in  congestion  of  the  portal 
circulation,  and  in  haemorrhoids  due  to  the  hepatic  obstruction,  they 
render  important  service.  Obesity,  which  is  frequently  diminished  by 
a  course  of  alkalies,  is  better  treated  by  alkaline  waters,  for  at  the 
springs  these  patients  can  be  induced,  more  easily,  to  conform  to  the 
plan  of  exercise  and  diet  necessary  in  these  cases. 

The  alkaline  springs  have  long  had  a  deserved  reputation  for 
the  cure  of  gout  and  rheumatism.  With  the  internal  use  of  the 
waters  should  be  conjoined  baths,  douches,  etc.  Gout  and  rheu- 
matic affections  of  internal  organs  are  equally  amenable  to  the  same 
treatment. 

These  alkaline  waters,  long  used,  are  especially  serviceable  in  the 
so-called  lithic-acid  diathesis.  There  is  little  doubt  that  the  continuous 
use  of  alkaline  waters  for  a  long  period  will  cause  the  solution  of  uric- 
acid  renal  calculi.  For  this  purpose  those  alkaline  waters  rich  in 
potassa  are  preferable. 

When  diabetes  is  hepatic  in  origin,  and  occurring  in  obese  subjects, 
the  alkaline  mineral  waters  are  extremely  useful.  A  suitable  diet 
should  be  enjoined. 

The  following  domestic  mineral  waters  maybe  advised  in  the  above 
states  :  Bladon  Springs  ;  the  California  Seltzer  ;  Perry  Springs  ;  St. 
Louis  springs  ;  but  especially  Capon,  Saratoga,  Buffalo-Li thi a,  Bethes- 
da,  and  other  alkaline  springs  of  Wisconsin. 

Of  the  foreign,  the  most  important  are  Vichy,  which  is  import- 
ed at  a  moderate  price,  Mount  Dore,  Vals,  Ems,  Salzbrunn,  and 
Gleichenberg. 

The  psychical  influences  of  change  of  scene,  associations,  and  cli- 


230  AGENTS   INCREASING  WASTE. 

mate,  are   largely  concerned   in   the   results   of  treatment  with   the 
waters  of  mineral  springs. 

SALINE   MINERAL   WATERS. 
1.  NORTH  AMERICAN. 

St.  Catharine's  Wells,  St.  Catharine's,  Ontario,  Canada. 

These  contain  chloride  of  sodium  (217  to  375  grains  to  the  pint), 
chlorides  of  potassium,  magnesium,  calcium  (108  to  127  grains  to  the 
pint),  sulphate  of  lime,  and  iodide  and  bromide  of  magnesium.  A 
concentrated  water  prepared  by  evaporation  is  used,  properly  diluted 
by  patients  at  a  distance  for  internal  diseases,  and  at  the  wells,  ex- 
ternally. 

These  waters  are  diluted  with  ordinary  water  to  three  fourths 
or  seven  eighths,  before  they  are  drunk.  They  are  chiefly  used  as 
warm  baths.  The  diseases  in  which  they  have  been  found  most 
beneficial  are  chronic  gout,  rheumatic  gout,  chronic  rheumatism, 
and  gouty  and  rheumatic  diseases,  strumous  diseases,  engorgement 
of  the  pelvic  viscera,  chronic  metritis,  uterine  fibroids,  haemor- 
rhoids, etc. 

Spring  Lake  Well,  Ottawa  County,  Michigan. 

The  water  of  this  spring  contains  chloride  of  sodium  (50*691  grains 
to  the  pint),  chloride  of  calcium  (14'177  grains  to  the  pint),  chloride 
of  magnesium,  carbonates  of  soda,  manganese,  and  iron,  in  small  quan- 
tity, sulphate  of  soda  (5'837  grains  to  the  pint),  bromide  of  magnesium, 
and  a  trace  of  lithia. 

These  waters  are  applicable  to  the  treatment  of  gout,  rheumatism, 
strumous  diseases,  etc.  The  waters  are  drunk  and  used  as  warm 
baths. 

Saratoga  Springs,  Saratoga,  New  York. 

In  general  terms,  these  waters  contain  chloride  of  sodium,  the  alka- 
line carbonates,  and  are  highly  charged  with  carbonic-acid  gas.  The 
springs  are  numerous,  and  differ  somewhat  in  composition.  I  subjoin 
a  tabular  statement  of  the  analyses  of  the  different  waters,  which  show 
their  adaptation  to  various  morbid  states. 

These  waters  are  useful  in  plethora  of  the  abdominal  viscera,  in 
obesity,  in  habitual  constipation  due  to  deficient  secretion,  in  plethora 
of  the  pelvic  viscera,  haemorrhoids,  etc.  The  waters  of  the  Pavilion 
and  Geyser  Springs,  owing  to  the  quantity  of  lithia  which  they  contain, 
are  especially  serviceable  in  chronic  gout,  chronic  rheumatism,  rheu- 
matic gout,  and  affections  dependent  on  these  diatheses.  The  Colum- 
bian, Pavilion,  Eureka,  and  Excelsior,  containing  a  considerable  pro- 
portion of  iron,  are  more  especially  adapted  to  cases  of  the  above- 
mentioned  disorders,  in  which  anaemia  exists,  but  they  must  be  drunk 
with  caution  by  the  plethoric. 


SALINE   SPRINGS. 


231 


ONE  PINT  CONTAINS— 

1 

ill 

P£  £ 

*»•« 

|Su 

£ 

Ill 

IN 

wS« 

•1 
1  w 

h 

i 

sl 

—  . 
E  fe 

Md 
t 

Colombian. 
J.  H.  Steele,  M.  D. 

j 
"3 

§'  -a 
B 

is 

£ 

.1 
11 

|8 

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J 

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IS.. 

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t 
fi 

SOLIDS. 
Carbonate  of  soda     

Graini. 
8-024 

Grains. 
0-934 

Grains. 

0-372 

Gralni. 

0-782 

Grains. 
1-836 

Grains. 

0-827 

Grain*. 
0-405 

Grains. 
2-552 

Carbonate  of  magnesia.  

4-069 

9-019 

13-072 

8-182 

8  461 

5-650 

5  '399 

2-988 

0-135 

0-031 

0-101 

0-079 

0-698 

0-283 

0-065 

0-155 

Carbonate  of  lime  

11-443 

12-449 

14-815 

9-520 

8-500 

10-482 

8-084 

7-804 

0-154 

0-374 

0-163 

0-744 

0-880 

0-071 

trace. 

trace. 

trace. 

trace. 

trace. 

0-001 

trace. 

0-050 

0-095 

0-178 

0-008 

0-090 

0-094 

trace. 

1-122 

1-006 

1-199 

0-536 

0-958 

1-078 

0-167 

Chloride  of  sodium  

48-766 

50-055 

68-746 

63-328 

83-375 

57-480 

17-784 

16-786 

0-201 

0-111 

trace. 

0-846 

0-254 

0-069 

trace. 

0-002 

0-001 

0-003 

o-ooi 

0'002 

trace. 

Phosphate  of  lime  

6-oii 

0'017 

0-025 

O'OOl 

0-820 

0-009 

0-006 

0-004 

Bromide  of  sodium  

0-091 

1'069 

0-192 

0-033 

0-128 

0-106 

0-079 

Fluoride  of  calcium  

trace. 

trace. 

trace. 

trace. 

trace. 

trace. 

Biborate  of  soda  

trace. 

trace. 

trace. 

trace. 

trace. 

0-158 

0-016 

0-052 

0-041 

0-012 

0-047 

Silicate  of  potassa.  

Silicate  of  soda  

Silica      

0-283 

0'105 

0-157 

0-182 

0-256 

0-894 

0-398 

0-320 

trace. 

trace. 

trace. 

trace. 

trace. 

Total  

69-502 

75-267 

93'874 

78-215 

47-946 

76-745 

88-764 

31*042 

GAS. 

Cubic  in. 
51 

Cubic  in. 
49 

Cubic  in. 

47 

Cubic  in. 

43 

Cubic  in. 

34 

Cubic  in. 
41 

Cubic  in. 

30 

Cubic  in. 
40 

(1866.) 

(1871.) 

(1872.) 

ONE  PINT  CONTAINS— 

iS 

i 

if1 
IN 

»s0- 

1 

| 
1 

si* 

Mo      * 
»O  Q 

1 

Red  Spring. 
Prof.  J.  H.  Appleton. 

q 

A 

M   a 

II 

J 

a 

a 

s* 

II 
*3 

V. 

« 
|S- 

5  g 

»l 

d 

ll» 

£-0      («. 

«§„• 

SOLIDS. 
Carbonate  of  soda  

Grains. 

6-175 

Grains. 

1-097 

Grains. 

1-107 

Grains. 
0-625 

Grains. 
1-875 

Grains. 
4-281 

Grains. 

1-212 

Carbonate  of  magnesia  

10-322 

4-586 

2-618 

8-667 

4-042 

4-883 

5-568 

Carbonate  of  iron  

0-089 

0-110 

0-375 

0-402 

0-578 

0-185 

Carbonate  of  lime  

14-793 

10-795 

7-324 

5-165 

9-625 

12-249 

8-845 

Carbonate  of  lithia  

0-549 

0-124 

0'016 

0'389 

Carbonate  of  strontia  

0-041 

trace. 

Carbonate  of  baryta  

0'206 

0-010 

0  074 

Chloride  of  potassium  

3-079 

1-212 

0-686 

1'040 

Chloride  of  sodium  

70-260 

49  '795 

8  '699 

20-852 

46-330 

37-332 

42-058 

Sulphate  of  potassa  

0-675 

0-269 

Sulphate  of  soda  

0-165 

Sulphate  of  magnesia  

0-268 

Phosphate  of  soda  ... 

o-ooi 

Phosphate  of  lime  

0-031 

0-015 

0-583 

0-529 

0-449 

O'OOS 

Bromide  of  sodium     

0-276 

0-071 

0-196 

0-051 

Fluoride  of  calcium  

trace. 

Biborate  of  soda  

trace. 

trace. 

Alumina  

>0-219 

6  -029 

0-088 

Silicate  of  potassa  

0-875 

Silicate  of  soda  

0-500 

Silica  

0-013 

0-160 

0-339 

0-067 

S0-125 

0  401 

Organic  matter  

trace. 

trace. 

Total  

105-834 

68-650 

21-008 

81-827 

64-343 

59-897 

60-089 

GAS. 
Carbonic  acid  

Cubic  in. 
57 

Cubic  in. 

50 

Cubic  In. 

Cubic  in. 
29 

Cubic  in. 
81 

Cubic  in. 
40 

Cubic  in. 
39 

(1870.) 

(1870.) 

1  Alumina  and  sesquioxide  of  iron. 


1  Silica  and  alumina. 


232  AGENTS   INCREASING   WASTE. 

Ballston  Spa,  Ballston,  Saratoga  County,  New  York. 

These  waters  are  similar  in  composition  to  the  waters  of  the  Sara- 
toga Springs,  but  they  are  richer  in  mineral  constituents. 

Bedford,  Bedford  County,  Pennsylvania.  These  waters  are  pur- 
gative saline  in  character  and  composition,  somewhat  like  those  of 
Saratoga,  but  contain  more  iron. 

There  are  probably  in  no  part  of  the  world  more  admirable  mineral 
springs  than  those  of  Saratoga,  and  of  Bath  County,  Virginia.  Physi- 
cians of  this  country  have  not  given  them  the  attention  they  deserve,  nor 
have  their  owners  been  sufficiently  awake  to  their  remarkable  utility. 

2.  EUROPEAN. 

Cheltenham,  Gloucestershire,  England. 

These  spas  are  saline  aperient,  iodureted  saline,  iodureted-magne- 
sian  saline,  and  the  waters  contain  a  good  deal  of  carbonic  acid.  The 
season  is  from  July  to  October.  These  waters  are  chiefly  serviceable 
in  dyspepsia,  hepatic  affections,  and  constipation.  Some  of  the  springs 
at  Cheltenham  contain  iron,  and  the  water  of  these  is  employed  in 
chlorosis  and  anczmla. 

Leamington,  Warwickshire,  England. 

These  waters  contain  chlorides  of  calcium  and  sodium,  and  sulphate 
of  soda,  with  carbonic  acid.  They  are  much  prescribed  in  dyspepsia, 
acidity r,  and  hepatic,  troubles,  constipation,  etc. 

Adelheidsquelle,  Heilbrun,  Bavaria.  Altitude,  2,000'.  Tempera- 
ture of  spring,  50°  Fahr.  Season,  May  to  September. 

This  valuable  water  contains  chloride  of  sodium,  carbonate  of 
sodium,  iodide  and  bromide  of  sodium,  etc.  ;  carbonic  acid,  13'18 
cubic  inches.  It  is  highly  prized  in  strumous  diseases,  rheumatism, 
gout,  affections  of  the  skin,  and  pelvic  troubles  of  females  (chronic, 
metritis,  fibroids,  etc.). 

Baden-Baden.  Altitude,  616'.  Mean  annual  temperature,  48°  Fahr. 
Season,  May  to  October. 

According  to  Bunsen's  analysis,  these  waters  contain  chloride  of 
sodium,  bicarbonate  of  lime,  magnesia,  and  iron,  sulphates  of  lime  and 
potash,  arseniate  of  iron  (a  trace),  chloride  of  potassium,  bromide  of 
sodium  (traces),  etc. ;  carbonic-acid  gas.  The  Meurquelle  contains 
2'3694  grains  of  chloride  of  lithium  in  20  ounces. 

Carlsbad,  Bohemia.    Altitude,  1,200'.     Season,  June  to  September. 

These  waters  contain  sulphate  of  soda,  carbonate  of  soda,  chloride 
of  sodium,  sulphate  of  potash,  carbonate  of  lime,  etc.  Marktbrunnen 
contains,  besides  these  ingredients,  a  small  quantity  of  carbonates  of 
lithia,  strontia,  and  manganese,  and  iodide  and  bromide  of  sodium  ; 
the  gas  is  carbonic  acid. 

The  Carlsbad  water  is  highly  prized  in  affections  of  the  liver  and 
portal  system,  uterine  diseases,  gout,  rheumatism,  and  diabetes. 


SALINE   SPRINGS.  233 

Friedrichshall,  Saxe-Meiningen,  Germany.     Bitter  water. 

According  to  Liebig,  this  water  contains  sulphate  of  soda,  46'51 
grains  ;  sulphate  of  magnesia,  39*55  ;  chloride  of  sodium,  61 '10;  chlo- 
ride of  magnesium,  30'25  ;  sulphates  of  potash,  1'52,  and  of  lime,  10*34 
grains.  Carbonic-acid  gas,  5*32  cubic  inches. 

This  is  aperient,  and  is  used  in  diseases  of  the  stomach,  liver,  intes- 
tines, and  kidneys.  It  is  imported  in  quart-bottles,  and  is  much  pre- 
scribed as  a  laxative  in  habitual  constipation,  in  hepatic  troubles,  pleth- 
ora of  pelvic,  organs,  etc. 

Homburg,  Central  Germany.  Altitude,  600'.  Open  all  the  year, 
but  the  season  is  from  May  to  September.  Temperature,  50°  to  53° 
Fahr. 

According  to  the  analysis  of  Liebig  and  Hofmann,  these  waters 
contain  chlorides  of  sodium  (79  to  104  grains),  potassium,  magnesium, 
and  calcium,  carbonates  of  lime,  magnesia  and  iron,  and  sulphates  of 
soda  and  lime.  Free  carbonic  acid,  48  cubic  inches. 

In  therapeutical  action  they  are  laxative,  and  are  prescribed  in 
habitual  constipation,  dyspepsia,  abdominal  and  pelvic  plethora,  obes- 
ity, hypochondriasis,  hysteria,  etc. 

Kissingen,  Bavaria.  Altitude,  800'.  Temperature  of  springs,  50° 
Fahr.  The  season  is  from  May  to  September. 

Liebig's  analysis  has  shown  that  these  waters  contain  chlorides  of 
sodium  (17'52  to  44'71  grains),  potassium,  lithium,  and  magnesium, 
sulphates  of  lime  and  magnesia,  carbonates  of  lime  and  iron,  bromide 
and  iodide  of  sodium,  etc.  They  are  highly  charged  with  carbonic 
acid. 

Kissingen  waters  are  laxative,  and  are  used  in  dyspepsia,  hepatic 
obstructions,  albuminuria,  diabetes,  etc. 

Kreutznach,  Rhenish  Prussia.  Altitude,  285'.  Season  is  from  June 
to  September. 

This  powerfully  alterative  water  contains  chloride  of  sodium  (72  to 
108  grains  to  the  pint),  chloride  of  calcium  (13  to  22  grains  to  the 
pint),  chlorides  of  magnesium,  potassium  and  lithium,  carbonate  of 
lime  and  iron,  bromide  and  iodide  of  magnesium. 

The  mother-liquor  of  Kreutznach  contains  2,484  grains  of  solid 
matter  in  sixteen  ounces. 

These  waters  are  extremely  serviceable  in  constitutional  syphilis, 
strumous  diseases,  affections  of  the  skin,  rheumatism,  gout,  engorge- 
ment of  the  abdominal  and  pelvic  organs,  hepatic  diseases,  etc. 

Marienbad,  Bohemia.  Altitude,  1,900'.  Season  is  from  May  to 
September. 

The  principal  constituents  of  this  water  are  sulphate  of  soda,  bi- 
carbonate of  soda,  chloride  of  sodium,  bicarbonate  of  lime,  bicarbonate 
of  magnesia,  and  salts  of  lithia,  strontia,  iron,  and  manganese,  in  small 
quantity  ;  carbonic-acid  gas. 


234  AGENTS   INCREASING  WASTE. 

Laxative,  and  used  in  hepatic  disorders,  dyspepsia,  habitual  con,' 
stipation,  gravel,  gout,  etc. 

Reichenhall,  Upper  Bavaria.  Altitude,  1,407'.  Mean  temperature 
of  spring,  56°  Fahr.  ;  of  summer,  64°  Fahr.  ;  of  autumn,  54°  Fahr. 
Season,  July  and  August. 

Used  only  for  baths.  Inhalations  are  practiced  here  on  a  large 
scale.  "  The  compressed-air  cure  "  is  also  a  prominent  feature  of  the 
curative  methods.  Scrofula,  phthisis,  and  affections  of  the  throat,  are 
chiefly  treated. 

The  waters  are  rich  in  chlorides  of  sodium  and  magnesia,  and  sul- 
phates of  soda  and  lime. 

Seidlitz,  Bohemia. 

The  chief  constituents  are  sulphate  of  magnesia,  sulphate  of  soda, 
carbonate  of  lime,  sulphate  of  lime,  sulphate  of  potash,  and  chloride 
of  magnesium. 

Saline  purgative. 

Sellers,  Nassau. 

Kastner's  analysis  has  shown  that  this  water  contains  bicarbonate 
of  soda,  chloride  of  sodium,  bicarbonates  of  lime  and  magnesia,  iron 
and  manganese,  phosphates  of  lime,  alumina  and  soda,  bromide  of 
sodium,  etc.  Highly  charged  with  carbonic  acid. 

Laxative  and  alterative. 

Authorities  referred  to  : 

BRACK,  DR.  JULIUS.     Systernatisches  Lehrbuck  der  Balneotherapie,  Berlin,  18Y3. 

MACPHERSOX,  DR.  JOHN.  The  Baths  and  Wells  of  Europe,  second  edition,  London, 
Macmillan  &  Co.,  1873. 

MOORMAX,  DR.  J.  J.  Mineral  Springs  of  North  America,  Philadelphia,  J.  B.  Lippin- 
cott  &  Co.,  1873. 

VALENTINES,  DR.  TH.  Handbuch  der  allaemeinen  und  speciellen  Balneotherapie,  Ber- 
lin, 1873. 

WALTON,  DR.  GEORGE  E.     Mineral  Springs  of  the  United  States  and  Canada. 

AMMONIUM  AND  ITS  PREPARATIONS. 

PREPARATIONS. — Ammonii  JBenzoas. — Ammonium  benzoate.  Ben- 
zoic  acid  and  ammonia.  In  minute,  white,  shining,  thin,  four-sided, 
laminar  crystals  ;  bitter,  saline,  and  somewhat  balsamic  taste  ;  sol- 
uble in  water  (1  in  5),  and  in  28  parts  of  alcohol.  Dose,  gr.  v — 
gr.  xv. 

Ammonii  Carbonas.  —  Ammonium  carbonate.  In  white,  trans- 
lucent masses,  with  a  pungent  and  ammoniacal  odor,  soluble  in  water 
(1  in  4).  Dose,  gr.  v — gr.  x. 

Ammonii  Chloridum. — Ammonium  chloride.  Sal  ammoniac.  In 
a  snow-white,  crystalline  powder,  soluble  in  three  parts  of  cold  water, 
and  sparingly  soluble  in  alcohol.  Dose,  gr.  j — 3j. 

Trochisci  Ammonii  Chloridi. — Troches  of  chloride  of  ammonium., 


AMMONIUM.  235 

(Ammonium  chloride,  sugar,  tragacanth,  and  sirup  of  tolu.)  Each 
troche  contains  two  grains  of  chloride  of  ammonium. 

Ammonii  Valerianas. — Ammonium  valerianate.  A  white  salt  in 
quadrangular  plates,  having  the  odor  of  valerianic  acid,  and  a  sharp, 
sweetish  taste,  and  is  very  soluble  in  water  and  in  alcohol.  Dose,  gr. 
j— gr.  v. 

Ammonii  Phosjjhas. — Ammonium  phosphate.  In  colorless,  trans- 
parent prisms,  soluble  in  water  (1  in  4),  but  insoluble  in  alcohol. 
Dose,  gr.  v — 3j. 

Aqua  Ammonice. — Water,  or  solution,  of  ammonia  ;  contains  10 
per  cent  by  weight  of  gas.  A  transparent,  colorless  liquid,  having  a 
very  pungent  odor,  and  a  strongly  alkaline  reaction.  Dose,  TTJ,  v — 
3  ss,  well  diluted  with  water. 

Aqua  Ammonice  Fortior.  —  Stronger  water  of  ammonia.  An 
aqueous  solution  of  ammonia  containing  28  per  cent  by  weight  of 
the  gas. 

Liquor  Ammonii  Acetatis. — Solution  of  acetate  of  ammonium. 
Spirit  of  Minderer.  Dose,  3  j —  §  j. 

/Spiritus  Ammonice. — Spirit  of  ammonia.  A  solution  of  ammonia- 
cal  gas  in  alcohol.  Dose,  m,  x —  3  j. 

Spiritus  Ammonice  Aromaticus.  —  Aromatic  spirit  of  ammonia. 
Solution  of  carbonate  of  ammonia  and  aqua  ammonia?,  oils  of  lemon, 
pimento,  and  lavender,  in  alcohol  and  water.  Dose,  3  ss —  3  ij. 

Linimentum  Ammonice. — Liniment  of  ammonia.  Cotton-seed  oil 
and  aqua  ammonias  (30  parts  to  70). 

ANTAGONISTS  AND  INCOMPATIBLES. — The  vegetable  and  mineral 
acids,  acidulous  salts,  earthy  salts,  and  lime-water,  are  incompatible 
with  the  carbonate.  In  addition  to  the  acids,  potash,  soda  and  their 
carbonates,  salts  of  lead,  silver,  and  metallic  sulphates,  are  incompati- 
ble with  the  solution  of  the  acetate.  The  persalts  of  iron,  acids,, 
and  liquor  potassae,  are  incompatible  with  the  benzoate.  Alkalies,, 
alkaline  earths  and  their  carbonates,  and  lead  and  silver  salts,  are  in- 
compatible with  the  muriate.  In  the  treatment  of  poisoning  by  am- 
monia or  its  carbonate,  the  vegetable  acids  should  be  used  to  neu- 
tralize the  poison,  and  its  irritant  action  on  the  mucous  membrane 
should  be  limited  as  much  as  possible  by  the  administration  of  oil  and 
demulcents. 

Therapeutically,  ammonia  is  antagonized  by  veratrum  viride,  aco- 
nite, digitalis,  cold,  and  other  cardiac  sedatives. 

SYNEKGISTS. — The  action  of  ammonia  is  favored  by  heat,  opium, 
iodine,  by  the  antispasmodics,  as  valerian,  asafoetida,  etc.,  by  the  diffu« 
sible  and  aromatic  stimulants,  as  alcohol,  ether,  etc.  The  therapeutical 
activity  of  the  iodides  and  bromides  is  promoted  by  combination  with 
carbonate  of  ammonia. 

PHYSIOLOGICAL  ACTION. — Ammoniacal  gas,  brought  in  contact  with 


230  AGENTS  INCREASING   WASTE. 

a  mucous  surface,  irritates  it  ;  applied  to  the  eye,  it  reddens  the  con- 
junctiva, and  causes  lachrymation  ;  applied  to  the  nares,  it  reddens  the 
mucous  membrane,  produces  a  sense  of  heat  and  burning,  and  increases 
the  secretion  of  mucus.  Inhaled,  an  overpowering  sense  of  suffocation 
is  experienced,  and  the  glottis  spasmodically  closes.  Prolonged  contact 
with  the  air-passages  excites  violent  inflammation.  When  solution  of 
ammonia  is  swallowed,  an  active  and  destructive  inflammation  of  the 
mucous  membrane  is  set  up  ;  the  lips,  tongue,  soft  palate,  and  tonsils 
are  swollen,  red,  and  glazed  ;  the  epiglottis,  and  especially  the  arytseno- 
epiglottidean  folds,  become  oedematous,  and  sudden  death  may  ensue 
from  oedema  of  the  glottis.  Inflammation  of  the  oesophagus,  and  of  a 
limited  portion  of  the  stomach,  will  also  follow  the  introduction  of  any 
portion  of  the  irritant.  Narrowing  (stenosis)  of  the  pyloric  orifice  has 
been  noted,  in  one  case,  as  an  after-result  of  the  inflammation  set  up  in 
this  part.  In  the  stomach,  ammonia  and  its  carbonate  must  quickly 
combine  with  the  acid,  and  probably  enter  the  blood  in  such  combina- 
tion. Increased  action  of  the  heart  is  produced  by  its  administration  by 
the  stomach,  but  much  more  decidedly  when  it  is  thrown  directly  into 
a  vein.  After  the  intra-venous  injection  of  ammonia,  the  blood-pressure 
at  first  rises,  then  falls  below  the  normal.  Resulting,  doubtless,  from 
the  increased  action  of  the  heart,  and  the  more  rapid  circulation  of  the 
blood,  a  subjective  sensation  of  warmth  throughout  the  body  is  expe- 
rienced, the  face  becomes  flushed,  the  eyes  are  more  brilliant,  and  the 
mental  operations  increase  in  activity.  Little  is  known  of  the  behavior 
of  ammonia  in  the  blood,  which  in  the  normal  state  contains  this  gas. 
Although  it  is  now  known  that  the  coagulation  of  the  blood  is  not 
caused  by  the  escape  of  ammonia,  as  supposed  at  one  time  by  Richard- 
son, yet  ammonia  helps  to  maintain  the  fluidity  of  the  blood,  as  its 
presence,  in  sufficient  quantity,  certainly  serves  to  hold  the  fibrin  in 
solution. 

The  long-continued  use  of  ammonia  impairs  digestion,  by  neutraliz- 
ing the  gastric  juice.  Increased  waste  of  tissue  is  also  one  result  of  its 
administration,  manifested  by  pallor,  emaciation,  and  feebleness.  When 
introduced  into  the  blood  in  sufficient  quantity,  it  damages  the  structure 
of  the  red  blood-globules,  and  in  this  way  also  it  affects  the  nutrition 
of  the  body,  besides  the  action  which  it  has,  in  common  with  the  other 
alkalies,  of  increasing  the  rate  of  waste  or  retrograde  metamorphosis. 

The  summary  of  the  physiological  actions  of  ammonia,  above  given, 
pretty  fairly  represents  the  movement  of  these  agents  as  a  group  ;  but 
individual  differences  undoubtedly  exist,  which  will  be  pointed  out 
when  the  therapy  is  considered. 

THERAPY. — Ammonia  and  its  carbonate  are  sometimes  used  to 
diminish  acidity  of  the  stomach-juices.  Obstinate  vomiting,  after  irri- 
tating substances  are  removed,  and  when  the  vomited  matters  are  acid, 
may  be  relieved  by  the  use  of  the  carbonate,  or  better,  by  an  excess  of 


AMMONIUM.  237 

carbonate  in  solution  of  the  acetate.  The  acidity,  gaseous  eructations, 
and  abdominal  distention,  which  accompany  attacks  of  hysteria  in  some 
females,  may  be  quickly  removed  by  the  aromatic  spirit  of  ammonia. 
Nervous  headache,  especially  when  it  is  present  with  the  last-mentioned 
group  of  symptoms,  is  speedily  relieved  by  the  aromatic  spirits  and  the 
carbonate  ;  but  true  migraine,  although  these  preparations  of  ammonia 
may  palliate  it,  is  generally  more  certainly  relieved  by  the  bromides. 
Raspail's  eau  s'edatif  often  gives  great  comfort  in  headache,  when 
locally  applied. 

In  gastric  and  intestinal  catarrh,  chloride  of  ammonium  is  held  in 
high  repute  by  our  German  confreres.  It  is  certainly  highly  serviceable 
in  some  hepatic  disorders — for  example,  in  catarrh  of  the  bile-ducts  and 
in  the  jaundice  arising  from  this  cause.  In  the  first  stage  of  cirrhosis, 
before  contraction  and  induration  have  occurred,  it  is  also  useful.  The 
nauseous  saline  taste  of  the  sal-ammoniac  is  best  covered  by  fluid  ex- 
tract of  taraxacum  or  extract  of  liquorice.  The  fluid  extract  of  tarax- 
acum is  to  be  preferred  as  the  vehicle  in  hepatic  disorders,  because 
this  drug  has  reputed  virtues  in  these  cases.  When  there  is  deficiency 
of  secretion  of  the  intestinal  juices,  constipation,  and  a  coated  tongue, 
with  scanty  and  high-colored  urine  (so-called  bilious  state),  sal-ammo^ 
niac  is  one  of  the  remedies  which  may  be  used  with  success.  That 
this  drug  has  a  selective  action  on  the  liver  seems  probable  from  the 
fact  that  it  increases  the  excretion  of  urea  by  the  kidneys. 

To  stimulate  the  action  of  the  heart  when  it  flags,  the  ammonia  prep- 
arations have  an  undoubted  effect ;  hence  in  adynamic  states  they  are 
frequently  used.  "When  employed  for  this  purpose,  small  doses  fre- 
quently repeated  (every  half-hour  or  hour)  are  necessary,  owing  to 
the  fact  that  ammonia  is  quickly  eliminated.  It  is  a  most  common 
practice  to  inhale  ammonia  to  prevent  that  depression  of  the  heart's 
action  called  fainting.  It  should  not  be  forgotten  that  ammonia,  in- 
cautiously inhaled,  may  give  rise  to  inflammation  of  the  fauces  and 
glottis.  The  preparations  of  ammonia  (spirits,  carbonate,  water  of) 
possess  a  high  degree  of  utility  when  thrombosis  is  actually  existent, 
but  especially  when  threatened,  as  in  the  puerperal  state,  after  free 
haemorrhage,  when  the  circulation  is  languid  from  weak  heart,  a  state 
of  hyperinosis  being  present.  It  is  perfectly  safe  and  legitimate  under 
these  circumstances  to  practice  the  intra-venous  injection  of  aqua  am- 
monise,  3  j —  3  ij,  diluted  with  an  equal  measure  of  water.  This  practice 
seems  more  particularly  advisable  when  sudden  thrombosis  of  a  large 
venous  trunk  ensues — as,  for  example,  in  the  pulmonary  artery,  after 
uterine  hemorrhage. 

As  ammonia  has  the  property  to  dissolve  fibrin,  and  as  its  presence 
in  the  blood  contributes  to  maintain  the  solubility  of  its  solid  and 
morphotic  constituents,  the  intravenous  injection,  if  timely,  may  suc- 
ceed in  redissolving  thrombi,  but,  as  direct  contact  is  necessary,  no 


033  AGENTS   INCREASING   WASTE. 

other  mode  of  administration  can  be  substituted.  When  thrombosis 
occurs  after  post-partum  haemorrhage,  the  promptest  action  is  neces- 
sary ;  hence  the  obstetrician  should  go  provided  with  the  materials 
required. 

In  sudden  paralysis  of  the  heart  from  poisonous  gases,  snake-bites., 
chloroform  narcosis,  etc.,  the  intravenous  injection  of  ammonia  is  a 
promising  expedient.  A  remarkable  example  of  the  power  and  utility 
of  the  practice  was  published  by  Dr.  J.  T.  Eskridge,  of  Philadelphia, 
in  1883.  As  the  author  had  personal  knowledge  of  all  the  circum- 
stances, he  can  testify  to  the  truth  of  the  narrative.  In  a  case  of  sud- 
den and  most  profound  depression  of  the  powers  of  life  caused  by  the 
gases  of  a  privy-vault,  and  which  must  have  proved  fatal  if  relief  had 
not  been  given,  Dr.  Eskridge  practiced  twelve  intravenous  injections 
of  what  was  supposed  to  be  diluted  aqua  ammonice,  but  on  subsequent 
examination  proved  to  be  aqua  ammonice  fortior.  The  whole  amount 
thrown  into  the  circulation  was  140  minims,  and  a  vein  in  front  of  the 
elbow  was  the  point  of  entrance  of  the  fluid,  the  usual  precautions 
being  taken  to  prevent  accident.  No  ill  result  occurring,  ana  the 
patient  saved  from  inevitable  death,  make  this  case  in  the  highest 
degree  instructive.  Although  Brunton  and  Fayrer  have  pronounced 
adversely  to  the  method  when  used  in  the  bites  of  the  venomous 
snakes  of  India,  it  appears  to  have  been  successful  in  the  hands  of  its 
discoverer,  Halford,  of  Australia,  against  those  of  that  part  of  the 
world.  It  appears  to  me  to  be  probable,  in  view  of  the  experience  of 
Eskridge,  that  the  failures  above  referred  to  were  a  consequence  of 
insufficient  quantity  of  the  ammonia.  In  failure  of  the  heart  during 
chloroform  narcosis,  the  intravenous  injection  of  ammonia  has  not 
succeeded.  The  reason  for  this  is  to  be  found  in  the  condition  of 
the  heart.  As  a  rule,  the  heart  stops  suddenly  and  completely,  and 
hence,  before  the  injection  can  be  practiced,  the  cardiac  ganglia  have 
ceased  entirely  to  functionate.  Other  medicinal  agents,  as  hydrocy- 
anic acid,  nicotine,  etc.,  in  toxic  quantity  paralyzing  the  heart,  cause 
a  complex  of  conditions  for  the  relief  of  which  the  ammonia  injections 
may  be  employed. 

The  mode  of  procedure  consists  in  completely  filling  the  syringe 
with  the  solution  so  that  no  air  is  contained  in  the  instrument,  or,  if 
the  quantity  is  insufficient  to  occupy  the  whole  space,  to  exclude  the 
air  by  a  movement  of  the  piston  ;  then  any  vein  conveniently  situ- 
ated for  the  purpose,  and  large  enough,  is  selected,  steadied  between 
two  fingers  of  the  left  hand,  with  the  right  hand  the  needle  is  plunged 
into  the  interior  of  the  vein,  and  the  solution  is  slowly  forced  into  the 
blood-current.  When  the  needle  is  withdrawn,  light  pressure  with  the 
finger  suffices  to  prevent  the  escape  of  any  blood.  The  repetition  of 
the  injection  will  depend  on  the  effects,  and  the  limit  to  the  amount 
used  will  be  determined  by  the  state  of  the  heart. 


AMMONIUM.  239 

Ammonia  is  a  physiological  antagonist  to  hydrocyanic  acid,  and 
is  used  in  poisoning  by  this  agent ;  it  counterbalances  the  depres- 
sion, and  maintains  the  heart's  action,  until  the  effects  of  the  poison 
are  spent. 

Carbonate  of  ammonia  is  one  of  the  remedies  occasionally  success- 
ful in  the  treatment  of  delirium  tremens.  It  is  indicated,  and  proves 
most  serviceable,  when  there  is  present  ansemia  of  the  brain,  and  the 
heart's  action  is  feeble.  Half -ounce  doses  of  solution  of  ammonia  ace- 
tate are  said  to  remove  the  effects  of  alcoholic  intoxication.  The  vale- 
rianate  of  ammonia  and  the  aromatic  spirits  of  ammonia  abort  or 
prevent  paroxysms  of  hysteria.  Nervous  headache  and  also  migraine 
may  sometimes  be  cured  by  the  various  preparations  of  ammonia  ;  but 
of  these  the  muriate  is  exceptionally  serviceable.  Indeed,  Dr.  Anstie 
affirms  that  this  agent,  if  given  early  enough,  seldom  fails  to  cut  short 
an  attack  of  migraine.  It  should  be  administered  in  doses  of  from  ten 
to  twenty  grains.  In  myalgia,  or  muscular  neuralgia,  it  is  equally 
effective,  according  to  the  same  authority  :  ]J  Ammonii  choridi,  §  ss; 
ext.  cimicifuga3  fluidi,  3  j  ;  glycerini,  3  ij  ;  syrupi  tolu,  aquae  lauro- 
cerasi,  aa  §  j.  M.  Sig. :  A  teaspoonful  three  or  four  times  a  day. 
In  other  neuralgia?  the  muriate  of  ammonia  is  occasionally  useful,  but 
by  no  means  so  curative  as  in  migraine  and  myalgia. 

The  preparations  of  ammonia  are  classed  with  the  stimulant  expec- 
torants. It  is  an  interesting  fact,  in  this  connection,  that  they  are  elimi- 
nated largely  by  the  lungs  ;  and  it  is  probable,  indeed,  that  in  thus 
escaping  they  stimulate  secretion  and  liquefy  the  products  of  inflamma- 
tion. In  bronchorrhcea  and  chronic  bronchitis,  muriate  of  ammonia 
renders  important  service.  It  is  given  in  extemporaneous  prescriptions 
with  extract  of  liquorice,  and  may  be  combined  with  other  stimulating 
expectorants  when  no  incompatibility  exists  :  $  Ext.  eucalypt.,  fl  §  j ; 
ammonii  chloridi,  3  ij  ;  ext.  glycyrrhizas,  3  ij  ;  glycerini,  f  iij.  M. 
Sig. :  A  teaspoonful  four  or  six  times  a  day.  When  great  depression 
exists  in  pneumonia,  carbonate  of  ammonia  is  given  with  advantage. 
It  should  be  remembered  that  to  stimulate  the  heart  merely,  when 
an  obstacle  exists  in  the  pulmonary  circulation,  is  of  doubtful  utility  ; 
but  ammonia  liquefies  the  exudation,  and  thus  removes  obstruction 
of  the  air-sacs  ;  hence  it  becomes  a  remedy  of  great  value  during  this 
stage  up  to  the  period  of  crisis.  When  there  is  much  adynamia  in 
these  various  pulmonary  inflammations,  the  carbonate  of  ammonia  is 
frequently  prescribed  in  infusion  of  senega,  a  stimulating  expectorant. 

Extraordinary  success  has  been  claimed  for  carbonate  of  ammonia 
in  variola,  scarlatina,  rubeola,  and  erysipelas.  A  convenient  mode  of 
administration  is  to  dissolve  the  carbonate  in  the  solution  of  the  ace- 
tate. The  indications  for  the  use  of  the  carbonate  are,  feeble  circula- 
tion, cyanosis,  delirium.  As  these  are  self-limited  diseases,  the  mild 
cases  do  quite  as  well  without  drugs. 


240  AGENTS  INCREASING  WASTE. 

Carbonate  and  acetate  of  ammonia  are  much  prescribed  in  continued 
fevers — the  latter  as  a  so-called  febrifuge  ;  the  former  when  decided 
adynamia  ensues.  In  typhoid  the  diarrhoea  may  be  increased  by  the 
solution  of  the  acetate.  As  in  typhus  and  typhoid  the  ammonia  in  the 
blood  is  increased  above  the  normal,  it  has  seemed  to  the  author  im- 
proper practice  to  administer  ammonia  as  a  remedy  in  these  diseases, 
and  his  observations  have  convinced  him  that  it  has  no  good  effects 
which  can  not  be  better  procured  by  other  means. 

The  chloride  of  ammonium  is  said  to  be  an  excellent  emmenagoguc 
in  from  ten  to  twenty  grains. 

Vapor  of  Ammonium  Chloride. — An  apparatus  for  generating 
fumes  of  ammonium  chloride  has  long  been  in  use  for  the  relief  of 
affections  of  the  upper  nasal  passages.  I  am  indebted  to  my  friend 
Dr.  W.  M.  Mew,  of  the  Army  Medical  Museum,  for  the  following 
suggestions  as  to  the  mode  of  preparing  the  vapor  for  inhalation  in 
suitable  cases : 

"  Of  course,  putting  two  open  vessels,  containing  respectively 
HC1  and  NH3,  would  result  in  giving  off  fumes,  but  the  supply  of 
almost  imponderable  smoke  would  be  so  small  as  to  be  wholly  inade- 
quate for  therapeutical  purposes.  My  plan  is  therefore  to  set  free 
a  large  amount  of  HC1  by  decomposing  NaCl  with  strong  H2SO4, 
yielding  gaseous  HC1  and  leaving  a  residue  of  NagSO4  in  the  contain- 
ing vessel,  usually  a  soup-plate.  A  saucer  (used  to  distinguish  it  from 
the  acid  container  to  avoid  mistakes)  containing  stronger  ammonia 
is  placed  by  the  side  of  the  soup-plate,  and  at  once  the  room  is  filled 
with  the  smoke.  .  .  .  Generally  I  direct  that  three  or  four  ounces  of 
the  acid  are  to  be  poured  into  the  soup-plate,  and  about  the  same 
quantity  of  the  ammonia  into  the  saucer,  and  without  loss  of  time 
about  a  tablespoonful  of  table-salt  is  sprinkled  on  the  acid.  Decom- 
position takes  place  at  once.  Some  precautions  are  necessary  here  ; 
should  there  be  an  excess  of  HC1  liberated  (which  would  irritate 
the  nasal  passages),  more  NH3  should  be  used.  An  excess  of  NH8 
would  be  in  evidence  by  its  odor,  requiring  more  salt  or  more  acid. 
The  neutral  or  properly  balanced  salt  does  not  irritate  the  most 
delicate  membrane.  .  .  .  By  the  occasional  addition  of  a  little  salt, 
or  acid,  or  ammonia,  this  can  be  kept  up  for  hours — from  four  to 
six  hours." 

The  air  of  the  apartment  charged  with  the  fumes,  the  inhalation 
can  go  on  from  four  to  six  hours  or  longer. 

BARIUM  AND  ITS  PREPARATIONS. 

Barii  Chloridum.  —  Chloride  of  barium.  Occurs  in  colorless, 
translucent  tablets.  It  is  soluble  in  diluted  alcohol,  and  freely  and 
entirely  soluble  in  water.  Dose,  gr.  -^ — gr.  ss. 


BARIUM.  241 

Barii  Dioxidum. — Barium  dioxide.  A  heavy,  grayish -white  or 
pale  yellowish-white,  amorphous,  coarse  powder.  Almost  insoluble  in 
cold  water.  Hydrochloric  and  phosphoric  acids  decompose  it,  forming 
corresponding  barium  salts  with  hydrogen  dioxide  in  solution. 

ANTAGONISTS  AND  INCOMPATIBLES.  —  Sulphates,  phosphates,  and 
carbonates,  and  most  of  the  salts  of  organic  acids,  are  incompatible 
with  it.  Nitrate  of  silver  decomposes  it.  The  sulphates  are  ready 
antidotes,  as  sulphates  of  magnesium  or  sodium. 

SYNEEGISTS. — The  alkalies,  and  metallic  salts  from  the  therapeu- 
tical stand-point,  increase  its  action  on  the  retrograde  metamorpho- 
sis. Ergot  and  digitalis  favor  its  influence  over  the  sympathetic 
system. 

PHYSIOLOGICAL  ACTIONS. — The  soluble  salts  of  barium  have  a  disa- 
greeable, bitter,  and  astringent  taste.  In  a  full  medicinal  dose  irrita- 
tion of  the  stomach  is  caused,  and  a  sense  of  heat  and  burning  is 
developed  at  the  epigastrium.  In  one  case  (Ferguson)  symptoms  of 
poisoning  came  on  in  a  week,  produced  by  one  twelfth  of  a  grain  of 
chloride  of  barium,  administered  three  times  a  day,  the  whole  amount 
taken  being  two  and  a  half  grains.  The  symptoms  were  extreme  ex- 
haustion and  nervousness.  An  idiosyncrasy  must  have  existed  here, 
as  so  small  an  amount  would  not,  under  ordinary  circumstances,  have 
produced  such  decided  effects.  The  usual  symptoms  in  cases  of  poi- 
soning are  intense  anguish,  free  salivation,  great  thirst,  loss  of  voice, 
violent  vomiting  and  purging,  dilated  pupils,  frequent  micturition, 
respiration  slow  and  labored,  pulse  slow,  increasing  weakness,  and 
finally  complete  paralysis  of  the  extremities.  The  intelligence  is  pre- 
served until  near  the  end,  when  convulsions  and  coma  come  on.  The 
post-mortem  rigidity  is  very  decided.  There  are  present  very  con- 
siderable bronchial  effusion  and  hypersemia  of  the  lungs,  the  heart  is 
distended  with  black  blood,  and  the  brain  is  engorged.  The  stomach 
presents  the  usual  appearances  ;  there  is  intense  hyperaemia,  and 
sometimes  perforation  of  this  organ.  The  quantity  necessary  to  cause 
death  varies  greatly — two  and  a  half  grains  have  brought  on  serious 
symptoms,  and  half  a  teacupful  of  the  carbonate  has  been  recovered 
from.  One  drachm  of  the  chloride  has  caused  death  in  seventeen 
hours,  and  one  ounce  of  the  same  salt  in  one  hour  (Woodman  and 
Tidy). 

The  effects  on  animals  have  been  studied  by  Onsum,  Cyon,  Bohm, 
and  myself  (unpublished).  Onsum  held  that  the  symptoms  produced 
by  the  soluble  salts  of  barium,  when  injected  into  the  blood,  were  due 
to  the  formation  of  the  insoluble  sulphate.  Cyon  criticises  this  view, 
and  shows  that  it  is  incorrect.  The  most  elaborate,  as  it  is  the  most 
recent,  account  of  the  physiological  effects  of  the  barium  salts  is  that 
of  Bohm.  The  statement  to  follow  is  based  on  this  paper  chiefly,  and 
on  the  author's  personal  researches.  In  frogs,  after  injection  of  the 


242  AGENTS   INCREASING  WASTE. 

chloride  into  the  lymph-sac,  extension  and  rigidity  of  the  yoluntary 
muscles  ensued,  followed  by  relaxation  and  paresis.  The  belly  becomes 
distended  and  the  intestines  are  thrown  into  active  movements  ;  the 
mouth  is  held  wide  open  and  a  watery  fluid  continually  escapes,  while 
from  the  skin  a  mucus-like  secretion  exudes.  When  given  to  warm- 
blooded animals  by  the  stomach,  profuse  secretion  takes  place,  active 
peristalsis  of  the  bowels  and  copious  alvine  discharges,  and  free  urina- 
tion follow,  but  not  until  about  a  half -hour  after  the  ingestion  of  the 
poison.  If  thrown  into  the  veins  the  same  symptoms  arise  immedi- 
ately :  in  either  case  the  tonic  and  clonic  convulsions  followed  by 
paralysis  occur  ;  the  pupils  dilate  ;  the  heart  is  slowed,  but  its  contrac- 
tion is  more  energetic  ;  the  tension  increases  enormously  in  the  arte- 
rial system  after  a  preliminary  fall,  and  finally  insensibility  and  coma 
terminate  the  action.  Very  large  doses,  suddenly  precipitated  on  the 
heart  by  injection  into  the  jugular  vein,  will  induce  paralysis  both  of 
the  heart  and  lungs.  With  the  peripheral  paralysis  labored  breathing 
ensues,  due  to  paresis  of  the  respiratory  muscles,  and  death  is  caused 
rather  by  this  than  by  cessation  of  the  heart's  action,  when  the  poison 
is  introduced  subcutaneously.  The  paralysis  in  animals  begins  in  the 
hind  extremities.  This  paralysis  is  preceded  by  fibrillary  trembling 
and  clonic  spasms  mixed  with  tonic  rigidity.  The  muscular  contrac- 
tility is  entirely  abolished  when  the  paralysis  is  complete.  On  the 
nervous  system  of  organic  life  barium  chloride  acts  as  a  stimulant. 
The  strong  cardiac  contractions,  the  dilated  pupil,  the  energetic  peris- 
talsis of  the  bowels,  the  closure  of  the  lumen  of  the  intestines  and  also 
of  the  bladder,  and  the  almost  complete  approximation  of  the  periph- 
eral vessel-walls,  are  the  proofs  of  this  excitation. 

THERAPY. — Influenced  by  the  observations  of  Bohm,  Dr.  Flint,  of 
Leeds,  England,  has  employed  the  chloride  of  barium  successfully  in 
the  treatment  of  aneurism.  The  case  was  one  of  abdominal  aneurism, 
in  a  woman  of  sixty-five.  TufnelPs  treatment  had  been  carried  out 
faithfully  for  five  months  without  success,  and  iodide  of  potassium, 
for  some  unexplained  reason,  could  not  be  taken.  Chloride  of  barium 
was,  after  careful  consideration,  selected,  and  one  fifth  of  a  grain  three 
times  a  day  was  administered  three  or  four  weeks,  when  it  was  in- 
creased to  two  fifths.  The  curative  effect  was  very  manifest,  for  after 
nearly  five  months  of  continued  use  of  the  same  remedy  the  tumor  was 
so  reduced  that  it  could  be  scarcely  felt.  Several  similar  cases  have 
since  been  reported.  Chloride  of  barium  has  proved  very  useful  in 
hemorrhage,  in  acute  congestion  of  organs,  in  atony  of  the  intestines 
with  deficient  secretions,  in  atony  of  the  bladder,  in  weakness  of  the 
heart  with  low  arterial  tension,  in  effecting  removal  of  inflammatory 
exudates,  etc.  In  the  last-mentioned  condition,  especially,  has  the 
author  used  chloride  of  barium  with  excellent  effect. 


VEGETABLE  ACIDS.  243 


VEGETABLE  ACIDS. 

Acidum  Aceticum. — Acetic  acid.  Liquid  ;  specific  gravity  l'048i 
Colorless,  having  a  pungent  and  characteristic  odor.  Of  this  acid  one 
hundred  grains  neutralize  sixty  grains  of  bicarbonate  of  potassium. 

Acidum  Aceticum  Dilutum.— Diluted  acetic  acid.  100  grm.  of 
acetic  acid,  and  distilled  water,  500  grm. 

Acidum  Aceticum  Glaciale. — Glacial  acetic  acid.  Nearly  or  quite 
absolute  acetic  acid.  At  or  below  59°  F.,  a  crystalline  solid. 

Acidum  Citricum. — Citric  acid.  In  colorless  crystals,  freely  solu- 
ble in  water  and  soluble  in  alcohol.  One  hundred  grains  of  citric  acid 
neutralize  one  hundred  and  fifty  grains  of  carbonate  of  potassium. 

Syrupus  Acidi  Citrici. — Citric  acid,  eight  parts  ;  water,  eight 
parts  ;  spirit  of  lemon,  four  parts,  and  nine  hundred  and  eighty  parts 
of  sirup. 

Acidum  Tartaricum. — Tartaric  acid.  In  colorless  crystals,  wholly 
or  almost  wholly  dissipated  by  heat,  and  readily  soluble  in  water. 
One  hundred  grains  of  tartaric  acid  saturate  one  hundred  and  thirty- 
three  and  a  half  grains  of  bicarbonate  of  potassium. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  alkalies  are  the  chemical 
antagonists. 

SYNERGISTS. — The  alkalies  and  agents  promoting  waste  favor  the 
therapeutical  actions  of  the  vegetable  acids. 

PHYSIOLOGICAL  ACTIONS. — The  vegetable  acids,  undiluted,  have  a 
sharp,  pungent,  and  rather  acrid  taste  ;  but,  when  considerably  diluted, 
they  are  rather  agreeable  and  refreshing.  They  have  the  property  to 
diminish  the  sense  of  thirst,  to  abate  heat  and  the  restlessness  of  fever. 
In  large  quantity,  they  possess  considerable  caustic  power,  producing 
gastro-enteritis  and  its  results. 

There  can  be  no  doubt  that  these  acids  obey  the  chemical  laws  of 
combination,  and  unite  with  alkalies  to  form  salts,  in  which  form  they 
enter  the  blood.  The  most  important  question  connected  with  the 
physiological  action  of  these  agents  is,  the  disposition  of  them  in  the 
blood.  The  most  recent  and  elaborate  examination  of  this  point  is  the 
"  Memoir  "  of  Friedrich  Walter.  This  research  appears  to  have  deter- 
mined that  these  acids  do  not  have  the  power  to  neutralize  the  alka- 
linity of  the  blood,  as  has  heretofore  been  supposed.  That  they  are 
in  part  destroyed  in  the  organism  by  the  ozonizing  action  of  the  blood, 
seems  undoubted.  Carbonic  acid  is  one  of  the  products,  and  the  pres- 
ence of  this,  we  may  assume,  accounts  for  the  increased  acidity  of 
the  blood  and  of  the  urine  which  follows  the  administration  of  these 
agents. 

They  are  eliminated  by  the  intestinal  canal,  and  chiefly  by  the  kid- 
neys.    They  increase  secretion  from  the  intestinal  mucous  membrane, 
18 


244  AGENTS   INCREASING   WASTE. 

and  are  apt  to  produce  tormina,  flatulence,  and  diarrhoea.  It  is  proba- 
ble that  these  intestinal  effects  are  in  part  due  to  the  fact  that  the  salts, 
formed  by  combination  of  the  acids  in  the  canal,  escape  absorption  and 
act  locally  as  they  descend. 

These  acids,  or  the  salts  formed  by  their  combination,  have  a  de- 
cided power  to  promote  diuresis.  In  this  result  all  of  the  urinary  con- 
stituents are  included  ;  but  it  is  chiefly  the  water  which  is  increased. 
To  these  general  statements  some  exceptions  must  be  made.  Thus, 
citric  and  acetic  acids  are  entirely  destroyed  in  their  passage  through 
the  organism  ;  benzoic  acid  is  converted  into  hippuric  ;  and  tartaric, 
citric,  and  malic  are  converted  into  carbonic  after  combination  with 
an  alkali  only.  Furthermore,  benzoic  acid  does  not  increase  any  of 
the  urinary  constituents. 

Ultimately,  wasting  and  emaciation,  a  watery  condition  of  the 
blood,  and  a  scorbutic  state  (Bence  Jones),  are  the  results  of  the 
action  of  these  agents. 

THERAPY. — Acetic  acid  applied  to  the  skin  has  some  superficial 
caustic  property.  This  is  made  use  of  to  cure  small  warts  and  vegeta- 
tions of  the  skin.  It  is  applied  with  a  pine  stick.  Parasitic  affec- 
tions of  the  skin  are  similarly  treated,  as,  for  example,  pityriasis. 

Internally  the  acids,  chiefly  citric,  in  the  form  of  lemonade,  are  used 
as  a  refreshing  drink  in  fevers.  They  allay  restlessness  by  relieving 
thirst,  and  they  also  act  upon  the  skin  and  kidneys.  Lime-juice  is 
the  most  important  antiscorbutic,  and  constitutes  part  of  the  equip- 
ment of  every  vessel  on  long  voyages.  It  should  not  be  forgotten 
that  the  use  of  lemon-juice  may  cause  precipitation  of  uric  acid,  and 
thus  favor  the  formation  of  calculi,  as  has  been  pointed  out  by  Bence 
Jones. 

Lemon-juice  was  at  one  time  the  fashion  in  the  treatment  of  acute 
rheumatism  ;  but  more  efficient  remedies  have  taken  its  place. 

Acids  are  serviceable  in  various  disorders  of  the  digestive  tract ; 
given  before  meals,  they  check  the  formation  of  acid,  and  thus  re- 
lieve acidity.  An  acid  and  dry  wine — as,  for  example,  a  Rhenish 
wine — may  sometimes  serve  a  useful  purpose.  The  juice  of  a  lemon 
may  be  taken  before  meals  with  the  same  object.  But  it  is  true  that 
the  mineral  acids  are  to  be  preferred  for  this  purpose.  Very  injurious 
effects  are  produced  by  the  long-continued  use  of  lemon-juice  in  such 
cases.  It  is  sometimes  taken  by  young  ladies  to  keep  down  the  for- 
mation of  fat ;  but  it  accomplishes  this  object  by  impairing  digestion. 

Authorities  referred  to  : 

JONES,  DR.  H.  BENCE.  Lectures  on  Materia  Medica.  The  Medical  Times  and  Gazette, 
October,  1854,  p.  408. 

PARSES,  DR.  E.  A.     On  the  Urine,  1860,  p.  146. 

WALTER,  FRIEDRICH.  Untersuchungen  uber  die  Wirkung  der  Sduren  auf  den  thierisch- 
m  Organismus.  Archivf.  exper.  Pathol.  u.  Phar.,  1877,  p.  148. 


OXALIC   ACID.  245 

Acidum  Oxalicum.— Oxalic  acid. 

PBOPEBTIES. — Oxalic  acid  occurs  in  flat  oblique  rhombic  prisms, 
transparent,  colorless,  soluble  in  about  eight  parts  of  cold  water,  and 
in  nearly  all  proportions  in  boiling  water.  It  is  strongly  acid  to  the 
taste  and  in  reaction,  and  combines  with  bases  to  form  salts.  Dose, 
gr.  |  to  gr.  ss. 

ACTIONS  A:NT>  USES. — In  sufficient  doses  it  is  an  irritant  poison,  caus- 
ing nausea,  vomiting,  and  gastro-intestinal  inflammation.  The  mat- 
ters brought  up  assume  a  brownish  hue  and  presently  become  bloody. 
Intense  burning  pain  occurs,  and  profound  depression  comes  on,  ter- 
minating in  collapse.  Very  large  doses  may  be  rejected  by  vomit- 
ing, and  no  further  symptoms  occur.  In  ordinary  toxic  quantity,  ox- 
alic, besides  the  local  gastro-intestinal  inflammation,  affects  the  action 
of  the  heart,  which  becomes  feeble  and  intermittent,  and  death  ensues 
by  cardiac  failure,  with  stupor,  coma,  and  insensibility,  and  some- 
times convulsions.  In  some  rather  exceptional  cases  the  gastro-intes- 
tinal symptoms  are  comparatively  mild,  and  the  force  of  the  poison 
is  expended  on  the  nervous  system.  In  such  examples  there  ensue 
stupor,  general  muscular  paralysis,  and  finally  complete  loss  of  con- 
sciousness ;  or,  with  but  little  gastro-intestinal  disturbance,  the  patient 
passes  at  once  into  coma  and  complete  muscular  resolution.  It  does 
not  act  on  the  peripheral  nerves. 

In  experiments  on  animals,  it  has  been  ascertained  that  repeated 
administration  in  moderate  doses  sets  up  oxaluria,  and  subsequently 
albuminuria  with  tube  casts  (Robert).  The  same  observer  found  that 
the  exhibition  of  non-toxic  quantities  caused  a  form  of  glycosuria  to 
appear.  Whether  this  is  due  to  the  local  action  of  the  poison  at  the 
point  of  excretion,  or  to  an  interference  with  the  amylolytic  transfor- 
mations of  the  primary  assimilation,  remains  undetermined.  It  is  cer- 
tainly true  the  oxalates  form  concretions  that  line  the  tubules  of  the 
kidneys  in  rabbits,  and  must  therefore  exercise  some  irritant  action 
along  the  points  of  contact.  In  what  way  soever  determined,  it  is  an 
interesting  fact  that  oxalic  acid  causes  albuminuria  and  glycosuria 
when  administered  to  animals,  and  the  presence  of  sugar  in  the  urine 
has  been  ascertained  in  some  cases  of  poisoning  in  man. 

Oxalic  acid  has  powerful  germicide  properties. 

Poisoning  by  this  agent  is  to  be  treated  on  the  same  general  prin- 
ciples as  the  mineral  acids. 

Therapeuticatty,  it  is  indicated  in  the  treatment  of  albuminuria 
with  tube  casts  on  the  principle  of  antagonism.  In  the  same  way  it 
may  be  applied  to  the  treatment  of  diabetes,  since  it  causes  glycosuria 
in  man.  It  is  said,  also,  to  be  an  efficient  remedy  in  amenorrhcea.  It 
is  indicated  in  cases  requiring  an  active  stimulant  to  the  uterus  and 
ovaries. 


246  AGENTS  INCREASING  WASTE. 

SULPHUROUS  ACID  AND   THE   SULPHITES. 

Acidum  Sulphurosmn. — Sulphurous  acid.  A  colorless  liquid,  hav- 
ing the  odor  of  burning  sulphur,  and  a  sulphurous,  sour,  and  somewhat 
astringent  taste.  Dose,  m,  v —  3  j- 

Sodii  Hyposulphis.  —  Sodium  hyposulphite.  In  large,  colorless, 
transparent  crystals,  having  a  bitter,  slightly  alkaline,  and  sulphurous 
taste.  It  is  soluble  in  one  and  a  half  part  of  water  at  60°,  and  insolu- 
ble in  alcohol.  Dose,  gr.  v — 3j. 

Sodii  Sulphis.  —  Sodium  sulphite.  In  white,  efflorescent,  pris- 
matic crystals,  soluble  in  four  parts  of  cold  and  in  less  than  one  part 
of  boiling  water.  It  has  a  sulphurous  taste,  and  a  feeble  alkaline  reac- 
tion. Dose,  gr.  v — 3j. 

Sodii  Bisulphis.  —  Sodium  bisulphite.  Opaque,  prismatic  crys- 
tals, or  a  crystalline  or  granular  powder,  slowly  oxidized  and  los- 
ing sulphurous  acid  on  exposure  to  air,  having  a  faint  sulphurous 
odor  and  taste,  and  an  acid  reaction  ;  soluble  in  four  parts  of  water 
at  60°  Fahr.,  and  in  two  parts  of  boiling  water.  Dose,  gr.  iij — 
gr.  x. 

Magnesii  Sulphis. — Magnesium  sulphite.  (Unofficial.)  A  white, 
crystalline  powder  ;  is  insoluble  in  alcohol,  but  soluble  in  twenty 
parts  of  water  at  59°  F.  Dose,  gr.  v — 3  j. 

Potassii  Sulphis. — Potassium  sulphite.  In  white,  opaque  frag- 
ments or  powder,  very  soluble  in  water.  It  has  a  saline  and  sulphurous 
taste.  Dose,  gr.  iij — gr.  x. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  mineral  acids — including 
sulphuric — decompose  the  sulphites  and  hyposulphites.  All  oxidizing 
substances  are  incompatible.  These  preparations  have  a  great  affinity 
for  oxygen,  and  the  sulphites  readily  become  sulphates. 

STNEKGISTS. — All  remedial  agents  which  arrest  fermentative  pro- 
cesses promote  the  therapeutical  activity  of  sulphurous  acid  and  the 
sulphites. 

PHYSIOLOGICAL  ACTIONS. — Sulphurous  acid  is  a  disinfectant  and  de- 
odorizer. It  attacks  organic  matter  with  energy,  by  virtue  of  its  affinity 
for  oxygen.  It  is  very  destructive  to  the  lower  forms  of  life,  bacteria, 
fungi,  etc.  Sulphurous-acid  gas  inspired  produces  great  irritation  of 
the  glottis,  and  an  intensely  suffocative  feeling.  In  sufficient  quantity 
it  produces  violent  inflammation  of  the  air-passages.  As  by  combina- 
tion with  oxygen  sulphuric  acid  is  formed,  the  destructive  effect  as- 
cribed to  sulphurous  acid  is  in  reality  chiefly  due  to  sulphuric. 

The  sulphites  exposed  to  the  air  rapidly  absorb  oxygen,  and  pass  to 
the  state  of  sulphates.  The  hyposulphites  are  more  constant  than  the 
sulphites.  In  the  stomach,  by  the  acid  of  the  gastric  juice,  these  salts 
are  in  part  decomposed  and  sulphurous  acid  is  given  off ;  in  part  they 


SULPHUROUS  ACID.  247 

are  converted  into  sulphates.  They  are  undoubtedly  absorbed  as  sul- 
phates, and  are  eliminated  partly  by  the  intestinal  canal,  but  chiefly 
by  the  kidneys,  as  sulphates.  The  author  demonstrated  these  facts 
soon  after  the  publications  of  Dr.  Polli  led  to  an  enthusiastic  adminis- 
tration of  these  remedies  in  the  zymotic  diseases. 

THERAPY. — Dilute  sulphurous  acid  is  one  of  the  numerous  local  ap- 
plications considered  efficacious  in  mercurial  stomatitis,  aphthce,  mucous 
patches,  ulcers  of  the  tonsils,  and  in  diphtheria.  In  all  of  these  affections 
the  diluted  acid  may  be  applied  directly  to  the  diseased  surface  by  a 
mop,  a  sponge-probang,  or  in  the  form  of  spray.  A  more  easily  managed 
application  is  a  solution  of  the  sulphite  of  soda  (  3  j —  3  j  in  water). 

In  certain  kinds  of  vomiting  of  a  yeast-like  material,  especially  when 
sarcina  are  present  in  the  vomited  matters,  the  sulphites  are  often 
curative.  Vomiting  of  acid  matters,  pyrosis,  and  indigestion,  due  to 
acid  fermentation  of  the  starchy  and  saccharine  elements  of  the  food, 
are  relieved  by  sulphurous  acid  (m,  v —  3  j,  well  diluted),  or,  but  less 
efficiently,  by  sulphite  of  soda  (3j — 3  j).  The  result  in  these  cases 
is,  no  doubt,  due  to  the  power  which  sulphurous  acid  has  of  arresting 
the  fermentation  processes. 

Sulphurous  acid  has  been  utilized  of  late  in  the  treatment  of 
phthisis,  by  rectal  injection  and  by  inhalation.  A  reaction  has  already 
begun  against  the  use  of  the  rectal  injections — for  they  are  trouble- 
some to  execute,  and  after  a  while  the  rectum  becomes  irritable.  In- 
halation of  the  gases,  however,  is  increasing  in  favor.  Dr.  Dewar's 
warm  advocacy  of  sulphurous  acid  was  never  tested  in  its  results  to 
any  extent.  Now,  however,  it  is  seen  that  his  mode  of  treatment  has 
much  to  recommend  it,  and  was  then  in  advance  of  his  time.  More 
effective,  the  author  finds,  is  the  "  Pictet  liquid  " — which  consists  of 
sulphurous-acid  gas  and  carbonic-acid  gas  liquefied  by  pressure  and 
kept  in  siphon-bottles.  A  small  quantity  of  this  can  be  given  out  in 
the  air  of  the  apartment  occupied  by  the  patient.  Care  must  be  used 
to  rightly  gauge  the  quantity  to  the  susceptibility  of  the  patient. 

Sulphurous-acid  spray  is  a  good  local  application  in  syphilitic  and 
tuberculous  laryngitis.  Cases  of  chronic  bronchitis,  with  profuse  expec- 
toration of  a  fetid  character  (bronchorrhcea),  are  sometimes  improved 
by  inhalations  of  sulphurous-acid  gas,  or  of  the  acid  in  the  form  of  spray. 

Externally  applied,  sulphurous  acid  and  the  hyposulphites  and  sul- 
phites are  in  some  maladies  extremely  serviceable. 

As  a  disinfectant  and  deodorizer  sulphurous  acid  is  at  the  same  time 
efficient,  easily  managed,  and  economical.  Sulphurous  acid  is  the  prod- 
uct of  the  combustion  of  sulphur  in  the  open  air ;  hence,  to  disinfect 
rooms,  it  is  necessary  only  to  close  all  egress  and  fill  them  with  the 
fumes  of  burning  sulphur.  It  is  to  be  remembered  that  sulphurous 
acid  is  injurious  to  many  fabrics.  The  sulphites  are  colorless  and  soluble. 

Sulphurous  acid  is  an  efficient  application  to  chilblains  :  IJ,  Acid. 


048  AGENTS  INCREASING   WASTE. 

sulphurosi,  3  iij ;  glycerin!,  3  j ;  aquae,  f  jss.  M.  In  parasitic  skin-dis- 
eases, the  sulphites,  hyposulphites,  and  sulphurous  acid  are  used  to 
destroy  the  parasites.  The  following  formula  is  employed  by  Startin 
in  these  affections  :  I£  Sodii  hyposulphitis,  f  iij  ;  acid,  sulphurosi  dil., 
§  ss  ;  aquae,  q.  s.  ad  §  xvj.  Fox  recommends  the  following  formula  in 
tinea  versicolor  and  in  pruritus  vulvce :  ]J  Sodii  hyposulphitis,  3  iv  ; 
glycerini,  3  ij  ;  aquse  destil.  ad  3  vj. 

Sulphurous  acid  is  an  excellent  application  to  ill-conditioned,  slough- 
iny,  or  gangrenous  icounds.     It  was  very  successful  in  these  cases,  at 
the  English  hospital  at  Metz,  during  the  Franco-German  War. 
Authorities  referred  to  : 

BARTHOLOW,  DR.  ROBERTS.      The  Lancet  and  Observer,  Cincinnati,  1865. 

BIRD,  DR.  ROBERT.     The  Practitioner,  vol.  ii,  p.  247. 

BRAUX  AND  BERNATZIK,  PROFS.      Wiener  med.  Wochenschrift,  Nos.  94-99,  1869. 

DEWAR,  DR.  JAMES.  On  the  Application  of  Sulphurous-Acid  Gas  to  the  Prevention, 
Limitation,  and  Cure  of  Contagious  Diseases,  Edinburgh,  1866. 

DRYSDALE,  DR.  CHARLES  R.     The  Lancet,  July  24,  1869. 

FERGUS,  MR.     The  Lancet,  November  26,  1860. 

Fox,  DR.  TILBCRY.     Skin  Diseases,  New  York,  1873. 

MILLER,  DR.     Edinburgh  MedicalJournal,  September,  1869. 

POLLI,  PROF.  Various  Papers.  Abstracts  in  Schmidfs  Jahrbucher  der  gesammten 
Median,  etc.,  for  1864,  '65,  '66,  to  1870. 

PURDON,  DR.  H.  S.     British  Medical  Journal,  May  9,  1868. 

Sulphur  and  Sulphides  (Sulphurets). — Potassa  Sulphurata.  Sul- 
phurated potassa  has  a  brownish-yellow  color  when  freshly  broken. 
It  dissolves  in  water,  with  the  exception  of  a  slight  residue,  and  forms 
an  orange-yellow  solution,  which  exhales  the  odor  of  hydrosulphuric 
acid.  Dose,  gr.  j — gr.  v. 

Calx  Sulphurata. — Sulphurated  lime.  A  mixture  containing  at 
least  60  per  cent  of  calcium  monosulphide.  A  greenish-gray  powder, 
having  a  strong  odor  of  sulphureted  hydrogen.  Dose,  gr.  j — gr.  v. 

ANTAGONISTS  AND  INCOMPATIBLES. — Solutions  of  the  sulphides  are 
decomposed  by  the  mineral  acids,  sulphureted  hydrogen  being  liber- 
ated and  sulphur  precipitated.  Solutions  of  the  metals,  generally,  are 
also  incompatible  with  the  sulphides  of  potassium  and  calcium,  for,  in 
the  decomposition  which  ensues,  the  metals  are  precipitated  in  the  form 
of  insoluble  sulphides.  Hence  it  is  that  these  preparations  have  been 
proposed  as  antidotes  to  the  metallic  poisons.  Chlorine-water,  chlorides 
of  sodium  and  potassium,  sulphate  of  iron,  etc.,  are  chemical  antidotes. 

SYNEBGISTS. — All  agents  promoting  waste  are,  therapeutically  con- 
sidered, synergistic.  Alkalies  favor  their  action,  both  chemically  and 
physiologically. 

PHYSIOLOGICAL  ACTIONS. — These  preparations  have  a  decidedly  nau- 
seous taste  and  smell,  and  are  somewhat  irritant.  In  the  stomach  they 
excite  a  sense  of  heat,  and  in  sufficient  quantity  cause  gastro-enteritis, 
with  all  the  attendant  symptoms  belonging  to  irritant  poisons.  Dis- 


SULPHIDES.  249 

agreeable  eructations  of  sulphureted  hydrogen  take  place  when  they 
are  administered  medicinally,  owing  to  the  reactions  in  the  presence 
of  an  acid  alluded  to  above.  They  stimulate  the  secretion  of  the  gas- 
tro-intestinal  canal,  and  are  laxative.  The  fetor  of  the  stools  is  in- 
creased by  their  use,  a  result  not  altogether  due  to  the  evolved  sul- 
phureted hydrogen,  but  to  the  increased  action  of  those  intestinal 
glands  concerned  in  elimination.  As  the  sulphides  pass  easily  to  the 
state  of  sulphates  by  the  action  of  oxygen,  it  may  be  assumed  that  a 
part  of  their  physiological  effects  is  produced  by  the  latter  salts. 
They,  however,  undoubtedly  exercise  a  toxic  action  on  the  blood,  im- 
pairing the  red  blood-globules,  and  increasing  the  amount  of  effete 
material.  Emaciation,  muscular  weakness,  and  trembling,  and  a  feeble 
circulation,  are  results  of  their  use  in  large  amount,  or  for  lengthened 
periods.  It  is  true  that  some  acceleration  of  the  pulse-rate  and  in- 
crease of  secretion  of  the  mucous  surfaces  follow  their  medicinal  ad- 
ministration" for  a  short  period  and  in  moderate  doses  ;  but  the  pro- 
longed inhalation  of  sulphureted  hydrogen,  or  the  prolonged  internal 
use  of  the  sulphides,  causes  great  anaemia,  wasting,  and  debility. 

THERAPY. — The  waters  of  the  well-known  Blue  Lick  Springs,  and 
others,  of  Kentucky,  which  are  almost  identical  in  composition  with 
the  famous  Harrogate,  of  England,  may  be  substituted  for  the  sul- 
phides in  many  of  the  cases  in  which  the  latter  are  useful. 

The  Blue  Lick  waters  are  useful  in  abdominal  plethora.  A  pint 
taken  before  breakfast  is  an  efficient  laxative,  which  is  indicated  in 
cases  of  habitual  constipation  from  deficient  secretion  of  the  intes- 
tinal juices.  Four  ounces  taken  before  each  meal  is  an  excellent 
remedy  for  obesity.  Engorgement  of  the  pelvic  viscera  in  women,  and 
haemorrhoids  in  both  sexes,  when  due  to  torpor  of  the  portal  circula- 
tion, are  relieved  by  the  same  agent.  For  these  purposes  the  Blue 
Lick  waters  may  be  taken  for  several  weeks  or  even  months,  but  their 
use  should  be  discontinued  when  anemia  is  threatened.  In  anaemic 
subjects,  chalybeates  and  a  generous  diet  should  be  conjointly  ad- 
ministered. The  author  has  observed  excellent  results  from  the  pro- 
longed use  of  this  water  in  glandular  affections,  hepatic,  splenic,  uter- 
ine, and  of  the  prostate. 

A  succession  of  common  boils,  scrofulous  and  other  abscesses,  are, 
it  is  said,  made  to  mature,  and  the  expulsion  of  the  pus  is  favored  by 
the  use  of  the  sulphides.  When  abscesses  are  threatened,  and  before 
matter  is  formed,  the  sulphides,  it  is  claimed,  may  cause  them  to  abort. 
Small  doses  (gr.  ss — gr.  j)  frequently  repeated  (every  hour  or  two)  are 
said  to  be  most  effective  under  these  circumstances.  Since  the  publi- 
cation of  the  last  edition  of  this  work,  rectal  injection  of  gases  ob- 
tained from  natural  waters  corresponding  in  composition  to  the  Ken- 
tucky Blue  Lick  has  been  brought  forward.  A  century  ago  Priestley 
•\nd  others  advocated  this  expedient,  but  the  method  did  not  appeal 


250  AGENTS   INCREASING  WASTE. 

to  the  practical  talent  of  the  profession,  and  hence  fell  into  complete 
desuetude.  Its  revival  was  due  to  the  discovery  of  Bernard,  that 
sulphureted-hydrogen  gas  and  carbonic-acid  gas,  when  thrown  into 
the  rectum,  escape  quickly  from  the  lungs,  and  hence  do  not  reach  the 
nerve-centers.  In  passing  through  the  lungs,  morbid  processes,  mor- 
bific germs,  etc.,  are  acted  on  by  the  gas.  The  discovery  of  the 
bacillus  tuberculosis  was  the  next  step,  and  after  this  the  utilization  of 
Bernard's  discovery.  Already  the  rectal  injection  of  the  gases  is  being 
superseded  by  the  more  direct  and  facile  inhalation  of  the  same  agents. 

EXTERNAL  USES  OF  THE  SULPHIDES. — A  solution  of  the  sulphide  of 
potassium  (  3  ss —  f  j)  is  an  efficient  application  in  scabies.  An  extem- 
poraneous sulphide  may  be  made  by  boiling  one  part  of  quicklime  and 
two  parts  of  sublimed  sulphur  in  ten  parts  of  water.  With  this  solu- 
tion the  parts  affected  by  scabies  may  be  painted  over,  after  prelimi- 
nary cleansing  with  a  warm  bath.  Sulphur-baths  (solution  of  sulphide 
of  potassium  in  water,  as  above  mentioned)  are  very  excellent  applica- 
tions in  the  chronic  forms  of  psoriasis  and  eczema.  The  following 
formula  is  recommended  by  Fox  in  scabies  and  prurigo  :  IJ  Potassii 
sulphured,  f  vi ;  sapon.  alb.,  foij  ;  ol.  olivae,  Oij  ;  ol.  thymi,  3  ij.  M. 
A  milder  preparation  is  the  following  :  IJ  Potassii  sulphured,  3  iij  ; 
sapon.  moll.,  f  j  ;  aquae  calcis,  f  viij  ;  alcohol,  f  ij.  M.  Or  the  fol- 
lowing :  IJ  Potassii  sulphured,  f  ss  ;  aquae  calcis,  f  xvj.  M.  For 
the  relief  of  pityriasis  and  parasitic  skin-diseases. 

The  sulphide  of  sodium  (unofficial)  being  more  stable,  is  better 
suited  for  the  preparation  of  sulphurous  baths.  An  artificial  sulphur- 
ous water,  in  imitation  of  the  Bareges,  is  made  as  follows  :  IJ  Sul- 
phidi  sodii,  sodae,  sodii  chloridi,  aa  §  ij.  M.  Sig.  :  A  sufficient  quan- 
tity for  one  bath.  The  Pommade  de  Bareges  of  the  French  is  consti- 
tuted as  follows  :  IJ  Sodii  sulphured,  sodii  carbonat.,  aa  3  ij  ;  axun- 
giae,  §  ijss.  M. 

Sulphur-baths  are  frequently  employed  to  favor  the  elimination  of 
lead,  in  cases  of  saturnine  disease. 

Authorities  referred  to  : 

Fox,  DR.  TILBCRY.     Skin  Diseases :  Their  Description,  Pathology,  etc.,  second  Ameri- 
can edition. 

LEWIS,  Louis.     The  Lancet,  March  14,  1874,  p.  393. 

MACPHKRSON,  DR.  JOHN.     The  Baths  and  Wells  of  Europe,  London,  1873. 

SULPHUROUS  MINERAL  WATERS. 

1.  NORTH  AMERICA. 
French-Lick  Springs. 

West-Baden  Springs,  Orange  County,  Indiana. 
Indian  Springs,  Martin  County,  Indiana. 

These  waters  contain  carbonates  of  soda,  potassa,  magnesia,  and 
lime,  and  chlorides  of  sodium,  potassium,  magnesium,  and  calcium. 


SULPHUROUS  WATERS.  251 

and  sulphates  of  soda,  magnesia,  lime,  and  potassa.  The  gases  are 
sulphureted  hydrogen  and  carbonic-acid  gas. 

Upper  Blue-Lick  Springs,  Nicholas  County,  Kentucky. 

Lower  Blue-Lick  Springs,  Nicholas  County,  Kentucky. 

Big-Bone  Springs,  Boone  County,  Kentucky. 

Paroquet  Springs,  Bullitt  County,  Kentucky. 

These  waters  are  remarkable  f pr  the  quantity  of  sulphureted  hydro- 
gen which  they  contain  (from  1'02  cubic  inch  to  3*75).  They  are  rich 
in  the  chloride  of  sodium  (from  38*700  grains  to  the  pint  to  64'567 
grains).  They  contain  also  chlorides  of  potassium,  sodium,  magnesium, 
and  calcium,  carbonates  of  soda,  magnesia,  iron,  and  lime,  sulphates  of 
soda,  potassa,  and  magnesia,  and  appreciable  quantities  of  iodides  and 
bromides. 

Alpena  Well,  Alpena  County,  Michigan. 

This  water  contains  the  large  quantity  of  4'42  cubic  inches  of  sul- 
phureted hydrogen  to  the  pint.  The  proportion  of  chloride  of  sodium 
is  small  (8'532  grains  to  the  pint).  The  other  ingredients  are  carbon- 
ates of  soda,  magnesia,  iron,  and  lime,  and  sulphate  of  lime. 

Sharon  Springs,  Schoharie  County,  New  York. 

Avon  Springs,  Livingston  County,  New  York. 

Mild  sulphureted  waters.  The  principal  salt  is  sulphate  of  lime, 
which  is  found  in  the  different  springs,  ranging  from  11*687  grains  to 
13'95  grains  to  the  pint  (Sharon). 

Yellow-Sulphur  Springs,  Montgomery  County,  Virginia. 

The  most  important  constituents  of  these  waters  are  sulphates  of 
lime,  magnesia,  soda,  potassa,  and  alumina,  and  carbonates  of  lime,  mag- 
nesia, and  iron.  The  gas  is  carbonic  acid  and  sulphureted  hydrogen. 

Greenbrier  White-Sulphur  Springs,  West  Virginia. 

Salt-Sulphur  Springs,  Monroe  County,  West  Virginia. 

Red-Sulphur  Springs,  Monroe  County,  West  Virginia. 

These  springs  are  nearly  alike  as  respects  the  composition  of  their 
waters.  They  contain  chlorides  and  sulphates,  but  their  principal  con- 
stituents are  sulphate  of  lime,  sulphate  of  soda,  and  sulphate  of  mag- 
nesia. The  Greenbrier  Spring  and  the  Red-Sulphur  Spring  waters 
contain  also  a  peculiar  sulphur  compound,  in  regard  to  the  nature  of 
which  but  little  is  known. 

2.  EUBOPEAN. 

Harrogate,  Yorkshire,  England.     Season  from  May  to  September. 

These  waters  contain  chlorides  of  calcium,  magnesium,  potassium, 
and  sodium,  carbonic-acid  gas,  and  sulphureted  hydrogen. 

Llandrindod,  Wales. 

Saline,  chalybeate,  and  sulphur  waters  ;  rich  in  chlorides,  especially 
of  sodium. 

Strathpeffer,  Ross-shire,  Scotland. 


9^7  AGENTS  INCREASING  WASTE. 

&O& 

This  is  a  strong  sulphureted  water,  and  contains  sulphate  of  lime, 
carbonate  of  lime,  sulphate  cf  magnesia,  and  sulphate  of  soda. 

Moffatt,  south  of  Scotland. 

The  waters  contain  chloride  of  sodium  (28*07),  sulphate  of  soda, 
sulphate  of  lime,  and  sulphureted-hydrogen  gas. 

Bareges,  Hautes-Pyrenees.  Altitude,  4,000'.  Temperature,  86°  to 
113°  Fahr.  Season  from  July  to  September. 

"Waters  contain  sulphide  of  sodium,  sulphate  of  soda,  chloride  of 
sodium,  etc. 

These  waters  are  used  chiefly  for  bathing  the  patients,  beginning 
with  the  colder  and  passing  on  to  the  hotter  waters.  These  springs 
have  a  special  celebrity  for  the  treatment  of  old  wounds,  diseases  of 
bones,  and  rheumatic  and  neuralgic  affections. 

Cauterets,  Hautes-Pyrenees.  Altitude,  3,000',  but  sheltered.  Sea- 
son, June  to  September.  Temperature  of  baths,  98°  to  131°  Fahr. 

The  composition  of  the  waters  is  similar  to  that  of  those  of  Bareges, 
but  it  is  more  stimulating,  and  contains  a  good  deal  of  iodine.  It  is 
especially  advised  in  incipient  tuberculosis,  bronchial  affections,  and 
pelvic  diseases  of  women. 

Eaux-Bonnes,  Basse-Pyrenees,  near  Pau.     Altitude,  2,000'. 

Waters  sulphurous  and  saline,  similar  to  but  not  so  exciting  as  those 
of  Bareges.  This  resort  is  celebrated  chiefly  for  its  effects  in  laryngeal 
diseases  and  clergyman's  sore-throat. 

Challes,  Savoy. 

This  water,  according  to  Macpherson,  is  one  of  the  most  remarkable 
in  Europe,  and  "  is  the  strongest  sulphur-well  known."  It  contains 
iodine  and  bromine,  sulphide  of  sodium,  bromide  of  sodium,  etc. 

Aix-la-Chapelle,  Rhenish  Prussia.  Altitude,  450'.  Temperature 
of  air  during  season,  mean,  63°  Fahr.  Season  from  June  to  Sep- 
tember. 

According  to  Liebig's  analysis,  these  waters  contain  chloride  of 
sodium  (20  grains),  bromide,  iodide,  and  sulphate  of  sodium,  carbon- 
ate of  soda  (4 -9  grains),  sulphate  of  soda  (2'1  grains),  sulphate  of 
potash  (I'l  grain),  and  carbonates  of  lime,  magnesia,  strontia,  lithia, 
etc.  Used  by  drinking  and  bathing^  and  especially  in  cutaneous 
diseases,  rheumatism,  syphilis,  hepatic  disorders,  etc. 

Eilsen,  Lippe-Schomburg,  Northern  Germany. 

Neundorf,  Prussian  Westphalia. 

These  waters  contain  the  sulphates  of  soda,  magnesia,  lime,  and 
chlorides  of  calcium  and  magnesium.  They  are  highly  charged  with 
carbonic-acid  gas  and  sulphureted  hydrogen.  They  are  useful  in 
gouty  and  rheumatic  affections,  syphilis,  skin-diseases,  etc. 

Schintznach,  Switzerland.     Altitude,  1,060'. 

This  is  a  highly-sulphurous  water,  and  is  charged  with  carbonic- 
acid  gas  and  sulphureted  hydrogen.  It  contains  sulphate  of  soda 


IODINE  AND  IODIDES.  253 

(9.87  grains),  sulphates  of  potash  and  lime,  chlorides  of  potassium  and 
magnesium,  and  carbonates,  etc. 

THERAPY  OF  THE  SULPHUR- WATERS. — Of  the  sulphurous  waters 
given  above,  those  belonging  to  this  country  are  quite  unsurpassed  in 
therapeutical  value.  As  a  rule,  such  waters  are  useful  in  liver-dis- 
orders ;  they  diminish  abdominal  plethora,  and  congestion  of  the 
portal  circulation.  They  are  indicated  in  malarial  affections  of  the 
liver  and  spleen.  Rheumatism  and  gout,  tuberculosis  in  its  incipi- 
ency,  chronic  poisoning  by  the  metals,  etc.,  are  certainly  benefited  by 
the  internal  use,  and  by  baths  of  sulphurous  waters.  Affections  of 
the  skin,  syphilitic  diseases,  chronic  rheumatic  affections,  etc.,  are 
especially  forms  of  disease  remediable  by  these  waters,  used  internally 
and  in  the  form  of  baths. 

Authorities  referred  to  : 

BRAUN,  DR.  JULIUS.     Systematisches  Lehrbuch  der  Balneotherapie. 

MACPHERSON,  DR.  JOHN.     Baths  and  Wells  of  Europe. 

MOORMAN,  DR.  J.  J.     Mineral  Springs  of  North  America. 

VALENTINER,  DR.  TH.     Handbuch  der  allgemeinen  und  speciellen  Balneotherapie. 

WALTON,  DR.  GEORGE  E.     Mineral  Springs  of  the  United  States  and  Canada. 

IODINE   AND   ITS  PREPARATIONS. 

lodlim. — lode,  Fr.  ;  lod,  Ger.  ;  lodum,  Latin. 

lodum. — Iodine.  In  bluish-black  crystalline  scales,  having  a  me- 
tallic luster  ;  very  slightly  soluble  in  water  (1  in  5,000)  ;  soluble  in 
alcohol  (1  in  10),  in  ether,  in  a  solution  of  iodide  of  potassium,  and  in 
a  solution  of  chloride  of  sodium.  Dose,  gr.  ss — gr.  j. 

lodoformum.  —  lodof orm.  In  yellow  crystals,  having  a  saffron 
odor.  Insoluble  in  water,  but  soluble  in  ether  and  the  fixed  and 
volatile  oils.  Dose,  gr.  j — gr.  v. 

Liquor  lodi  Compositus. — Compound  solution  of  iodine.  Iodine, 
5  grm.  ;  iodide  of  potassium,  10  grm.  ;  distilled  water,  q.  s.  to  make 
100  grm.  Dose,  m,  v — m,  xx. 

Tinctura  lodi. — Tincture  of  iodine.  Iodine,  70  grm.  ;  alcohol, 
to  1,000  grm.  Dose,  in,  j — TTI  v. 

Unguentum  lodi. — Iodine  ointment.  Iodine,  4  grm.  ;  iodide  of 
potassium,  1  grm.  ;  water,  2  c.  c.  ;  and  benzoinated  lard,  93  grm. 

Syrupus  Acidi  Hydriodici. — Sirup  of  hydriodic  acid.  A  sirupy 
liquid,  containing  about  one  per  cent  by  weight  of  absolute  hydriodic 
acid.  Dose,  3  ss —  3  ij. 

Sulphuris  lodidum. — Sulphur  iodide.  In  brittle  masses  of  a  crystal- 
line fracture,  a  grayish-black  metallic  luster,  and  having  the  odor  of 
iodine.  Dose,  gr.  £  to  gr.  j. 

Unguentum  Potassii  lodidi. — Ointment  of  potassium  iodide.    Po- 


254  AGENTS  INCREASING  WASTE. 

tassium  iodide,  12  gnn. ;  sodium  sulphite,  1  grm. ;  boiling  water,  10  c.  c.; 
benzoinated  lard,  77  grm. 

Ammonli  lodidum. — Ammonium  iodide.  A  white,  granular,  very 
deliquescent  salt,  becoming  yellowish-brown  by  exposure.  Very  solu- 
ble in  water  and  in  alcohol.  Dose,  gr.  ij — gr.  x. 

Potassii  lodidum. — Potassium  iodide.  In  white  or  transparent 
crystals,  wholly  soluble  in  water  at  59°  Fahr.  in  0'75  part,  and  in  al- 
cohol (1  in  18).  Dose,  gr.  v —  3  j. 

Sodii  lodidum. — Sodium  iodide.  In  minute  crystals,  or  crystal- 
line powder,  deliquescent,  having  a  saline  and  bitter  taste  and  an  alka- 
line reaction.  Soluble  in  water  and  in  alcohol.  Dose,  gr.  ij — 3  j. 

ANTAGONISTS  AND  INCOMPATIBLES. — Iodine  is  incompatible  with 
the  mineral  acids,  the  metallic  salts,  the  vegetable  alkaloids,  etc.  The 
chemical  antidote  is  starch,  or  substances  containing  it,  as  flour.  These 
should  be  given  freely  diffused  in  water.  It  should  be  remembered 
that  starch  is  the  antidote  to  free  iodine.  As,  however,  the  iodide  of 
starch  is  not  devoid  of  activity,  in  cases  of  poisoning  by  iodine  the 
contents  of  the  stomach  should  be  evacuated.  It  is  obvious  that  the 
preparations  of  iodine,  taken  after  a  meal  consisting  of  amylaceous 
materials,  will  have  their  activity  impaired  by  the  formation  of  the 
iodide  of  starch,  the  acid  of  the  stomach  freeing  the  iodine  from  its 
chemical  association. 

SYNERGISTS. — Alkalies,  and  other  remedies  which  increase  waste, 
favor  the  action  of  iodine  and  the  iodides.  Under  some  circumstances, 
mercurials  are  especially  synergistic. 

PHYSIOLOGICAL  ACTIONS.  —  Iodine. — When  brought  into  contact 
with  albuminous  substances,  iodine  combines  with  it  and  prevents 
putrefactive  change.  The  vapor  of  iodine,  like  chlorine,  but  in  a  fee- 
bler degree,  decomposes  sulphureted  and  phosphureted  compounds. 
It  is,  therefore,  justly  ranked  among  the  disinfectants. 

Applied  to  the  skin  or  mucous  membrane,  iodine,  according  to  the 
extent  of  the  application,  is  irritant  or  caustic.  It  stains  the  skin  yel- 
low, causes  a  sensation  of  warmth  in  small  quantity,  or  of  burning  in 
larger  quantity,  and  excites  a  superficial  inflammation  followed  by  des- 
quamation.  In  some  subjects  the  application  of  iodine-paint  causes 
vesication.  Pure  iodine,  kept  in  contact  with  the  tissues,  produces  a 
brown  and  dry  eschar.  The  vapor  of  iodine  is  very  irritant  to  the 
broncho-pulmonary  mucous  membrane,  causing  cough,  spasm  of  the 
glottis,  and  increased  flow  of  mucus. 

Iodine  has  a  hot,  pungent  flavor,  and  excites  a  sensation  of  heat  or 
burning  in  the  stomach.  In  sufficient  quantity,  it  acts  as  an  irritant 
poison,  inflames  the  mucous  membrane  of  the  stomach,  and  causes  su- 
perficial eschars.  The  amount  of  iodine  necessary  to  produce  toxic 
symptoms  varies  greatly,  and  the  variation  depends  in  part  on  consti- 
tutional peculiarities,  but  chiefly  on  the  amount  and  quality  of  the 


IODINE   AND   IODIDES.  255 

food  in  the  stomach.  Whether  applied  to  the  surface  of  the  skin  or 
taken  into  the  stomach,  it  quickly  diffuses  into  the  blood,  and  enters 
into  combination  with  sodium  or  potassium,  or  with  both. 

Iodides. — The  iodides  are  among  the  most  diffusible  substances. 
They  have  a  bitter,  saline,  and  very  disagreeable  taste.  In  a  few  min- 
utes after  being  swallowed,  the  taste  of  iodide  of  potassium  returns  in 
the  mouth,  and,  during  a  course  of  this  salt,  the  saliva  is  constantly 
charged  with  it.  In  the  stomach,  in  considerable  doses,  they  produce 
first  a  cooling  sensation,  followed  by  warmth,  and  even  burning. 
They  pass  into  the  blood  with  great  rapidity.  It  is  said  that  the  base. 
is  changed  in  the  blood,  and  the  iodides  of  ammonium  and  potassium 
become  iodide  of  sodium.  In  the  blood  they  probably  undergo  no  fur- 
ther changes,  and  do  not,  so  far  as  is  known,  modify  the  composition 
of  that  fluid.  At  the  points  of  elimination  from  the  free  mucous  sur- 
faces (nasal,  faucial,  and  bronchial  mucous  membrane),  the  chemical 
changes  which  ensue  set  free  ozone,  and  the  irritation  there  experi- 
enced is  probably  in  part  due  to  the  iodine,  separated  from  its  combi- 
nations by  the  action  of  that  agent  (Buchheim).  Elimination  doubt- 
less takes  place  by  the  broncho-pulmonary,  faucial,  and  salivary  glands, 
but  chiefly  by  the  kidneys.  The  diffusion  of  the  iodides  into  and  out 
of  the  blood  takes  place  with  such  rapidity  that  in  fifteen  minutes  they 
may  be  detected  in  the  saliva  and  in  the  urine. 

Diverse  opinions  have  been  expressed  in  regard  to  the  influence  of 
the  iodides  over  the  assimilative  functions.  By  the  syphilographers  it 
is  held  that  the  iodides  promote  constructive  metamorphosis,  and  that 
a  gain  in  body -weight  is  a  result  of  their  use.  This  opinion  is  devel- 
oped in  this  way  :  The  subjects  of  syphilis  in  its  constitutional  form 
emaciate,  and  their  forces  are  depressed  ;  but,  when  the  iodides  are 
given  them,  the  virus  is  eliminated,  and  the  organism  at  once  reacts.  In 
the  physiological  state  the  iodides  increase  waste  and  the  elimination 
of  the  products  of  waste,  and  emaciation  with  a  general  depression  of 
the  vital  functions  ensues,  when  they  are  administered  for  lengthened 
periods. 

The  proof  of  the  statements  just  made  has  been  afforded  us  by  the 
researches  of  Duchesne,  who  has  ascertained  that  a  decided  increase  in 
the  amount  of  urea  excreted  results  from  the  action  of  the  iodides, 
especially  of  the  iodide  of  potassium,  and  this  enhanced  metabolism  of 
the  nitrogenous  elements  persists  for  several  days  after  their  adminis- 
tration has  ceased.  Bouchard,  so  long  ago  as  1872,  had  ascertained  the 
same  fact.  The  other  iodides — of  ammonium,  sodium,  and  calcium — 
act  in  a  similar  manner  during  the  time  of  their  administration,  but 
their  subsequent  effects  are  far  feebler  and  shorter  in  duration. 

The  tincture  of  iodine  acts  in  a  manner  similar  to  iodide  of  potas* 
sium,  but  it  has  a  more  powerful  effect  in  increasing  nitrogenous 
waste,  as  represented  in  the  excretion  of  urea.  An  important  observa- 


256  AGEXTS   INCREASING   WASTE. 

tion  has  been  made  by  Duchesne  as  to  the  influence  of  iodine  in  the 
condition  of  interstitial  nephritis  with  albuminuria.  He  notes  that 
when  increasing  doses  of  the  tincture  are  given,  the  quantity  of  albumen 
lessens  and  finally  disappears  entirely.  As  the  actions  of  iodine  and 
of  its  combinations  are  really  so  different  in  character  as  well  as  in 
power,  it  becomes  important  to  ascertain  which  may  be  the  better 
fitted  for  particular  service.  Lasegue  had,  long  ago,  empirically  ascer- 
tained that  tincture  of  iodine  should  be  preferred  to  iodide  of  potas- 
sium, whenever  it  is  necessary  to  stimulate  the  retrograde  metamor- 
phosis— to  increase  oxidation,  or  to  enact  the  part  of  "alterative" 

lodism. — When  the  prolonged  administration  of  iodine  or  iodides 
becomes  necessary,  certain  precautions  must  be  observed  to  prevent 
the  development  of  iodism.  Especially  will  such  precautions  be  neces- 
sary when  massive  doses  of  iodides  are  administered  through  many 
months  and  years  in  cases  of  arterio-sclerosis.  Prof.  See  maintains 
that  by  occasional  intermissions,  and  the  use  of  elmiinants  at  such- 
times,  iodism  may  be  prevented. 

Ehrlich,  and  subsequently  Kronig,  have  ascertained  that  sulphanilic 
acid  has  the  power  to  prevent  or  arrest  iodism.  The  action  is  a  chemi- 
cal one,  and  is  explained  thus  :  the  phenomena  of  iodism  are  due  to- 
the  presence  of  free  iodine,  and  this  agent  is  separated  from  its  com- 
binations by  the  nitrates  in  the  presence  of  a  weak  acid.  As  sulpha- 
nilic acid  has  a  strong  affinity  for  nitric  acid,  the  Reaction  which  frees 
iodine  is  prevented. 

Atropine  is  quite  effective  as  a  remedy  for  iodism,  by  arresting  the 
morbid  action  taking  place  on  the  mucous  surface,  where  the  recom- 
bination of  iodine  is  taking  place  (Binz).  Some  of  the  rashes,  hydroa, 
etc.,  which  belong  to  iodism,  are  also  removed  by  atropine.  The  acne, 
the  gastric  disturbances,  and  the  depression  of  the  vital  powers,  are  to 
some  extent  favorably  affected  by  arsenic,  and  hence,  if  there  be  no  con- 
traindications, it  can  be  given  in  the  same  prescription  with  the  iodides. 
It  is  iodine,  rather  than  the  iodides,  when  given  in  large  quantity,  that 
produces  the  state  termed  iodism.  The  quantity  which  will  set  up  this 
state  of  irritation  in  one  subject  will  affect  another  but  slightly,  if  at 
all ;  in  other  words,  the  susceptibility  to  the  iodine  impression  varies 
greatly  in  different  individuals.  lodism  is  manifested  by  general 
malaise  and  rise  of  temperature,  frontal  headache,  coryza,  lachryma- 
tion,  and  sometimes  inflammatory  swelling  of  the  eyelids,  a  bittter  sa- 
line taste  in  the  mouth,  soreness  of  the  throat,  hoarseness,  and  difficulty 
of  swallowing— phenomena  strikingly  similar  to  summer  catarrh.  In- 
deed, patients  who  experience  these  sensations  for  the  first  time,  sup 
pose  them  to  be  an  acute  catarrh.  Usually  the  symptoms  of  iodism 
subside,  notwithstanding  the  dose  which  caused  them  may  still  be 
taken,  or,  as  it  may  be  expressed,  a  "  tolerance  "  is  established.  The 
quantity  which  at  one  time  may  have  caused  violent  iodism  will  not 


IODINE   AND   IODIDES. 

necessarily  again  do  so,  although  a  considerable  interval  may  have 
elapsed.  Indeed,  it  is  sometimes  difficult  to  induce  iodism  in  those 
who  have  become  habituated  to  the  use  of  the  iodides  in  considerable 
medicinal  doses. 

An  eruption  of  acne,  especially  on  the  face,  shoulders,  and  thighs,  is 
a  very  common  result  of  the  internal  use  of  the  iodides  ;  hydroa  on 
the  face  and  forehead  is  an  occasional  consequence,  but  eczema  is  more 
frequent,  yet  less  so  than  acne,  which  is  usual. 

Wasting  of  the  mammae  and  of  the  testes  has  never  been  observed 
by  the  author,  although  he  has  used  the  largest  doses  of  the  iodides, 
for  long  periods.  There  is  no  doubt  about  their  antaphrodisiac  ef- 
fects, and  it  has  seemed  to  the  author  that  permanent  loss  of  sexual 
power  has  resulted  from  their  long-continued  use. 

When  it  is  desirable  to  avoid  iodism,  large  draughts  of  water  should 
be  taken  during  a  course  of  the  iodides.  As  Rosenthal  has  shown,  large 
dilution  of  the  salt  hastens  elimination,  and  thus  prevents  the  more 
severe  effects  of  iodism. 

Benedict  has  experimentally  studied  the  effects  of  iodine  and  of 
iodide  of  potassium  on  the  nervous  system.  His  observations,  made 
on  frogs,  demonstrated  that  these  agents  caused  paralysis  of  the  heart 
and  of  the  respiration.  Schule  reports  a  case  in  which  such  symptoms 
were  induced  by  injecting  the  sac  of  a  spina  bifida  with  tincture  of 
iodine,  but  the  direct  and  reflex  effects  of  the  injection  on  the  spinal 
cord  may  have  had  much  to  do  with  the  result. 

THERAPY. — The  selection  of  an  iodide  for  internal  administration 
is  influenced  by  the  type  of  the  individual,  by  the  condition  of  the 
heart,  and  by  the  purpose  to  be  subserved.  If  an  idiosyncrasy  to  the 
action  of  an  iodide  exist,  its  nature  and  power  should  be  ascertained. 
When  the  combinations  of  iodine  with  alkaline  bases  can  not  be  taken, 
iodide  of  starch — "  amylum  iodatum  " — may  be  substituted,  and,  al- 
though not  so  efficient  as  a  remedy,  is  far  less  likely  to  cause  acute 
iodism,  or  to  set  up  a  gastric  catarrh.  Also,  as  the  salts  of  potassium 
have  a  more  depressing  effect  on  the  heart  than  the  corresponding 
sodium  salts,  the  latter  are  preferable  when  long-continued  admin- 
istration is  required.  On  the  other  hand,  if  the  circulation  is  active 
and  the  forces  unabated,  iodide  of  potassium  will  prove  more  effective. 

The  vomiting  of  pregnancy  can  sometimes  be  greatly  relieved  by 
drop-doses,  every  hour  or  two,  of  the  tincture  of  iodine.  This,  like  all 
other  remedies  for  this  disorder,  is  very  uncertain,  and  precise  indica- 
tions for  its  use  have  not  hitherto  been  ascertained.  Catarrh  of  the 
duodenum,  catarrh  of  the  biliary  ducts,  and  the  jaundice  dependent 
thereon,  are,  after  the  acuter  symptoms  have  subsided,  greatly  bene- 
fited by  the  smaller  doses  of  iodide  of  sodium  or  ammonium.  This 
is  one  of  the  best  remedies  for  the  first  stage  of  cirrhosis.  The  efficacy 
of  the  iodide  is  increased  by  combination  with  arsenic  :  IJ  Ammonii 


258  AGENTS   INCREASING   WASTE. 

iodid.,  3  j;  liq.  potassii  arsenitis,  3  ss;  tinct.  colombae,  §  ss;  aquae,  §  jsa 
M.  Sig. :  A  teaspoonful  three  times  a  day,  before  meals. 

The  preparations  of  iodine  and  the  iodides  are,  generally  speaking, 
contraindicated  in  all  inflammatory  states  of  the  intestinal  canal  ;  but 
in  passive  haemorrhage,  and  diarrhoea  from  atony  of  the  mucous  mem- 
brane, the  tincture  or  compound  solution  of  iodine  in  small  doses — one 
or  two  drops — frequently  repeated,  renders  important  service  (Schmidt). 

Large  doses  (grs.  xv —  3  ss)  of  the  iodide  of  potassium,  three  or 
four  times  a  day,  often  afford  remarkable  relief  in  aneurism,  and  some- 
times  effect  a  cure.  The  author  has  seen  several  instances  in  which 
great  benefit  was  derived  from  it,  and  one  case  certainly  in  which  a 
cure  apparently  resulted.  He  is,  therefore,  able  to  confirm  the  observa- 
tions of  Chuckerbutty,  Roberts,  Balfour,  and  others. 

In  arterio-sclerosis  and  in  sclerosis  of  the  heart,  kidneys,  and  other 
organs,  our  French  colleagues  maintain  that  the  iodides  possess  distinct 
curative  power,  if  given  in  sufficient  quantity,  for  several  years.  About 
one  drachm  daily  is  the  minimum  amount  that  will  accomplish  the  ob- 
ject. As,  however,  the  potash  base  is  more  injurious  in  action  than 
the  soda  base,  the  iodide  of  sodium  should  be  preferred  for  this  pur- 
pose. Prof.  See,  Heuchard,  and  others  of  the  French  school,  are  con- 
vinced that  the  condition  of  sclerosis,  which,  as  it  affects  the  arterial 
system,  plays  an  important  part  in  pathogeny,  can  be  arrested,  the  mor- 
bid deposits  removed,  and  the  integrity  of  the  vessels  restored.  Pro- 
longed use  of  the  iodide  of  sodium,  although  not  without  its  disadvan- 
tages, can  be  safely  carried  on  if  occasional  intermissions  are  allowed. 

In  summer  catarrh  or  hay-asthma,  the  best  results  are  obtained  by 
the  use  of  larger  doses,  and  the  efficacy  of  the  iodides  is  increased  by 
combination  with  arsenic  :  $  Potassii  iodidi,  §  j  ;  liq.  potassii  arse- 
nitis, 3  j  ;  aquae,  |  iv.  M.  Sig.:  A  teaspoonful  every  four  or  six  hours. 
With  the  internal  use  of  the  iodides  may  be  combined  the  local  use,  to 
nares  and  fauces,  of  the  following  solution  :  $  Tinct.  iodinii,  3  j  ; 
acid,  carbol.,  gtts.  x ;  aquae  destil.,  f  iv.  M.  Sig. :  Apply  with  a  post- 
nasal  syringe.  Ethyl  iodide  is  especially  valuable  inhaled  frequently. 

The  iodide  of  potassium  is  one  of  the  most  effective  remedies  which 
we  possess  for  spasmodic  asthma.  But  it  is  not  adapted  to  all  cases 
arising  under  various  conditions — a  fact  which  explains  the  difference 
of  opinion  on  the  subject  between  Williams,  Salter,  and  others.  It  is 
most  beneficial  when  the  asthmatic  seizures  are  reflex.  Salter,  how- 
ever, holds  that  we  possess  no  exact  indications  for  its  use,  and  that 
cases  the  most  diverse  are  sometimes  benefited  in  a  remarkable  manner. 

Chronic  bronchitis,  with  profuse  secretions  (bronchorrhoea),  is  fre- 
quently improved  by  the  iodides,  more  especially  the  iodide  of  am- 
monium. The  efficacy  of  this  remedy  is  increased  by  the  conjoined 
administration  of  arsenic.  In  capillary  bronchitis,  the  author  has 
•witnessed  most  astonishing  relief  by  the  rapid  administration  of  iodide 


IODINE   AND   IODIDES.  259 

of  ammonium  in  small  doses.  It  may  be  combined  with  the  carbonate, 
or  with  the  stimulant  expectorants.  To  remove  the  deposited  inflam- 
matory exudations  of  catarrhal  and  fibrinous  pneumonia,  no  remedy  is 
more  efficient  than  the  iodide  of  ammonium.  To  lessen  the  effect  of 
this  remedy  on  the  tissue-changes,  arsenic  should  be  combined  with  it, 
and  every  means  used  to  support  the  body  nutrition.  The  iodide  of 
potassium  is  one  of  the  remedies  resorted  to  in  chronic  pleurisy,  to 
promote  absorption  of  effusions.  In  these  cases  the  iodides  are  admin- 
istered steadily  for  a  considerable  period,  and  pilocarpine  given,  as 
may  be  necessary,  to  increase  the  sorbifacient  action. 

Affections  of  the  broncho-pulmonary  mucous  membrane,  alluded 
to  above,  in  which  there  is  profuse  exudation,  all  inflammatory  symp- 
toms having  subsided,  are  advantageously  treated  "by  iodine  inhala- 
tions. The  method  which  the  author  has  found  most  convenient  is 
the  following  :  A  small,  wide-mouthed  bottle,  containing  a  moistened 
sponge,  is  placed  in  a  vessel  of  hot  water.  The  tincture  of  iodine 
(gtts.  v — gtts.  x)  is  dropped  upon  the  sponge,  and,  as  the  vapor  of 
iodine  rises,  is  inhaled  with  the  vapor  of  water.  This  inhalation  is 
serviceable  in  acute  catarrh,  hay-asthma,  and  chronic  bronchitis.  The 
carbolate  of  iodine  (tinct.  iodi,  3  ij  ;  acid,  carbol.,  3  j )  may  be  used 
instead  of  the  simple  tincture  of  iodine.  Ten  to  twenty  drops  for 
inhalation. 

But  few  affections  of  the  brain,  non-specific  in  origin,  are  benefited 
by  the  iodides.  According  to  Niemeyer,  the  iodide  of  potassium  given 
to  iodism  has  in  few  instances  cured  basilar  meningitis.  The  author, 
who  has  used  it  faithfully  in  various  cases,  has  not  been  so  successful. 
Trousseau  et  Pidoux  express  their  disbelief  in  the  reported  cures  of 
tubercular  meningitis  by  this  agent.  Seguin  maintains,  on  the  other 
hand,  that  remarkably  good  results  sometimes  follow  the  use  of  large 
doses  of  the  iodides  in  other  than  specific  diseases — in  the  various  sub- 
acute  and  chronic  inflammatory  affections  of  the  meninges  and  brain. 

No  remedy  is  more  efficient  in  the  treatment  of  certain  glandular 
enlargements  of  the  thyroid,  spleen,  and  lymphatic  glands.  Goitre  is 
curable  by  the  internal  and  external  application  of  iodine,  when  it  con- 
sists of  simple  hypertrophy  of  the  gland-elements.  Cystic  and  calca- 
reous degeneration  of  the  thyroid  are  unaffected  by  the  use  of  iodine 
preparations  never  so  vigorously  used.  One  of  the  best  remedies  for 
true  goitre,  as  will  be  seen  hereafter,  is  the  unguent um  hydrarg.  iodidi 
rubri.  Enlarged  spleen,  when  it  consists  merely  of  an  hypertrophy  of 
the  organ  (chronic  splenitis),  is  cured  by  the  internal  use  of  the  iodides 
conjoined  with  the  local  use  of  iodine-paint,  or  ointment  of  the  red 
iodide  of  mercury.  The  enlargements  of  the  spleen  and  liver,  with 
functional  derangement  of  these  organs,  which  are  caused  by  malarial 
disease,  are  most  effectually  removed  by  moderate  doses,  frequently 
repeated,  of  the  iodide  of  ammonium.  The  author's  experience  jus- 
19 


2(50  AGENTS   INCREASING   WASTE. 

tifies  him  in  strongly  urging  the  combined  use  of  iodide  of  ammonium 
and  arsenic  in  chronic  malarial  poisoning. 

The  prolonged  administration  of  the  iodides  has  the  power  to  re- 
tard the  growth  and  to  remove  the  changes  which  ensue  in  chronic 
Brighfs  disease  (fibroid  degeneration),  and  the  arterio-sclerosis  ac- 
companying it. 

The  utility  of  the  iodides  is  most  conspicuous  in  certain  constitu- 
tional states.  The  expectations  which  were  at  first  entertained  of  the 
cure  of  scrofula  by  iodine  and  its  preparations  have  not  been  realized. 
The  iodides  are  unquestionably  useful  in  the  scrofulous  (so  called) 
enlargements  of  the  lymphatic  glands,  but  cod-liver  oil  and  suitable 
hygienic  means  are  more  influential  in  improving  the  strumous  di- 
athesis. The  preparations  of  iodine  are  effective  only  when  simple 
hypertrophy  of  the  lymphatic  glands  has  taken  place  ;  if  they  have 
undergone  caseation,  or  have  proceeded  to  suppuration,  no  medicine 
has  any  influence  over  them. 

The  most  important  therapeutical  applications  of  the  preparations 
of  iodine  are  in  the  treatment  of  constitutional  syphilis.  For  the  pri- 
mary and  secondary  stage,  mercury  is  generally  admitted  to  be  best ; 
but  for  tertiary  symptoms  no  remedy  at  all  approaches  the  iodide  of 
potassium.  In  the  secondary  affections  of  the  skin,  mercury,  especially 
if  it  have  not  been  given  for  the  primary  troubles,  is  to  be  preferred 
in  the  papular,  tubercular,  squamous,  and  pustular  syphilides  ;  iodide 
of  potassium  in  the  ulcerating,  especially  if  the  patient  is  cachectic. 
It  may  be  stated  in  general  that  the  preparations  of  iodine  are  indi- 
cated when  the  patient  is  under  the  mercurial  cachexia.  On  the  other 
hand,  it  is  well  known  that  sometimes,  even  when  the  tertiary  symp- 
toms have  not  been  relieved  by  a  thorough  course  of  iodides,  mercury 
will  quickly  remove  them.  But  this  fact  does  not  invalidate  the  rule 
that  the  iodides  are  specially  serviceable  for  the  tertiary  period. 

No  therapeutical  fact  is  more  conspicuous  than  the  cure  of  syphi~ 
loma  of  the  nervous  system  by  iodides.  Mental  disorders,  epileptiform 
seizures,  paralytic  states,  etc.,  dependent  on  gummata,  nodes,  etc.,  are 
usually  removed  in  a  manner  little  short  of  magical.  Neuralgia  of  the 
fifth  (tic-douloureux),  the  pain  being  nocturnal  chiefly,  or  nocturnal 
pain  in  the  head,  is  similarly  promptly  cured.  In  syphilitic  affections 
of  the  brain,  more  imperatively  than  in  the  same  affections  of  other 
organs,  are  large  doses  of  the  iodide  of  potassium  required.  The  limi- 
tation of  the  dose  depends  entirely  on  the  physiological  susceptibility 
of  the  patient,  and  the  influence  exerted  over  the  progress  of  the  case. 
Hence  the  dose  may  vary  from  ten  grains  to  a  drachm  every  four  hours, 
or  three  or  four  times  a  day.  The  symptoms  of  iodism — the  use  of  the 
agent  to  saturation — should  be  induced  ;  for  this  effect  is  the  only 
measure  of  the  therapeutical  power  of  the  remedy.  The  more  promptly 
iodism  can  be  induced,  the  better,  for  the  soft  nervous  tissue  may 


IODINE   AND   IODIDES.  261 

be  quickly  and  irreparably  damaged  by  syphilitic  deposits  and  new 
growths.  Syphilitic  paraplegia  is  equally  amenable  to  the  same 
means  ;  but,  as  above  remarked,  much  depends  on  the  promptness 
with  which  the  iodide  is  used. 

Recent  experience  has  conclusively  shown  the  curative  power  of 
iodine  in  malarial  fevers.  Thus  three  hundred  consecutive  cases  were, 
with  few  exceptions,  promptly  arrested  (Anderson).  In  some  cases  no 
paroxysm  occurred  after  the  medicine  was  administered  ;  sometimes 
the  attacks  persisted  for  two  or  three  days,  but  then  the  relief  was 
complete.  The  official  compound  tincture  of  iodine  may  be  prescribed 
— for  adults,  ten  to  fifteen  minims,  three  times  a  day,  well  diluted,  and 
before  meals.  Carbolic  acid,  itself  having  considerable  anti-periodic 
power,  may  be  combined  with  the  tincture  of  iodine.  I£  Tinct.  iodi, 
|  ij  ;  acid,  carbolic.,  3  ij.  M.  Sig.  :  Ten  to  fifteen  minims  three  or 
four  times  a  day.  The  tincture  of  iodine  is  stronger  than  the  com- 
pound tincture.  If  quinine  be  necessary  to  break  up  the  paroxysms, 
iodine  is  highly  useful  in  the  interim,  as  has  been  indicated.  Some 
recent  experiences  by  Dr.  Atkinson,  of  Baltimore,  throw  doubts  on 
the  previous  statements.  He  found  that  iodine  failed  in  two  thirds  of 
the  cases  of  intermittent  fever. 

The  use  of  the  compound  solution  of  iodine  during  the  course  of 
the  first  and  second  week  of  typhoid  fever  is  known  in  Germany  as 
the  "specific  treatment."  A  very  considerable  reduction  in  mortality 
appears  to  have  followed  this  method.  The  solution  of  iodine  or  the 
tincture  is  administered  regularly  three  times  a  day,  well  diluted  with 
water.  "When  it  does  good,  the  temperature  falls,  the  nausea  lessens, 
and  the  diarrhoea  is  restrained  within  safe  limits. 

Chronic  rheumatism,  when  there  are  present  thickening  of  the 
fibrous  tissues,  and  inflammatory  depositions  about  joints,  tendons,  peri- 
osteum, and  nerve-trunks,  is  often  very  signally  benefited  by  the  iodides. 
The  cases  in  which  these  remedies  prove  so  serviceable  are  most  prob- 
ably due  to  syphilitic,  mercurial,  saturnine,  or  other  constitutional 
causes.  There  are,  in  our  modern  life,  many  ways  in  which  these 
mineral  poisons  enter  the  organism,  and  it  is  probable  that  they  are 
often  undiscovered  and  even  unsuspected  causes  of  rheumatic  symp- 
toms. I/umbago,  sciatica,  and  paraplegia,  apparently  of  rheumatic 
origin,  and  curable  by  the  iodides,  may  not  unfrequently  be  caused  by 
syphilis,  mercury,  copper,  tin,  or  lead. 

The  various  accidents  caused  by  the  metals  above  named,  especially 
the  mercurial  and  saturnine,  are  removed  by  the  use  of  the  iodides, 
notably  by  the  iodide  of  potassium.  With  regard  to  the  dose  neces- 
sary, what  is  true  of  syphilis  is  equally  true  of  the  mineral  poisons  :  in 
order  to  remove  them,  the  organism  must  be  saturated  by  the  remedy. 
From  fifteen  grains  to  a  drachm,  three  or  four  times  a  day,  should  be 
given  ;  but  the  measure  of  the  quantity  required  is  the  effect  pro- 


2(32  AGENTS  INCREASING  WASTE. 

duced.  The  iodides  penetrate  into  every  tissue,  convert  the  deposited 
metal  into  soluble  combinations,  and  cause  them  to  be  discharged  by 
the  various  organs  of  excretion,  chiefly  by  the  kidneys.  It  has  been 
repeatedly  asserted  that  salivation  may  be  induced,  and  existing  sali- 
vation increased,  by  the  use  of  the  iodides  for  the  removal  of  mercu- 
rial salts  from  the  organism  ;  but  the  author  has  not  witnessed  any 
facts  which  support  this  statement. 

In  skin-diseases  of  syphilitic  origin  there  can  be  no  question  as  to 
the  utility  of  the  iodides.  But  these  remedies  are  more  especially  cura- 
tive in  the  tertiary  affections,  especially  in  destructive  syphilitic  ulcera- 
tions.  Hebra  insists,  and  with  justice,  that  the  preparations  of  iodine 
are  only  useful  in  lupus,  whether  syphilitic  or  scrofulous,  and  do  not 
permanently  improve  other  cutaneous  diseases.  Greve  asserts  that 
large  doses  of  the  iodides  (3  j-  3  j  ter  die)  rapidly  cure  psoriasis  ;  and 
in  this  opinion  specific  origin  is  not  said  to  be  necessary  to  the  cura- 
tive result.  Boeck  confirms  Greve's  statements. 

LOCAL  USES  OF  THE  PREPARATIONS  OF  IODINE. — The  tincture  of 
iodine  is  in  universal  use  as  a  counter-irritant.  It  is  applied  by  means 
of  a  camel's-hair  brush  to  goitre,  to  enlarged  glands,  and  to  superficial 
inflammatory  swellings  before  the  formation  of  pus.  Painted  over  the 
neck,  it  is  a  useful  counter-irritant  in  acute  affections  of  the  pharynx 
and  larynx,  and  to  the  chest  to  relieve  the  chest-pains  which  occur  in 
phthisis.  It  is  the  most  serviceable  counter-irritant  to  promote  absorp- 
tion of  inflammatory  products  in  catarrhal  and  flbrinous  pneumonia 
after  the  acuter  symptoms  have  subsided.  The  same  application  ap- 
pears to  possess  the  power  to  promote  the  absorption  of  pleuritic  effu- 
sion. It  is  a  good  plan  in  these  affections  to  paint,  on  successive  days, 
the  tincture  over  the  front,  the  lateral,  and  the  posterior  wall  of  the 
chest,  so  that  one  surface  has  time  to  recover  from  the  irritation  before 
it  is  again  attacked.  As  the  susceptibility  to  the  action  of  the  iodine 
varies  in  different  subjects,  it  is  always  prudent  to  make  a  slight  appli- 
cation in  the  beginning.  If  extreme  burning  follow  the  applications, 
the  iodine  may  be  dissolved  off  by  a  solution  of  iodide  of  potassium, 
by  alcohol,  or  ether. 

The  tincture  and  the  ointments  of  iodine  are  also  used  to  remove 
the  induration  of  the  breasts  which  results  from  attacks  of  inflamma- 
tion. It  must  be  remembered  that  the  integument  in  this  situation  is 
extremely  sensitive  to  irritating  applications.  Splenic  and  hepatic  dis- 
orders of  a  chronic  kind  are  frequently  treated  locally  by  the  applica- 
tion of  tincture  and  ointment  of  iodine.  Enlarged  spleen  of  malarial 
origin  is  more  speedily  cured  by  the  application  of  the  official  red 
iodide-of -mercury  ointment,  and,  as  regards  hepatic  disorders,  the  only 
affection  which  has  seemed  to  the  author  to  be  benefited  by  iodine  ap- 
plications is  the  engorgement  due  to  malarial  attacks. 

After  the  acute  symptoms  have  subsided,  tincture  of  iodine  will  re- 


IODINE   AND   IODIDES.  263 

move  the  swelling  of  orchids.  The  scrotum,  like  the  female  breast,  is 
very  sensitive  to  the  irritation  of  iodine  tincture  and  ointments.  Bubo, 
like  the  enlarged  lymphatic  glands  in  other  situations,  may  be  treated 
by  the  application  of  iodine-tincture,  but  it  is  not  very  effective. 

Although  Hebra  does  not  approve  of  the  internal  use  of  iodine  in 
cutaneous  diseases,  he  advises  the  local  application.  He  employs  the 
tincture  or  glycerine  solution  in  chloasma,  lentigo,  and  lupus.  The 
tincture  of  iodine  is  used  to  prevent  the  pitting  of  small-pox.  Accord- 
ing to  Piringer,  it  should  be  applied  as  follows  :  If  on  the  first  day  of 
the  eruption,  the  whole  face,  including  the  eyelids,  is  brushed  over  with 
the  tincture  of  iodine  ten  times,  there  being  an  interval  of  a  half -hour 
between  each  application  ;  if  on  the  second  day,  twelve  applications  ; 
if  on  the  third  day,  twelve  to  sixteen  applications.  The  tincture  of 
iodine  is  sometimes  painted  over  the  affected  surface  in  erysipelas,  and 
over  the  surrounding  healthy  integument,  to  prevent  the  spread  of  the 
disease,  but,  according  to  the  author's  experience,  it  is  bad  practice. 

lodoform  may  be  substituted  for  iodine  in  the  form  of  the  official 
ointment.  This  may  be  used  locally,  rubbed  in,  as  the  iodine-oint- 
ments are,  for  the  relief  of  local  inflammatory  swellings,  enlarged  lym- 
phatic glands,  goitre,  etc.  The  strong,  diffusive,  and  peculiar  odor  of 
iodoform  is  an  objection  to  its  use  in  this  way.  lodoform  powdered 
and  dusted  over  the  diseased  surface  is  an  excellent  application  to 
sloughing  and  ill-continued  wounds,  irritable  ulcers,  rodent  ulcer,  chan- 
croid, sloughing  phagedena,  and  serpiginous  syphilitic  ulcers.  It  allays 
pain,  changes  the  morbid  action,  and  is  antiseptic.  Syphilitic  ulcers 
of  the  tonsils,  pharynx,  and  tongue,  are  most  effectually  treated  by  local 
and  direct  application  of  powdered  iodoform.  In  these  cases  the  pow- 
der may  be  blown  on  to  the  surface  of  the  ulcer  by  an  insufflator  or 
insufflation-tube.  Fissures  of  the  anus,  hcemorrhoids  and  ttlcers  of 
the  rectum,  are  improved  in  condition,  and  the  pain  which  attends  them 
relieved  by  application  of  the  ointment  of  iodoform  and  by  iodoform 
suppositories.  The  latter  are  also  of  undoubted  service  in  chronic 
metritis  and  hypertrophy  of  the  prostate  when  introduced  into  the 
rectum  ;  the  iodoform  diffuses  into  the  neighboring  organs,  and  acts 
directly  upon  them.  T\\Q  pain  of  cancer  may  be  somewhat  relieved, 
and  the  fetid  odor  which  attends  the  discharges  may  be  removed,  by 
the  application  of  iodoform  to  the  diseased  surface.  This  treatment 
may  be  applied  to  cancer  in  any  situation,  but  is  especially  applicable 
to  cancer  of  the  uterus  and  rectum. 

The  parenchymatous  injection  of  tincture  of  iodine  is  a  remedial 
means  of  great  importance.  The  method  of  employing  it  is  exceeding- 
ly simple.  An  ordinary  hypodermatic  syringe  (glass  or  hard  rubber) 
is  charged  with  five  to  fifteen  minims  or  more  of  the  tincture,  and  the 
needle  is  thrust  deeply  into  the  affected  tissue,  and  the  iodine  is  slowly 
discharged.  For  injection  into  parts  very  deeply  situated,  long  needles, 


264  AGENTS   INCREASING  WASTE. 

such  as  are  made  for  aspiration,  can  be  used.  This  method  of  treat- 
ment is  very  effective  in  hypertrophied  tonsils,  goitre,  glandular  tumors, 
and  the  compound  cystic  and  glandular  growths  so  frequently  found 
in  the  neck.  The  author  has  witnessed  the  cure  of  many  cases  of  this 
kind  by  the  parenchymatous  injection  of  tincture  of  iodine.  Some  pre- 
cautions must  be  attended  to  in  practicing  these  injections.  When  the 
point  of  the  needle  is  inserted  as  deeply  as  desired,  it  should  be  moved 
about  to  disengage  it  from  any  vessels  into  which  it  may  have  pene- 
trated. Recent  observations  (1887)  by  Terrillon  and  Sebileau  have 
fully  confirmed  the  opinion  expressed  above  as  to  the  value  of  iodine 
injections  in  the  simple  and  fibroid  goitre,  and  they  express  a  decided 
preference  for  iodine  tincture  over  the  ethereal  solution  of  iodoform, 
recently  recommended. 

When  hydrothorax  returns  after  evacuation  of  the  cavity  by  the 
trocar,  the  compound  solution  of  iodine  or  the  tincture  may  be  injected 
into  the  pleural  sac.  In  empyema,  the  undiluted  tincture  of  iodine  may 
be  thrown  in  without  risk,  and  with  great  benefit.  Ordinarily,  a  solu- 
tion of  the  following  strength  may  be  used  to  wash  out  the  cavity  in 
cases  of  empyema  :  ^  Liq.  iodi  comp.,  §  j  ;  aquae,  f  xv.  M. 

Hydatids  of  the  liver  may  easily  be  destroyed  by  injecting  into  them 
a  few  drops  of  tincture  of  iodine.  It  has,  however,  been  shown  that  in 
some  instances  simple  capillary  puncture  and  withdrawal  of  the  fluid 
suffice  to  arrest  the  growth  and  to  abort  these  parasites.  Injection  of 
tincture  of  iodine  is  one  of  the  means  resorted  to  to  cure  hydrocele. 

It  is  said  that  hypertrophied  prostate  may  be  diminished  and  fur- 
ther enlargement  prevented  by  parenchymatous  injection  of  iodine. 
In  the  performance  of  this  operation  a  Sims  or  bivalve  rectal  speculum 
is  inserted,  and  the  needle  of  the  syringe  is  passed  through  the  walls 
of  the  rectum  into  the  gland.  Careful  palpation  previous  to  the  inser- 
tion of  the  needle  will  enable  the  operator  to  avoid  important  vessels. 

Unilocular  ovarian  cysts  may  sometimes  be  cured  by  injecting 
into  them,  after  the  withdrawal  of  the  fluid,  ten  to  sixteen  ounces  of 
tincture  of  iodine.  No  other  form  of  ovarian  cyst  will,  however,  be 
affected  favorably  by  this  expedient. 

Large  abscesses  may  be  made  to  close  much  more  speedily  than 
they  would  otherwise,  and  septic  infection  be  prevented,  by  the  injec- 
tion of  iodine-tincture  after  the  evacuation  of  the  matter. 

Numerous  cases  of  spina  bifida  have  been  cured  by  the  injection 
into  the  sac  of  tincture  of  iodine  (  3  ss ),  or  a  solution  of  iodine  (gr.  ss) 
and  iodide  of  potassium  (gr.  v)  in  water  (  3  j  )• 

lodo- Tannin. — This  is  an  excellent  application  for  local  diseases. 
Tannin  may  be  dissolved  to  saturation  in  tincture  of  iodine,  or  an  aque- 
ous solution  may  be  prepared  as  follows  :  3  Iodi,  3  j  ;  acid  tannici, 
§  j  ;  aquae,  Oj.  After  filtration,  to  be  evaporated  to  f  iv. 

The  author  has  found  a  saturated  solution  of  tannin  in  tincture  of 


IODIXE   AND   IODIDES.  265 

iodine  is  a  most  efficient  application  in  all  those  cases  of  uterine  disease 
in  which  the  tincture  of  iodine  and  iodized  cotton  and  iodized  glycerin 
are  now  so  much  used.  It  is  serviceable  in  chronic  cervicitis,  chronic 
endo-metritis,  sub-involution  and  hypertrophy  of  the  uterus.  The  au- 
thor has  also  found  that  the  following  combination  is  a  capital  appli- 
cation in  leucorrhoza  and  the  above-named  uterine  affections  :  IJ  lodo- 
f  ormi,  3  j  ;  acid,  tannici,  §  j.  M.  A  sufficient  quantity  to  be  packed 
in  the  dry  state  around  the  cervix. 

The  iodide  of  starch  is  used  by  Mr.  Marshall  as  a  dressing  for  syphi- 
litic ulcers,  and  he  speaks  highly  of  its  efficacy. 

A  decolorized  tincture  of  iodine  for  external  use  may  be  prepared 
as  follows  :  iodine,  hyposulphite  of  sodium,  distilled  water,  of  each  ten 
parts.  Dissolve  with  a  moderate  heat,  and  add  sixteen  parts  of  spirits 
ammonia,  and,  after  a  few  minutes'  agitation,  add  seventy-five  parts 
of  alcohol.  The  solution  must  stand  in  a  cool  place  for  three  days, 
and  then  be  filtered  (Waldenburg  und  Simon).  Decolorized  iodine  is 
of  doubtful  utility. 

An  extemporaneous  iodo-tannin  may  be  prepared  according  to  the 
formula  of  Sigmund  :  1J  Tinct.  iodi,  tinct.  gallse,  aa  §  ss.  M.  The 
strength  of  this  may  be  increased  by  the  addition  of  iodine  3ij. 

Acidum  lodicum. — lodic  acid.  It  occurs  in  the  form  of  white  crys- 
talline tablets  and  masses,  having  a  bitter  taste,  astringent,  odorless, 
and  freely  soluble  in  water. 

lodic  acid  combines  with  bases  to  form  salts,  which  are  crystalline 
and  freely  soluble  in  water. 

The  dose  of  iodic  acid  is  from  gr.  £  to  gr.  j. 

Sodii  lodas. — lodate  of  sodium.     Dose,  gr.  j  to  gr.  x. 

Potassii  lodas. — lodate  of  potassium.     Dose,  gr.  j  to  gr.  x. 

ACTIOXS  AND  USES. — lodic  acid  readily  parts  with  its  oxygen  in 
the  presence  of  reducing  substances,  depositing  iodine.  In  contact 
with  organic  matter  and  with  vegetable  alkaloids — morphine,  for  ex- 
ample— it  loses  oxygen.  When  administered  internally,  it  is  reduced 
in  its  passage  through  the  system,  iodine  appearing  in  the  urine.  It 
promotes  appetite  and  digestion,  favors  the  constructive  metamorpho- 
sis, and  improves  the  globular  richness  of  the  blood.  It  is  an  active 
haemostatic,  and  stops  general  oozing  of  blood  and  arrests  bleeding 
from  the  stomach.  Binz  shows  that  it  is  an  effective  antipyretic,  and 
that  it  depresses  the  functions  of  the  brain,  causing  sleep  and  ulti- 
mately coma.  The  iodine  is  eliminated  by  the  kidneys. 

Locally  applied  to  the  mucous  membrane  or  to  an  abraded  surface 
it  acts  as  an  irritant,  having  a  similar  effect  to  iodine  and  iodoform. 

Therapeutically,  iodic  acid  and  the  iodates  are  applied  topically  to 
the  nares,  throat,  and  auditory  canal  by  subcutaneous  injection  in  the 
treatment  of  specific  disorders,  by  the  stomach  for  the  relief  of  mala- 
dies of  that  viscus,  for  diseases  of  the  glandular  system,  for  bronchitis 


266  AGENTS   INCREASING   WASTE. 

and  asthma,  for  rheumatic  and  joint  affections,  for  the  effects  of  sub- 
acute  inflammation,  and  to  procure  the  absorption  of  exudates.  For 
ulcerations  of  the  nasal  and  pharyngeal  mucous  membrane  Ruhemann 
advises  a  mixture  of  iodic  and  boric  acids — 1  to  5  up  to  10  parts.  As 
a  local  application,  the  same  authority  advocates  the  mixture  of  iodate 
of  sodium  and  boric  acid  in  the  proportion  of  1  part  of  the  iodate  to  8 
or  10  parts  of  the  acid.  He  finds  this  combination  useful  as  an  anti- 
septic application  in  catarrh  and  other  affections  of  the  broncho-pul- 
monary mucous  membrane.  For  instillation  into  the  eye  he  advises  a 
solution  in  water  of  1  to  10  or  20. 

Iodic  acid  seems  specially  valuable  as  a  haemostatic  to  restrain  bleed- 
ing after  surgical  operations,  and  to  arrest  general  oozing  of  blood. 
It  is  indicated  in  hcematemesis.  Solutions  of  iodic  acid,  5  per  cent  up 
to  20  per  cent,  are  useful  in  the  treatment  of  gonorrhoea,  as  applica- 
tion to  soft  chancre,  for  cervicitis  and  other  catarrhal  affections  of 
the  genito-urjnary  mucous  membrane. 

In  strumous  affections,  glandular  tumors,  bronchial  asthma,  and 
in  the  various  manifestations  of  constitutional  syphilis  the  iodates  are 
said  to  be  effective  remedies.  In  these  diseases,  especially  in  the 
syphilitic,  iodate  of  sodium  has  been  administered  subcutaneously 
with  much  success.  In  joint  tuberculosis,  treated  heretofore  by  iodo- 
form  injections,  iodic  acid  is  said  to  be  preferable,  used  in  the  same 
manner.  The  pain  of  the  injection  may  be  allayed  by  the  simulta- 
neous use  of  cocaine.  Iodic  acid  is  also  recommended  to  be  used  by 
the  method  of  parenchymatous  injection  in  the  treatment  of  tumors, 
glandular  enlargements,  and  cystic  growths. 

Authorities  referred  to  : 

RUHEMANN,  DR.  J.  Therapeut.  Verwerthbarkeit  der  lodsdurer  und  des  iodsauren 
Natron.  Therapeut.  Jtfonate.,  Marz,  April,  1894. 

Ether  Hydriodicus. — Iodide  of  ethyl.    Ethyl  iodide. 

This  is  a  colorless,  non-inflammable  liquid.  The  odor  is  peculiar, 
very  powerful  and  diffusible,  and  the  taste  pungent.  It  is  not  soluble 
in  water,  but  dissolves  to  some  extent  in  alcohol.  Its  specific  gravity 
is  1'92,  and  its  boiling-point  160°  Fahr.  Exposed  to  light  and  air  it 
assumes  a  dirty,  brownish-yellow  color,  from  the  setting  free  of  iodine  ; 
hence  it  should  be  kept  in  closely-stoppered  bottles  in  the  dark.  The 
dose  is  five  to  twenty  drops  inhaled  from  a  handkerchief,  or  from  the 
vial  containing  it,  three  or  more  times  a  day. 

PHYSIOLOGICAL  ACTIONS. — Although  ethyl-iodide  might  be  classi- 
fied with  the  other  anaesthetic  agents,  its  physiological  and  therapeuti- 
cal effects  ally  it  more  nearly  to  the  iodides.  As  an  anaesthetic,  the 
action  is  slow  and  imperfect.  Dr.  Lawrence,  of  Boston,  testing  the 
action  in  his  own  person,  found  that  a  half -hour  of  inhalation  failed  to 
produce  even  drowsiness.  It  is  said,  however,  that  it  induces  the  anaes- 
thetic state  in  animals,  but  further  information  is  needed  on  this  point. 


IODINE   AND   IODIDES.  267 

THERAPY. — Ethyl  iodide  is  administered  by  the  broncho-pulmonary 
mucous  membrane.  Five  to  twenty  drops  are  put  on  a  handkerchief 
and  inhaled  as  may  be  necessary — every  two,  three,  or  four  hours,  or 
more  or  less  frequently  ;  or,  contained  in  a  small  vial,  the  heat  of  the 
hand  suffices  to  disengage  the  vapor,  which  can  then  be  inhaled 
directly.  As  a  means  of  introducing  iodine  into  the  blood,  it  offers 
many  advantages.  When,  therefore,  it  is  necessary  to  induce  iodism 
speedily,  as  in  syphiloma  of  the  brain  or  spinal  cord,  it  is  an  appro- 
priate remedy.  In  the  spasmodic  affections — the  neuroses  of  the  re- 
spiratory organs — as  asthma,  emphysema,  whooping-cough,  etc.,  when 
accompanied  by  catarrh  of  the  mucous  membrane  especially,  excel- 
lent results  are  obtained  from  the  inhalations.  Dr.  Lawrence  has 
found  it  of  exceptional  utility  in  asthma.  Good  effects  may  be  had 
from  it  in  capillary  bronchitis,  in  chronic  bronchitis,  in  fibroid 
phthisis,  in  caseous  phthisis,  and  in  local  catarrhs  of  the  air-passages. 

lodoforamm. — lodoform. — Iodide  of  formyl.  Small,  lemon-yellow, 
lustrous  crystals  of  the  hexagonal  system,  having  a  saffron-like  and 
almost  insuppressible  odor,  and  an  unpleasant,  slightly  sweetish  iodine- 
like  taste.  Not  perceptibly  soluble  in  water,  to^ which  it  imparts  a 
slight  odor  and  taste  ;  soluble  in  80  parts  of  alcohol  at  15°  C.  (59° 
Fahr.)  and  in  12  parts  of  boiling  alcohol,  in  5'2  parts  of  ether,  and  in 
chloroform,  benzol,  benzin,  disulphide  of  carbon,  fixed  or  volatile  oils. 
It  sublimes  slightly  at  ordinary  temperatures.  (U.  S.  P.) 

Unguentum  lodoformi. — lodoform  ointment.  lodoform,  10  grm.  ; 
benzoinated  lard,  90  grm. 

ACTIONS  AND  USES.  Notwithstanding  iodoform  contains  97  per 
cent  of  iodine,  it  possesses  properties  in  some  respects  different  from 
that  agent.  Discovered  by  Serullas  in  1822,  it  was  not  prescribed 
until  1836,  when  Bouchardat  used  it  because  of  the  large  quantity  of 
iodine  contained  in  it.  In  1853  D'Olleggio  brought  it  forward  as  a 
disinfectant  and  deodorizer  ;  and  in  1856  MM.  Moretin  et  Humbert 
showed  it  might  be  substituted  for  the  iodides,  because  easily  absorbed 
and  free  from  any  irritant  properties.  They  also  demonstrated  that 
iodoform  has  anodyne  effects,  that  it  induces  analgesia  of  the  rectum 
when  applied  to  it,  and  that  it  can  be  used  in  the  same  classes  of  dis- 
ease as  iodine,  and  in  some  neuralgias  and  painful  affections  of  the 
bladder  and  prostate.  In  1866  Dr.  Eastlake,  in  the  course  of  a  paper 
on  uterine  therapeutics,  referred  to  iodoform  as  a  valuable  sedative  in 
uterine  cases.  Dr.  Greenhalsrh  soon  after  confirmed  these  observa- 

O 

tions.  The  following  year,  Voelker  added  some  new  facts  of  the 
same  kind.  In  1868  Fereol,  in  a  paper  read  before  the  Therapeutical 
Society,  gave  full  details  regarding  the  effects  of  iodoform  on  wounds, 
fully  anticipating  many  of  the  observations  since  made  on  its  antiseptic 
and  healing  properties. 


268  AGENTS   INCREASING  WASTE. 

Little  attention  had  been  given  to  iodoform  in  Germany,  before 
the  investigation  made  by  Binz.  Moleschott  followed  these  researches 
by  some  important  chemical  observations,  and  afterward  Mosetig  and 
Mikulicz,  of  Vienna,  and  Gussenbauer,  of  Prague,  set  forth  the  remark- 
able virtues  of  this  substance  as  an  antiseptic  dressing.  Since  these 
communications  appeared,  the  use  of  iodoform  has  received  enormous 
extension,  and  its  popularity  has  attained  to  such  extravagant  propor- 
tions, that  the  wide-spread  enthusiasm  may  be  entitled  iodoform-mania. 
There  can  be  no  question,  however,  as  to  its  utility.  There  are,  never- 
theless, limitations  to  its  employment,  imposed  by  the  nature  of  the 
substance.  It  seems  desirable,  hence,  to  set  forth  in  a  special  article  its 
actions  and  uses,  according  to  the  modern  conceptions  of  its  powers. 

As  iodoform  contains  97  per  cent  of  iodine,  it  may  be  supposed  to 
have  analogous  properties,  but,  as  the  iodine  is  combined  with  the  radi- 
cal formyl,  another  influence  enters  into  the  action.  Applied  in  the 
form  of  crystals  or  as  a  powder,  the  immediate  effect  is  that  of  the 
compound — iodide  of  formyl — and  not  that  of  iodine  merely,  or  of 
formyl  merely  ;  but  the  latter  distinctly  modifies  the  former  ;  hence 
there  is  more  or  less  of  an  anodyne  effect.  Binz  holds  that  when  iodo- 
form is  applied  to  a  wound  it  is  dissolved  in  the  fatty  bodies  of  the 
organism,  and  that  iodine  is  disengaged  to  form  iodides  and  iodates. 
Hogyes,  on  the  contrary,  maintains  that  the  iodine  when  set  free  unites 
with  albumen,  and  afterward  forms  salts.  Moleschott  explains  the 
more  energetic  action  of  iodoform  by  the  assumption  that  it  is  readily 
decomposed  in  the  blood,  and  that  the  free  iodine  in  its  nascent  form 
has  more  energetic  affinities  (Rohmer).  In  what  manner  soever  its 
mode  of  action  may  be  explained,  the  main  point,  in  regard  to  which 
all  are  agreed,  is,  that  the  action  of  iodoform  is  chiefly  due  to  the  io- 
dine. The  effects  of  iodine  have  already  been  set  forth,  and  hence  no 
further  statements  are  necessary  ;  but  the  antiseptic  action  of  iodoform, 
to  which  its  present  applications  are  chiefly  due,  requires  further  ex- 
position. Mikulicz  has  especially  studied  the  effect  of  iodoform  on 
decomposing  animal  substances,  and  he  finds  that  it  prevents  change 
and  arrests  decomposition  when  begun.  For  the  purpose  of  determin- 
ing its  power  to  prevent  putrefaction,  he  employed  Pasteur's  liquid, 
composed  of  extracts  of  foods,  of  malt,  of  peptones,  of  alkaline  urine, 
and  of  bouillon,  and  blood,  and  covered  this  mixed  solution  with  pow- 
der and  crystals  of  iodoform.  The  experiment  was  varied  by  adding 
iodoform  in  different  quantity  to  solutions  having  the  same  composi- 
tion, and  a  "  control  experiment "  was  employed,  to  verify  the  results. 
It  was  shown  that,  in  those  solutions  treated  with  sufficient  iodoform, 
there  was  absolutely  no  development  of  minute  organisms,  while  in 
the  "  control "  fluid  the  germs  were  abundant  and  the  putrefactive 
process  active.  In  contact  with  wounds  it  has  a  very  prompt  and 
thorough  antiseptic  action.  It  promotes  union  and  cicatrization,  and 


IODINE   AND   IODIDES.  269 

at  no  time  are  there  any  heat,  redness,  swelling,  or  pain  produced  by 
it  at  the  point  of  application.  There  is  very  little  secretion  from  the 
wound  treated  by  the  application  of  iodoform,  and  the  little  observed 
has  rather  a  serous  than  a  purulent  character.  When  a  considerable 
loss  of  substance  is  to  be  closed  by  granulations,  iodoform  does  not 
act  so  well,  it  is  said,  and  hence,  when  the  granulations  have  filled  the 
wound  up  to  the  level  of  the  skin,  it  is  better  to  substitute  solutions  of 
nitrate  of  silver,  of  acetate  of  lead,  etc. 

Notwithstanding  iodoform  acts  in  many  respects  like  iodine,  there 
are  differences.  When  the  iodides  or  iodine  tincture  are  given  in  suf- 
ficient doses,  among  the  phenomena  of  iodism  caused  are  coryza, 
pharyngeal  and  laryngeal  catarrh,  etc.,  and  there  ensues  very  consid- 
erable wasting  of  the  tissues  in  general.  On  the  other  hand,  when 
iodoform  is  given,  wasting  does  not  occur,  but  the  body-weight  in- 
creases, the  complexion  grows  better,  and  the  general  condition  im- 
proves in  every  way  (Rohmer).  It  can  not  be  affirmed,  the  author 
believes,  that  these  beneficial  results  are  constant  for  all  doses  of  the 
remedy  administered  by  the  stomach,  or  for  all  quantity  when  applied 
topically.  In  fact,  the  first  enthusiasm  awakened  by  the  discovery  of 
the  antiseptic  powers  of  iodoform  has  been  chilled  by  the  untoward 
results  of  too  lavish  application.  Not  only  dusted  over  the  wounded 
surface,  but  applied  in  thick  layers,  it  was  soon  found  that,  notwith- 
standing the  slow  absorption  of  iodoform,  sufficient  entered  the  blood 
to  produce  alarming,  serious,  even  fatal  symptoms. 

Poisoning  by  Iodoform. — It  is  very  important  to  have  a  clear  con- 
ception of  the  mischief  which  may  be  thus  caused.  As  iodoforra,  or 
some  corresponding  chemical,  will  probably  continue  to  have  an  im- 
portant place  in  the  antiseptic  method  of  surgical  dressings,  and  as  it  is 
also  much  employed  in  medical  practice,  the  practitioner  should  learn 
to  recognize  the  untoward  symptoms.  "  Eseter,  of  Trieste,"  says  Lou- 
guet,  "  had  a  case  of  death  from  the  iodoform -mania."  But  many 
deaths  have  since  followed  from  the  too  lavish  use  of  this  agent.  An 
idiosyncrasy  is  observed  in  some  subjects — a  special  susceptibility  to 
the  action  of  the  iodides  in  general,  and  to  iodoform  in  especial.  It 
sometimes  happens  that  this  idiosyncrasy  develops  suddenly  and  with- 
out warning,  and  the  toxic  symptoms  occur  at  once,  death  quickly  ensu- 
ing, although  the  remedy  is  suspended  (Schede).  When  the  action  of 
iodoform  is  unfavorable,  the  symptoms  observed  have  been  as  follows  : 
1.  Kise  of  temperature  to  104°  Fahr.,  or  even  higher.  2.  In  addition  to 
fever,  there  will  be  headache,  loss  of  appetite,  a  rapid  pulse,  low  tension 
of  the  vessels,  etc.,  but  the  symptoms  in  both  classes  will  quickly  dis- 
appear if  the  remedy  is  discontinued.  3.  In  this  form  of  iodoform- 
poisoning,  the  pulse  is  quick,  reaching  even  180,  and  is  feeble  ;  there  is 
much  depression  of  the  forces  in  general,  and  the  condition  of  the  mind 
is  anxious,  restless,  and  melancholic.  These  symptoms  may  be  caused 


270  AGENTS   INCREASING   WASTE. 

in  some  subjects  by  the  first  application  of  iodoform,  or  may  come  on 
after  an  apparent  tolerance  has  been  established.  4.  In  this  group  of 
toxic  cases,  the  same  symptoms  occur  as  in  the  third,  viz.,  high  fever, 
melancholia,  etc.,  but  the  termination  is  quickly  fatal,  although  the  ap- 
plication of  the  remedy  is  stopped.  5.  In  this  group,  the  symptoms  of 
a  profound  depression  come  on,  and  death  speedily  occurs  in  a  condi- 
tion of  collapse.  In  many  examples  of  this  kind,  it  may  well  be  a 
question  whether  this  accident  is  not  due  to  the  injury  of  operative 
procedures.  6.  In  the  more  formidable  results  of  iodoform  applica- 
tions, very  decided  cerebral  symptoms  have  been  observed.  These 
have  been  described  by  Schede  and  Kiister  more  especially,  and  are 
mentioned  by  them  in  connection  with  the  several  classes  of  iodoform- 
poisoning  above  referred  to.  There  is,  however,  a  condition  of  the 
cerebrum  caused  by  iodoform-poisoning  characterized  by  disordered 
stomach,  high  fever,  dilated  pupils,  melancholic  depression,  stupidity 
of  mind,  involuntary  evacuations,  hallucinations,  etc. 

Notwithstanding  the  above-described  forms  of  poisoning  have  a 
real  existence,  it  is  held  by  Mundy,  Czerny,  Ktister,  and  others,  that 
now  and  then,  probably  frequently,  a  septicaemic  state,  and  undiscov- 
ered complications,  are  responsible  for  the  symptoms  attributed  to 
iodoform.  Making  due  allowance  for  such  an  error,  there  are  still 
examples  of  the  toxic  effects  of  iodoform ;  hence  the  need  of  proper 
caution  in  using  it  topically. 

Treatment  of  Iodoform  Intoxication. — The  first  step  consists  in 
the  withdraw?  .  of  the  application,  and  every  adherent  particle  should 
be  at  once  removed.  The  powers  of  life  should  be  supported  by  a 
judicious  use  of  stimulants,  and  especially  by  small  doses  of  the  tinc- 
ture of  opium,  frequently  repeated.  Elimination  should  be  promoted 
by  diluents  freely  administered. 

The  most  important  point  as  regards  prophylaxis  is  to  avoid  too 
lavish  use  of  the  agent.  Schede  says  that  large  flesh-wounds  should 
not  be  filled  with  iodoform,  for  then  it  can  be  removed  only  with  the 
scab.  Granulating  surfaces  absorb  less,  but  here  the  danger  of  in- 
toxication also  exists.  Mundy  advises  that  a  small  quantity  only  of 
the  powder  be  dusted  over  the  wound,  that  the  dressings  be  allowed 
to  remain,  and  that  close  sutures  and  tight  bandages  be  avoided.  It 
appears  that  caution  is  needed  in  the  application  to  the  amputated 
breast,  and  in  all  operations  involving  the  peritonaeum.  As  to  quantity 
used,  we  are  guided  by  the  results  following  lavish  use.  Three  hun- 
dred grammes  in  one  case  (Beger),  100  to  200  grammes  (Henri)  in 
another,  have  induced  poisoning.  Death  followed  the  use  of  35  to  40 
grammes  (542  to  620  grains)  in  a  case  of  operation  involving  the  peri- 
tonaeum (Kiister). 

Von  Mosetig-Moorhof  has  employed  iodoform  in  several  thousands 
of  surgical  cases  without  a  single  instance  of  poisoning,  and  he  attrib- 


IODINE   AND   IODIDES.  271 

utes  this  favorable  result  to  the  fact  that  he  has  not  used  large  quanti- 
ties of  the  remedy,  that  the  wound  was  not  subjected  to  pressure,  that 
the  dressings  were  frequently  changed,  and  that  carbolic  acid  was  not 
used  at  the  same  time. 

Mode  of  applying  locloform. — The  simplest  mode  consists  in  merely 
dusting  the  powder  over  the  surface,  wound,  or  sore,  to  be  acted  on.  A 
common  tin  pepper-box  or  an  insufflator  may  be  utilized  for  this  pur- 
pose. Gauze  or  absorbent  cotton  may  be  saturated  with  an  ethereal 
saturated  solution  of  iodoform  and  applied  according  to  the  methods 
of  Lister.  Iodoform  and  tannin  may  be  applied  in  any  desired  pro- 
portion after  they  have  been  thoroughly  triturated  together.  Iodoform 
may  also  be  suspended  in  a  mixture  with  gum — with  glycerin  and  gum- 
tragacanth.  As  the  odor  of  this  substance  is  so  diffusive  and  persist- 
ent, various  means  have  been  resorted  to  for  its  removal  or  modifica- 
tion. The  essential  oils,  the  balsams  of  Peru  and  tolu,  essences  of  all 
kinds,  menthol,  eucalyptol,  and  thymol,  have  been  employed  with  vary- 
ing success  ;  of  these,  thymol  appears  to  be  the  best,  for,  while  it  modi- 
fies the  odor,  it  less  impairs  the  antiseptic  qualities.  The  mixture  of 
iodoform  and  thymol  may  be  in  any  desired  proportion.  Lindemann 
advises  the  following  mixture  :  Iodoform,  1  part  ;  balsam  of  Peru, 
3  parts  ;  and  vaseline,  8  parts  :  or  iodoform,  1  part ;  balsam  of  Peru, 
3  parts  ;  alcohol,  glycerin,  or  collodion,  12  parts.  Recently,  pulverized 
roasted  coffee  has  been  shown  to  be  very  effective,  and  this  material 
does  not  impair  the  peculiar  qualities  of  iodoform,  as  many  of  the 
disguises  now  used  do. 

THERAPY. — In  general  it  may  be  stated  that  iodoform  is  now  used 
in  all  the  tcounds,  injuries,  diseases,  requiring  the  action  of  an  anti- 
septic. Chancres,  ulcers,  sloughing  and  phagedenic  ulcers,  surgical 
operations,  etc.,  are  especially  benefited  by  its  application.  It  is, 
above  all  topical  remedies,  the  most  appropriate  for  gunshot  wounds 
and  injuries  (Mundy).  As  an  antiseptic  remedy,  it  has  hardly  kept 
the  position  originally  attained,  for  it  has  proved  to  be  less  destruc- 
tive of  pathogenic  organisms  than  was  supposed  during  the  period  of 
'''iodoform  mania."  Notwithstanding  this  change  in  opinion  and  prac- 
tice as  to  its  utility  in  surgical  maladies,  there  has  been  a  steady 
growth  in  the  appreciation  of  iodoform  in  certain  diseases  of  internal 
organs — in  phthisis,  hepatic  disorders,  malarial  troubles,  etc. 

For  internal  use  the  dose  of  iodoform  will  range  between  one  half 
a  grain  to  five  grains,  but  the  usual  dose  for  an  adult,  free  from  any 
idiosyncrasy  as  to  its  action,  is  two  grains,  three  to  six  times  a  day. 
The  most  suitable  form  for  administration  is  the  pill,  or  capsule  ;  but 
for  some  affections,  solution  in  cod-liver  oil  makes  an  advantageous 
preparation. 

In  chronic  gastric  catarrh,  g astro-duodenal  catarrh,  and  when  the 
catarrhal  process  invades  the  hepatic  and  pancreatic  ducts,  iodoform 


272  AGENTS   INCREASING   WASTE. 

renders  an  important  service.  It  checks  fermentation,  and  modifies 
the  catarrhal  troubles.  The  most  conspicuous  and  valuable  effects 
are  those  produced  in  catarrhal  jaundice — for  the  remedy  not  only 
lessens  or  removes  the  morbid  action  going  on  in  the  liver-ducts,  but 
it  promotes  elimination  of  the  bile  acids  and  pigment  contained  in  the 
blood.  The  author  has  reason  to  believe  that  cirrhosis  of  the  liver,  if 
the  disease  is  not  too  far  advanced,  especially  the  hypertrophic  form, 
may  be  arrested  by  the  diligent  and  persistent  use  of  iodoform  in 
moderate  doses.  Combination  with  the  salts  of  manganese — the  sul- 
phate chiefly — increases  the  action,  and  has  been  ascertained  to  be 
peculiarly  effective  in  gouty  subjects. 

In  chronic  dysentery,  good  results  have  been  obtained  by  iodoform 
injections  (Culbertson).  The  systemic  effects  of  iodoform  are  sedative 
and  resolvent  (Kirsch),  and  it  has  been  applied  with  some  success  in 
phthisis  and  in  strumous  affections,  but  has  not  proved  useful  in 
syphilitic  adenitis,  although  a  priori  it  would  appear  to  be  clearly 
indicated.  There  is  much  evidence  that  it  is  beneficial  in  the  more 
chronic  cases  of  phthisis,  and  in  those  originating  in  chronic  bronchitis 
and  in  exudative  pleuritis,  but  examples  showing  its  remarkable  power 
in  phthisis  florida  have  also  been  recently  published.  In  a  highly  in- 
teresting and  valuable  paper  read  by  Dr.  Shingleton  Smith  before  the 
International  Medical  Congress,  he  presents  the  results  obtained  from 
its  internal  administration  by  numerous  observers  in  various  countries. 
All  forms  of  phthisis  are  included,  and  the  results  of  the  practice  as 
reported  by  such  authorities  as  Prof.  Semmola,  of  Naples  ;  Dr.  Cols- 
feld,  of  Bremen  ;  Drs.  Bummo  and  Renzi ;  Dr.  Dreschfeld,  of  Man- 
chester, and  Dr.  Shingleton  Smith,  are  included  in  the  summary.  The 
therapeutical  effects  were  gain  in  weight,  increase  of  appetite,  lessen- 
ing of  cough  and  expectoration,  lowering  of  the  temperature,  and  de- 
cided diminution,  often  entire  suppression,  of  sweating.  Although,  as 
has  been  stated,  iodoform  is  not  one  of  the  more  active  germicides,  it 
is  very  destructive  of  the  bacillus  tuberculosis,  which  is  remarkably  in- 
hibited, and  its  pullulation  prevented.  With  the  internal  treatment 
the  topical  may  be  combined,  the  iodoform  in  the  finest  powder,  ap- 
plied by  means  of  an  insufflator,  or  the  ethereal  solution,  inhaled.  Also, 
simultaneously,  ethyl  iodide  can  be  inhaled,  with  or  without  iodoform 
dissolved  in  it.  Drs.  Renzi  and  Rummo  have  ascertained  that  the 
systemic  effects  of  iodoform  are  more  promptly  and  powerfully  pro- 
duced when  this  agent  is  taken  by  inhalation  than  when  it  is  adminis- 
tered by  the  stomach. 

In  cases  characterized  by  insufficient  oxidation,  as  the  so-called 
lithoBmia,  diabetes,  obesity,  etc.,  iodoform  has  proved  highly  effective 
in  some  instances.  The  amount  of  testimony  in  regard  to  its  benefi- 
cial action  in  diabetes  is  quite  considerable.  The  physiological  basis 
for  its  administration  in  these  maladies  consists  in  its  power  to  increase 


IODINE   AND   IODIDES.  273 

the  conversion  of  uric  acid  into  urea,  and  to  promote  combustion  of 
the  nitrogenous  material  submitted  to  its  action  (Testa,  Moleschott, 
Ransome,  and  others).  In  cases  of  obesity,  it  is  highly  effective,  as 
compared  to  the  influence  of  other  remedies  ;  but  it  should  not  be  for- 
gotten that  it  causes  rapid  wasting  and  anaemia,  probably  because  of 
the  injury  done  to  the  red  blood-corpuscles  (Bozzolo),  and  hence  it 
must  be  administered  with  caution,  and  in  combination  with  other 
remedies  that  will  lessen  its  injurious  action  on  nutrition.  Moleschott 
reports  that,  in  five  cases  of  diabetes,  iodoform,  in  doses  of  one  and  a 
half  to  three  grains,  rapidly  reduced  the  quantity  of  sugar  and  caused 
its  disappearance  in  four  or  five  days,  although  no  change  in  diet  had 
been  made.  If  these  extraordinary  results  are  confirmed  by  the  ex- 
perience of  others,  it  will  be  impossible  to  overestimate  the  value  of 
iodoform  as  a  remedy. 

The  susceptibility  to  the  toxic  action  of  iodoform  varies  so  great- 
ly that  no  arbitrary  rule  of  dosage  can  be  properly  made.  One 
grain  may,  if  given  frequently,  cause  iodism  in  some  subjects  ;  on  the 
other  hand,  three-grain  doses  may  be  continued  for  a  long  time  with- 
out any  unpleasant  effects.  Gastric  disorder,  drowsiness,  maniacal 
excitement,  weakness,  impaired  locomotion,  rapid  wasting,  fever,  etc., 
are  symptoms  that  may  arise  during  the  administration  of  this  remedy 
in  moderate  doses. 

lodol. — The  disagreeable,  penetrating,  and  diffusive  odor  of  iodo- 
form has  greatly  restricted  its  use.  The  attempts  made  to  overcome 
this  inconvenient  quality  have  not  been  satisfactory,  and  hence  the 
attention  of  chemists  has  been  turned  in  the  direction  of  a  substi- 
tute, which  shall  be  possessed  of  the  valuable  powers  of  iodoform  and 
free  from  its  unpleasant  odor.  lodol  has  been  produced,  and  may  be 
employed  in  all  of  the  conditions  for  which  iodoform  has  hitherto 
been  prescribed.  The  new  medicament  is  obtained  by  the  action  of 
iodine  on  certain  constituents  of  animal  oil.  Its  chemical  name  is 
Tetraiodopyrol.  The  proportion  of  iodine  is  quite  large — about  85 
parts  to  90  by  weight — yet  not  equal  to  iodoform  in  this  respect, 
which  contains  about  96  parts. 

lodol  occurs  in  the  form  of  a  grayish- white  powder  which  darkens  by 
exposure  to  light,  is  without  odor,  has  very  little  taste,  is  readily  soluble 
in  alcohol,  ether,  and  chloroform,  but  is  almost  insoluble  in  water.  It  is, 
however,  quite  soluble  in  the  juices  of  the  stomach,  for  its  characteris- 
tic actions  take  place  in  a  short  time  after  its  ingestion.  The  dose  for 
internal  administration  will  range  from  one  fourth  of  a  grain  to  five 
grains.  It  can  be  given  in  a  wafer,  in  pill  or  pellet,  or  in  simple  powder,, 

Although  iodol  contains  somewhat  less  of  iodine  than  iodoform,  it 
parts  with  that  constituent  more  readily,  whence  we  conclude  that  it 
is  quite  as  effective.  Clinical  experience  confirms  this  view,  for  iodol, 
applied  in  all  the  morbid  conditions  heretofore  treated  by  iodoform, 


274  AGENTS   INCREASING   WASTE. 

has  been  found  to  be  quite  as  useful.  It  is  antiseptic,  deodorant,  and 
anaesthetic.  Iodine  liberated  acts  on  the  albuminous  elements,  and 
ozone  set  free  oxidizes  the  compounds  of  sulphur  and  phosphorus.  It 
has  a  feeble  escharotic  action,  whence  it  forms  a  thin  crust  on  the  sur- 
face to  which  it  is  applied,  and  thus  acts  mechanically  in  part  to  re- 
tain the  medicament  in  contact  with  the  diseased  surface. 

The  proof  that  iodol  diffuses  throughout  the  organism  is  conclu- 
sive. Applied  to  a  wounded  surface,  it  can  presently  be  detected  in 
the  saliva  and  in  the  urine,  and  the  same  results  are  obtained  when  it 
is  administered  by  the  stomach.  As  compared  with  iodide  of  potas- 
sium it  is  much  less  prompt  in  action,  but  more  prolonged,  and  its 
elimination  slower  (Pick,  Mazzoni). 

Experience  has  now  shown  that  it  is  never  necessary  to  administer 
a  quantity  of  iodol  that  could  cause  toxic  symptoms.  Unlike  iodo- 
form,  no  quantity,  applied  to  an  open  wound,  will  have  a  toxic  effect 
(Wolfenden).  As  a  remedy,  various  modes  of  application  have  been 
proposed — as  an  impalpable  powder,  to  be  dusted  on  wounds,  ulcers, 
etc.,  without  any  addition  to  it,  or  any  vehicle.  A  solution  in  alcohol 
and  glycerin,  thus  :  iodol,  1  part ;  alcohol,  16  parts  ;  glycerin,  34  parts, 
was  proposed  originally  by  Mazzoni,  and  much  used  by  him  as  a  topi- 
cal application.  An  ethereal  solution  ( 3  j  —  3  j)  has  some  advantage, 
in  that  when  the  ether  evaporates,  the  medicament  remains  deposited 
in  the  minutest  subdivision  on  the  affected  part.  Various  forms  of 
applications  are  now  resorted  to — for  example,  iodol  pastils,  bougies, 
ointment  ;  iodol  cotton,  iodol  gauze,  etc.,  corresponding  to  those  made 
with  iodoform. 

Without  repeating  the  various  therapeutical  details,  it  will  suffice 
to  say  that  iodol  can  be  advantageously  substituted  for  iodoform  in 
the  multiform  applications  of  the  latter  which  have  had  so  much  pro- 
fessional appreciation  within  a  few  years  past.  That  iodol  can  effect- 
ively improve  morbid  conditions,  appropriate  for  its  action,  is  now 
admitted  by  all  those  who  have  had  experience  in  its  use. 

Authorities  referred  to  : 

CABRERAS- ARAGO.     Iodol  in  Ophthalmic  Practice.     Abstract  in  Virchow  and  HirscNs 
Jahresbericht,  1886. 

MAZZONI,  MARCUS,  and  others,  in  Berliner  klin.  Woch.   Various  Nos.  for  1885  and  1886. 

PICK,  DR.  J.  P.     Revue  de  Therapeutigue,  May  15,  1887,  p.  260.     Ibid.,  1885,  1886. 

THERAPEUTIC  GAZETTE.     Therapeutics  of  Iodol,  May  16,  1887. 

SCHNIRER,  DR.     Bui.  Gen.  de  Therap.,  February  15,  1887. 

TROUSSEAU,  DR.     Ibid. 

WOLFENDEN,  DR.  R.  N.     The  Praetitioner,  vol.  xxxviii,  p.  836. 

Authorities  referred  to  for  iodoform,  iodol,  and  ethyl  iodide : 

BELLINI,  of  Florence,  and  RENZI,  of  Naples.     Controversy  on  the  Action  of  Iodine, 
reported  in  1}  Union  Medicale,  No.  20,  p.  481. 

BENEDICT,  DR.  MORIZ.     SclynidCs  Jahrbucher  der  gesammten  Medicin,  vol.  cxv,  p.  284. 


IODINE   AND   IODIDES.  275 

BINZ,  PROF.  DR.  C.  Ueber  lodoform  und  uber  lodsdure.  Archiv  fur  experiment. 
Pathologie  und  Pharmacologie,  Band  viii,  p.  309. 

CULBERTSON,  DR.  R.  H.     Therapeutic  Gazette,  March  15,  1885. 

FRANKEL,  DR.  B.     Berliner  klinische  Wochenschrift,  ix,  6,  1872. 

HEBRA,  PROP.  VON.  Allg.  Wien.  med.  Zeitg.,  vii,  3,  1862.  Schmidfs  Jahrbucher,  voL 
cxvii,  p.  26. 

HERMANN,  DR.  Jos.  Die  Nichtezistenz  des  constitutionellen  lodismus.  Schmidfs  Jahr- 
biicher,  vol.  cxii,  p.  19. 

HOGYES.  PROF.  ANDREAS.  Anmerkungen  uber  die  physiologische  Wirkung  des  lodo- 
form und  uber  eine  Umwandlung  im  Organismus.  Archiv  fur  experiment.  Pathologie 
vnd  Pharmacologie,  Band  x,  p.  228. 

HUTCHISON,  MR.  JONATHAN.     Lancet,  May  22,  1875,  p.  725. 

KAMMERER,  PROF.  DR.  HERMANN.  Archiv  fur  path.  Anat.  und  Phys.,  von  Rudolph 
Virchow,  1874,  p.  459.  The  article  of  Binz,  above  referred  to,  was  instigated  by  this  paper. 

KtrsTER,  PROF.  DR.     Revue  de  Chiruraie,  1882,  and  L1 Union  Medicale,  August,  1882. 

LAWRENCE,  DR.     New  York  Medical  Journal,  1881,  p.  685. 

LINDEMANN,  DR.     Annuaire  de  Tlierapeutique,  1881,  p.  269. 

MUNDT,  PROF.  DR.  Berliner  klin.  Wochenschrift,  No.  14,  1882,  quoted  by  Z' Union 
Med.,  No,  125,  1882,  p.  439. 

POLIAKOFF,  DR.     London  Medical  Record  for  February  15,  1886. 

ROSENTHAL,  PROF.  DR.  Zur  Kenntniss  der  Resorption  und  Absorption  der  lodprdpa- 
rate.  Wien.  mcd.  Woch.,  xiii,  1863. 

RCMMO,  DR.     Archives  de  Physiol.  normale  et pathol.,  Nos.  6  and  7,  1885. 

RUMMO  AND  RENZI.     London  Medical  Record,  1885. 

SANDS,  DR.  II.  B.     New  York  Medical  Journal,  November  12,  1882. 

SCHEDE,  PROF.  DR.  Deut.  med.  Zeit.,  quoted  by  the  London  Medical  Record,  July 
15,  1882. 

SCHMIDT,  Dr.  J.  B.     Berl  klin.  Wochen.,  vii,  34,  1870. 

Loretin. — The  chemical  designation  of  this  substitute  for  iodoform 
is  meta-iodo-ortho-oxyquinoline-ana-sulphonic  acid.  Some  more  man- 
ageable title  is  clearly  necessary,  and,  although  trade  names  are  objec- 
tionable, this  may  be  adopted  as  a  convenient  term  sufficiently  sig- 
nificant. 

Loretin  contains  iodine  in  considerable  quantity;  it  has  the  crys- 
talline structure  and  the  appearance  of  iodoform,  but  is  entirely  free 
from  odor.  It  is  unirritating,  and  can  be  freely  applied  in  the  form 
of  powder  to  any  open  wound  without  occasioning  any  distress.  It  is 
but  slightly  soluble  in  water  and  alcohol,  and  not  all  soluble  in  ether 
and  fats.  It  may  be  dissolved  in  solutions  of  alkaline  salts,  but  the 
chief  if  not  the  only  mode  of  application  is  in  the  form  of  powder.  It 
does  not  cause  any  erysipelatous  or  eczematous  rash,  such  as  are  apt 
to  appear  when  iodoform  is  used,  and  will  remove  such  when  formed. 

Loretin  can  be  made  use  of  as  an  antiseptic  by  merely  local  appli- 
cation to  the  surface  of  wounds  in  sinuses  and  cavities,  in  the  treat- 
ment of  lupus,  etc. 

Authorities  referred  to  : 

CLACS,  PROF.  DR.  Pharm.  Post.,  quoted  by  Centralblatt  fur  die  gesammte  Therapie. 
Wien,  Janner,  1894. 

SCHINZINGER,  PROF.  DR.     Ibid. 
20 


276  AGENTS   INCREASING   WASTE. 

Nosophen. — This  is  the  proprietary  designation  of  tetra-iodo-phenol- 
phtalcin,  a  recent  substitute  for  iodoform.  It  contains,  it  is  said,  61 
per  cent  of  iodine.  It  occurs  as  a  greenish-yellow  powder,  is  without 
taste,  has  no  odor,  and  is  entirely  insoluble  in  water.  It  must,  there- 
fore, be  prescribed  in  the  form  of  powder,  or  suspended  in  an  emulsion, 
or  mixed  with  ointments.  The  dose  for  internal  administration  ranges 
from  three  to  six  grains,  but  as  it  is  not  irritating  nor  poisonous  it  can 
probably  be  given  in  much  larger  quantity. 

As  a  substitute  for  iodoform,  it  is  no  doubt  applicable  to  the  same 
conditions  as  that  agent,  but  it  contains  one  third  less  of  iodine,  and, 
although  effective  as  a  local  anaesthetic  and  antiseptic,  must  therefore 
be  somewhat  less  powerful.  It  does  not  cause  any  local  irritation, 
nor  act  on  the  brain,  nor  produce  any  of  the  systemic  effects  which 
have  followed  the  free  application  of  iodoform.  Nosophen  is  said  to 
be  a  powerful  antiseptic  and  germicide,  and  therefore  applicable  as  a 
remedy  to  poisoned  wounds,  to  abscess  cavities  and  sinuses,  to  the 
throat  and  nares  in  diphtheria,  and  to  chronic  catarrhal  affections  of 
these  parts.  It  has  been  employed  successfully  in  otorrhoea.  Chancre, 
gonorrhoea,  and  specific  local  diseases  are  conditions  in  which  it  may 
be  highly  useful. 

Europhen  [not  euphorin]. — By  this  proprietary  designation  is  iodo- 
iso-butyl-ortho-cresol  now  known.  It  has  been  brought  forward  as  one 
of  the  substitutes  for  iodoform.  It  is  a  yellowish,  amorphous  powder 
with  a  saffron-like  odor.  It  is  soluble  in  ether,  alcohol,  and  fats,  but 
not  in  water.  It  should  contain  one  fifth  to  one  fourth  of  iodine,  and 
should  not  be  used  in  a  mixture  with  the  metallic  oxides  and  mercu- 
rials with  which  it  is  incompatible. 

Europhen  is  employed  as  a  powder  undiluted,  or  mixed  with  talc 
or  some  neutral  powder,  or  in  the  form  of  ointment,  or  dissolved  in 
ether  or  oil  of  vaseline.  As  a  substitute  for  iodoform  it  is  prescribed 
in  affections  of  the  nose,  throat,  and  ear,  in  diseases  of  the  skin,  in 
venereal  diseases,  and  as  an  antiseptic  in  wounds  and  injuries,  and 
after  surgical  operations  to  prevent  sepsis  and  to  promote  healing. 
Dr.  Szenes,  of  Budapest,  finds  it  equal  to  the  most  approved  of  the  top- 
ical remedies,  in  a  series  of  comparative  trials.  Dr.  Saalfield,  of  Ber- 
lin, has  employed  it  successfully  in  intertrigo,  eczema,  and  ulcers,  in 
the  form  of  ointment,  using  5  to  10  per  cent  of  europhen  to  the  same 
proportion  of  lanolin  and  to  100  parts  of  talc.  Mixed  with  collodion, 
it  is  applied  to  bubo.  Neuberger  reports  on  successful  trials  of  euro- 
phen in  balanitis,  herpes,  soft  chancre,  applying  it  undiluted  in  the 
form  of  powder.  Jasinski  has  had  good  results  with  it  in  the  treat- 
ment of  local  tuberculosis,  and  Goldschmidt,  of  Madeira,  in  leprosy. 
Ullmann  has  found  it  useful  in  skin  diseases  in  general  as  a  topical 
application.  Chappell,  of  New  York,  has  employed  it  with  success  in 
the  treatment  of  ozoena,  and  has  found  it  a  valuable  haemostatic. 


IODINE   AND   IODIDES.  277 

Sozoiodol. — The  chemical  name  of  this  substance  is  di-iod-para- 
phenol-sulphonic  acid.  It  combines  with  bases  to  form  salts,  of  which 
the  combinations  with  mercury,  potassium,  and  sodium  have  been 
used  or  proposed  for  use  in  medical  practice.  Sozoiodol  contains  52 
per  cent  of  iodine,  and  crystallizes  in  prisms.  It  is  soluble  in  water, 
alcohol,  and  ether. 

This  preparation  has  been  introduced  as  a  substitute  for  iodoform, 
and  was  first  reported  on  in  1888  by  Dr.  Fritsche,  since  which  time  it 
has  been  used  with  a  measure  of  success,  especially  in  its  combination 
with  mercury.  But  sozoiodol  has  been  applied  in  the  undiluted  form, 
and  in  solution  in  water  in  the  treatment  of  rhinitis  and  other  nasal 
affections,  in  otorrhoea,  and  catarrhal  and  ulcerative  affections  of  the 
mouth  and  throat  (Teichmann).  It  is  an  excellent  antiseptic  dressing 
for  wounds  and  injuries,  for  venereal  sores,  and  as  an  injection  for 
gonorrhoea.  In  venereal  diseases  it  stands  in  the  front  rank  as  a  rem- 
edy, according  to  Rosinski.  The  combination  with  mercury  has  been 
used  subcutaneously  with  much  success.  In  fact,  in  the  whole  range 
of  the  applications  of  iodoform  for  external  and  internal  purposes,  so- 
zoiodol may  be  equally  applied. 

Authorities  referred  to  : 

ROSINSKI,  DR.  Zur  Sozoiodolbehandlung  eiternder  und  Geschwure.  Therapeut.  Mo- 
nafe.,  December,  1893. 

TEICHMANN,  DR.  MAX.     Ibid.,  April,  1894. 

WOLF,  DR.  FR.  Beitrdge  zur  Sozoiodoltherapie.  Virchow  und  Hirsch  Jahresbericht, 
1893. 

.  Aristol. — Dithymol-diiodide  is  a  substitution  compound,  in  which 
two  molecules  of  hydroxyl  have  been  replaced  by  two  of  iodoxyl,  and 
to  this  product  has  been  given  the  name  aristol.  It  contains  48  per 
cent  of  iodine.  It  is  insoluble  in  water,  but  dissolves  in  ether  and  col- 
lodion, and  slightly  in  chloroform. 

It  is  a  reddish-brown  powder,  and  has  a  faint  aromatic  odor.  The 
powder  may  be  applied  undiluted  or  mixed  with  other  innocuous  pow- 
der, or  made  into  ointment  with  lanolin  or  vaseline. 

It  has  been  used  chiefly  in  nasal,  aural,  and  cutaneous  maladies. 
In  purulent  otitis  media  it  has  given  better  results  than  boric  acid, 
according  to  Gaevert,  Krebs,  and  Biirkner.  In  ulcerations  of  the  eye, 
boils,  and  granulations  it  has  proved  efficacious.  For  these  purposes 
it  is  applied  in  the  form  of  ointment  (10  per  cent).  Chronic  rhinitis  is 
also  cured  by  application  of  the  same  ointment.  In  burns,  according 
to  Haas,  it  is  a  valuable  antiseptic  and  analgesic  application.  Accord- 
ing to  Heckel,  it  relieves  sweating  of  the  feet,  and  in  psoriasis  it  is  as 
effective  as  chrysarobin,  while  not  staining  the  neighboring  parts.  It 
is  also  useful  in  pityriasis. 

In  local  venereal  affections,  as  balanitis,  soft  chancre,  warts,  etc.,  it 
has  usually  acted  most  favorably. 


278  AGENTS  INCREASING  WASTE. 

Authorities  referred  to  : 

BURK.NER,  DR.      Virehow  und  Hirsctis  Jahresbericht  for  1894. 

HECKEL,  DR.     Ibid. 

GAEVERT,  DR.  CH.     Therapeutische  Monatshefte,  September,  1895. 

KREBS,  DR.,  in  Hildesheim.     Ibid.,  August,  1894. 

LEWIS,  DR.  DANIEL.     The  New  York  Medical  Record,  June,  1894. 

Airol. — Under  this  designation  Haegler  has  recently  brought  for- 
ward a  combination  of  basic  gallic  acid  with  bismuth-oxy-iodide.  It 
is  dermatol,  in  which  iodine  replaces  OH.  It  occurs  as  a  greenish-gray 
voluminous  powder,  without  odor  or  taste,  and  permanent  in  the  air. 
It  is  slightly  soluble  in  water,  and  decomposes  in  acid  and  alkaline  so- 
lutions. For  topical  administration  the  powder  may  be  dusted  over 
the  affected  surface,  or  it  may  be  applied  in  the  form  of  gauze  to  10 
to  20  per  cent;  as  an  ointment,  10  to  20  per  cent;  and  as  a  collodion — 
airol  collodion — 10  per  cent.  For  internal  administration  it  may  be 
used  in  powder,  in  capsule,  or  in  wafer,  or  it  may  be  suspended  in 
equal  parts  of  glycerine  and  water.  As  an  injection  in  tubercular  ab- 
scesses, Haegler  proposes  an  emulsion  of  10  per  cent  in  equal  parts  of 
water  and  glycerine.  The  dose  for  use  internally  ranges  from  5  to  15 
grains  or  more.  As  respects  its  comparative  toxicity,  the  fatal  dose 
in  cats  is  between  3  and  4  grin.  (45  to  60  grains)  per  kilogramme  of 
body-weight.  The  toxic  dose  of  iodoform  in  the  same  animals  is 
about  1  grm.  (15^-  grains). 

The  bacteriological  researches  of  Haegler  have  demonstrated  that 
airol  is  about  equal  to  iodoform  as  a  poison  of  the  bacillus  of  cholera 
and  other  pathogenic  organisms.  As  it  has  the  composition  of  derma- 
tol, and  contains  besides  a  considerable  proportion  of  iodine,  it  should 
possess  a  wider  range  of  attributes  than  this  much-vaunted  remedy. 
As  a  dressing  for  wounds,  it  has  been  used  in  the  same  manner  and 
under  the  same  conditions  as  iodoform.  The  gauze,  ointment,  and 
collodion  preparation  are  thus  employed.  In  chronic  otorrhcea  and 
chronic  nasal  catarrh  it  is  used  as  powder  and  ointment  successfully. 

Authorities  referred  to : 

HAEGLER,  DR.  C.  S.  Ueber  Airol,  ein  neues  Ersatzmittel  des  lodoforms,  und  ahnliche 
antiseptische  Pulvermittel.  Beit.  z.  klin.  Chirurgie,  Band  xv,  Heft  L  Therapeut.  Monats- 
hefte,  February,  1896. 

MERCURY  AND  ITS  PREPARATIONS. 

Hydrargyrum. — Mercury.  Mercure,  Fr.  ;  QuecJcsilber,  Ger.  A 
silver-white  metal,  liquid  at  common  temperatures,  and  having  the 
specific  gravity  13*5. 

PBEPABATIONS. — Emplastrum  Ammoniaci  cum  Hydrargyro. — 
Plaster  of  ammoniac  with  mercury.  Composition  :  Ammoniac,  720 
grm. ;  mercury,  180  grm.  ;  oleate  of  mercury,  8  grm. ;  diluted  acetic 
acid,  1,000  c.  c. ;  and  lead  plaster,  q.  s.  to  make  1,000  grm. 


MERCURY.  279 

Emplastrum  Hydrargyri. — Mercurial  plaster.  Composition  :  Mer- 
cury, 300  grin.  ;  oleate  of  mercury,  12  gnn.  ;  lead  plaster,  q.  s.  to 
make  1,000  grin. 

Hydrargyrum  cum  Greta. — Mercury  with  chalk.  Composition  : 
Mercury,  38  grm.  ;  prepared  chalk,  57  grin.  ;  clarified  honey,  10  grin. 
A  gray  powder  partly  dissipated  by  heat.  When  a  small  portion  is 
treated  with  dilute  acetic  acid  in  excess,  it  is  partly  dissolved,  nothing 
remaining  but  mercury  in  the  form  of  minute  globules.  Dose,  gr.  ss 
— gr.  x.  Eight  grains  contain  three  grains  of  mercury. 

Massa  Hydrargyri. — Pills  of  mercury.  Blue  mass.  Composition  : 
Mercury,  confection  of  rose,  and  powdered  licorice-root.  Three  grains 
contain  one  grain  of  metallic  mercury.  Dose,  gr.  ss — gr.  xv. 

Unguentum  Hydrargyri.  —  Mercurial  ointment.  Composition  : 
Mercury,  lard,  suet,  and  oleate  of  mercury. 

Hydrargyri  Oxidum  Flavum. — Yellow  mercuric  oxide.  An  or- 
ange-yellow powder,  which,  on  being  heated,  assumes  a  red  color ; 
then,  if  the  heat  be  increased,  it  evolves  oxygen,  and  finally  the  mer- 
cury evaporates  without  residue. 

Unguentum  Hydrargyri  Oxidi  Flam. — Ointment  of  yellow  mer- 
curic oxide.  Composition  :  Yellow  oxide,  10  grm.  ;  ointment,  90  grm. 

Oleatum  Hydrargyri. — Oleate  of  mercury.  Yellow  oxide,  10  parts ; 
oleic  acid,  90  parts. 

Hydrargyri  Oxidum  Rubrum. — Red  mercuric  oxide.  Red  pre- 
cipitate. An  orange-red  powder,  entirely  soluble  in  muriatic  acid. 
When  heated  it  does  not  emit  reddish  fumes,  but  gives  off  oxy- 
gen, while  the  mercury  either  runs  into  globules  or  is  wholly  dissi- 
pated. 

Unguentum  Hydrargyri  Oxidi  Eubri. — Ointment  of  red  mercuric 
oxide.  Composition  :  Red  oxide,  10  grm.  ;  ointment,  90  grm. 

Hydrargyri  Subsulphas  Flavus.—  Yellow  mercuric  subsulphate. 
Turpeth  mineral.  A  lemon-yellow  powder,  sparingly  soluble  in  water. 
It  is  entirely  dissipated  by  heat,  sulphurous  acid  being  evolved,  and 
globules  of  mercury  sublimed.  Dose,  gr.  ij — gr.  v,  as  an  emetic. 

Hydrargyri  Chloridum  Corrosivum. — Corrosive  mercuric  chlo- 
ride. Corrosive  sublimate.  In  colorless  crystals  or  crystalline  masses, 
which  are  fusible,  and  sublime  without  residue.  It  is  entirely  soluble 
in  water  (1  in  16),  alcohol  (1  in  3),  and  in  4  parts  of  ether.  Lime- 
water  causes  a  yellowish  precipitate  and  ammonia  a  white  one,  from 
its  solution.  Dose,  gr.  fa — gr.  -fa. 

Hydrargyri  Chloridum  Mite.— Mild  mercurous  chloride.  Calomel. 
A  white  powder,  wholly  volatilized  by  heat,  and  insoluble  in  water,  al- 
cohol, and  ether.  With  solution  of  potassa  it  yields  a  black  precipitate 
of  oxide  of  mercury,  which  is  reduced  by  heat  to  the  metallic  state. 
Distilled  water,  after  having  been  boiled  with  it,  yields  no  precipitate 
with  ammonia  or  nitrate  of  silver.  Dose,  gr.  -fa — gr.  x. 


280  AGENTS   INCREASING   WASTE. 

Pilules  Antimonii  Composites.  —  Compound  pills  of  antimony. 
Plummer's  pills.  Composition  :  Sulphurated  antimony,  calomel,  and 
guaiac.  Each  pill  contains  one-half  grain  each  of  antimony  and  calo- 
mel, and  one  grain  of  guaiac. 

Hydrargyri  Cyanidum. — Mercuric  cyanide.  In  white  prismatic 
crystals,  soluble  in  12'8  parts  of  water.  When  muriatic  acid  is  added 
to  the  solution,  hydrocyanic  acid  is  evolved,  made  evident  by  its  odor, 
and  bichloride  of  mercury  is  left,  which  is  entirely  volatilized  by  heat. 
Dose,  gr.  ^— gr.  f 

Hydrargyrum  Ammoniatum. — Ammoniated  mercury.  White  pre- 
cipitate. In  white  powder  or  pulverulent  masses,  decomposed  and 
entirely  dissipated  by  a  strong  heat,  insoluble  in  water  and  alcohol, 
but  dissolved  without  effervescence  by  muriatic  acid. 

Unguentum  Hydrargyri  Ammoniati. — Ointment  of  ammoniated 
mercury.  Composition  :  Ammoniated  mercury,  lOgrm.  ;  benzoinated 
lard,  90  grm. 

Hydrargyri  lodidum  Flavum. — Yellow  mercurous  iodide.  A 
greenish-yellow  powder,  which  becomes  red  when  heated.  It  is  in- 
soluble in  water  and  alcohol.  Dose,  gr.  \ — gr.  j. 

Hydrargyri  lodidum  Rubrum.  —  Red  mercuric  iodide.  A  red 
powder,  which  becomes  yellow  when  heated,  and  red  again  when  cold. 
It  is  wholly  volatilized  by  heat,  condensing  in  scales,  which  are  at  first 
yellow,  but  afterward  become  red.  It  is  insoluble  in  water,  but  is  dis- 
solved by  boiling  alcohol,  and  by  solutions  of  iodide  of  potassium  and 
chloride  of  sodium.  Dose,  -fa — gr.  -^. 

Unguentum  Hydrargyri  lodidi  Rubri. — Ointment  of  red  mer- 
curic iodide.  Composition  :  Red  iodide,  5  parts ;  ointment,  95 
parts. 

Hydrargyri  Sulphidum  Rubrum.  —  Red  sulphuret  of  mercury. 
Cinnabar.  In  brilliant  crystalline  masses,  of  a  deep-red  color  and 
fibrous  texture.  It  is  entirely  volatilized  by  heat.  When  heated  with 
potassa  it  yields  globules  of  mercury.  It  is  not  soluble  in  either  nitric 
or  muriatic  acid,  but  is  dissolved  by  a  mixture  of  the  two.  Acetic  acid 
which  has  been  digested  with  it  does  not  yield  a  precipitate  with  iodide 
of  potassium. 

Liquor  Hydrargyri  Nitratis. — Solution  of  mercuric  nitrate.  Mer- 
cury dissolved  in  nitric  acid.  Acid  nitrate  of  mercury.  "  A  trans- 
parent, nearly  colorless,  acid  liquid,  having  the  specific  gravity  2*100. 
It  is  not  precipitated  by  the  addition  of  distilled  water  ;  and  the  di- 
luted solution  affords,  with  potassa,  a  dirty-yellow  precipitate,  and  with 
iodide  of  potassium  a  bright-red  one,  soluble  in  an  excess  of  the  pre- 
cipitant. When  dropped  on  a  bright  surface  of  copper,  the  diluted 
solution  instantly  deposits  a  coating  of  mercury." 

Unguentum  Hydrargyri  Nitratis. — Ointment  of  mercuric  nitrate. 
Citrine  ointment. 


MERCURY.  281 

Uhguentum  Hydrargyri  Nitratis  cum  ol.  Morhuce. — Not  official. 
In  the  preparation  of  this  ointment  there  are  two  steps  :  Solution  No. 
1  is  composed  of  cod-liver  oil,  13  oz.  ;  lard,  3  oz.  Solution  No.  2  is 
made  by  dissolving  1£  oz.  of  mercury  in  3£  ozs.  of  nitric  acid.  By  a 
heat  of  200°  Fahr.,  the  lard  is  dissolved  in  the  oil.  Both  solutions  are 
slowly  mixed  by  stirring  until  thoroughly  incorporated. 

ANTAGONISTS  AND  INCOMPATIBLES. — Corrosive  sublimate  is  incom- 
patible with  alkalies  and  their  carbonates,  lime-water,  tartar  emetic, 
nitrate  of  silver,  acetate  of  lead,  albumen,  iodide  of  potassium,  soaps, 
various  vegetable  infusions,  including  cinchona.  Calomel  is  incom- 
patible with  the  alkalies  and  alkaline  earths  and  alkaline  carbonates» 
with  iron,  lead,  and  copper.  It  should  not  be  given  in  the  same  pre- 
scription with  iodine  (forms  red  iodide),  and  nitre-muriatic  acid  should 
not  be  prescribed  in  conjunction  with  it,  lest  corrosive  sublimate  be 
formed.  There  is  little  doubt,  also,  that  calomel  is  converted  into 
corrosive  sublimate  by  the  chlorides  of  sodium,  potassium,  and  ammo- 
nium. The  acids  and  acidulous  salts  are  incompatible  with  hydrargy- 
rum cum  creta. 

In  cases  of  poisoning  by  mercurial  salts,  especially  corrosive  subli- 
mate, albumen,  white  of  egg,  wheaten  flour,  milk,  etc.,  may  be  admin- 
istered. The  white  of  one  egg  is  considered  sufficient  for  four  grains 
of  corrosive  sublimate.  An  excess  of  albumen  may  redissolve  the  com- 
pound. Emesis  should  be  promptly  induced. 

SYNERGISTS. — Depressing  medicines,  antimony,  alkalies,  especially 
alkaline  chlorides,  etc.,  promote  the  physiological  activity  of  mercurials. 

PHYSIOLOGICAL  ACTIONS. — Metallic  mercury  in  direct  contact  with 
the  skin  or  mucous  membrane  is  without  action.  Swallowed,  it  is  pur- 
gative by  virtue  of  its  weight.  If  retained  in  the  intestinal  canal,  it 
will  form  soluble  combinations,  enter  the  blood,  and  produce  charac- 
teristic systemic  effects.  Similarly  prolonged  contact  with  the  skin 
will  be  followed  by  the  constitutional  action  of  the  drug.  Injected, 
into  the  veins,  it  will  be  arrested  in  the  capillaries,  producing  the  usual 
phenomena  of  capillary  embolism.  Mercury  gives  off  vapors  at  the 
ordinary  temperatures,  which  have,  in  notable  instances,  caused  serious 
constitutional  symptoms.  As  used  in  the  mechanical  arts,  by  gilders 
and  others,  the  fumes  of  mercury  cause  wasting,  ptyalism,  necrosis  of 
bones,  trembling,  impaired  intellect,  and  in  women,  abortion.  With- 
out producing  such  obvious  effects  as  ptyalism,  mercurial  cachexia, 
eczema,  and  disease  of  the  bones,  obscure  nervous  phenomena  may  re- 
sult. Among  these  may  be  enumerated  headache,  loss  of  memory, 
trembling,  defects  of  co-ordination,  disorders  of  sensation,  convulsions, 
and  dementia. 

Mercury  is  readily  absorbed — as  a  vapor  by  the  pulmonary  mucous 
membrane,  when  applied  to  the  integument,  or  when  taken  into  the 
alimentary  canal.  It  probably  exists  in  the  blood  as  an  albuminate. 


ogo  AGENTS   INCREASING  WASTE. 

Recent  experiments  (Wilbouchewitch,  Keyes)  have  shown  that  mer- 
cury, as  iron,  manganese,  and  other  metals,  has  the  power  to  increase 
the  number  of  red  corpuscles,  and  to  improve  the  quality  of  the  blood, 
provided  it  is  exhibited  in  small  quantities,  not  often  repeated.  It  has 
long  been  known  (Liegeois)  that  this  result  followed  the  use  of  cor' 
rosive  chloride  in  syphilis.  Schlesinger  has  recently  gone  over  the 
question  anew  with  the  same  result,  but  he  doubts  whether  the  effects 
are  really  tonic.  It  remains  true,  however,  that  any  considerable 
quantity  of  mercury,  administered  a  sufficient  time,  will  affect  the 
quality  and  composition  of  the  blood  ;  the  red  globules  are  diminished 
in  number  ;  the  fibrin  loses  its  plasticity  ;  the  proportion  of  water  is 
increased,  and  various  effete  materials,  whose  nature  is  unknown,  ac- 
cumulate. Mercury  is  deposited  in  all  the  textures,  interferes  with 
the  normal  nutritive  processes,  and  is  found  in  all  the  secretions  and 
excretions.  A  marked  degree  of  anaemia,  loss  of  flesh,  muscular  weak- 
ness, intractable  ulcerations  of  the  skin,  loss  of  hair,  eczema,  a  foul 
breath,  diarrhoea,  the  stools  being  very  fetid,  are  the  characteristic 
symptoms  of  the  action  of  mercury  on  the  solids  and  fluids  of  the  body. 

This  metal  has  a  selective  action  on  the  lymphatic  glandular  sys- 
.tern,  and  notably  on  the  salivary  glands  and  pancreas.  Among  the 
earlier  symptoms  of  the  action  of  mercury  are  an  increase  of  the  sali- 
vary secretion,  an  alteration  of  its  quality,  fetor  of  the  breath,  swol- 
len tongue,  soreness  of  the  teeth,  a  blue  or  dark  slate-colored  line 
along  the  margin  of  the  teeth,  sponginess  of  the  gums,  swelling  of  the 
parotid,  sublingual,  and  submaxillary  glands,  aching  of  the  jaws  and 
teeth,  with  general  muscular  soreness  and  aching  of  the  limbs,  and 
some  elevation  of  temperature.  To  this  state  are  applied  the  terms 
acute  mercurialismics,  ptyalism,  in  common  language,  salivation. 
Mercury  certainly  stimulates  the  pancreas  ;  this  gland,  like  the  sali- 
vary glands,  becomes  swollen,  congested,  and  pours  out  an  abundant 
secretion  which,  however,  is  not  a  normal  but  a  pathological  secretion. 
There  is  little  doubt  also  that  mercury  increases  the  action  of  the  in- 
testinal glandular  appendages,  and  thus  acts  as  a  purgative.  It  not 
only  increases  the  activity  of  these  glands,  but  is  itself  in  part  ex- 
creted by  them.  The  products  of  the  increased  waste  of  the  tissues 
caused  by  mercury  are  also  largely  eliminated  by  the  intestinal  glands. 

Although  calomel  had  been  long  known  to  act  well  in  some  cases 
of  dropsy,  especially  when  associated  with  squill  and  other  diuretics, 
the  untoward  effects  not  infrequently  observed — since  known  to  be 
examples  of  renal  dropsy  with  albuminuria — lessened  confidence  in  its 
utility,  and  increased  the  distrust  felt  of  all  mercurials,  against  which 
a  general  revolt  was  rising.  The  experimental  method  and  the  growth 
of  a  truer  scientific  spirit  have  combined  to  revive  confidence  in  the 
use  of  mercury,  and  hence  the  former  belief  in  its  diuretic  power  haa 
been  subjected  to  clinical  trials  by  such  observei's  as  Leyden  [Therap, 


MERCURY.  283 

Monatshefte  of  April,  1887],  Rosenheim  and  Furbringer  [Ibid],  Wein- 
stein  [Wiener  med.  Blatte,  1887],  and  Jendrassik  [Deutsch.  Archiv  f. 
Jclin.  Med.,  April,  1886],  with  many  others. 

These  recent  experiences  confirm  the  belief  in  the  diuretic  action  of 
calomel,  formerly  an  article  of  medical  faith.  The  quantity  required  to 
act  on  the  kidneys,  and  the  conditions  under  which  this  physiological 
property  is  manifested,  have  been  the  subject  of  careful  inquiry,  and 
conclusions  of  a  practical  character  have  been  reached.  It  is  generally 
held  by  those  most  familiar  with  its  diuretic  action  that  the  dose  of 
three  grains  three  times  a  day  is  about  the  quantity  usually  required. 
Experience  has  shown  that  more  than  this  will  cause  diarrhoea  or  more 
serious  trouble  of  the  gastro-intestinal  mucous  membrane,  and  the 
danger  of  acute  mercurialismus  rises  with  the  quantity  administered. 

Although  the  diuretic  property  is  an  endowment  of  calomel  per  se, 
and  is  exerted  under  suitable  conditions,  it  is  quite  certain  that  in  the 
renal  dropsies  there  is  far  more  danger  of  ptyalism,  and  the  explana- 
tion of  this  is  afforded  by  the  changes  in  the  composition  of  the  blood 
due  to  albuminuria.  To  prevent  ptyalism,  the  use  of  potassium  chlorate 
is  practiced  from  the  outset,  and  diarrhoea  is  prevented  or  restrained 
by  the  conjoint  administration  of  opium.  Such  are  the  prophylactic 
measures  suggested  by  some  of  those  advocating  the  diuretic  property 
of  calomel,  and  who  are  mentioned  above.  Although  anticipating 
somewhat,  the  author  has  to  say  that  the  combination  of  belladonna 
extract  with  the  calomel  has  an  excellent  effect  both  to  prevent  diar- 
rhoea and  ptyalism,  and  is  more  efficient  in  the  latter,  and  is  active 
enough,  usually,  to  keep  the  former  in  due  restraint. 

An  explanation  of  the  diuretic  action  of  calomel  may  be  sought  for 
in  several  directions.  It  is  well  known  that  purgatives  often  increase 
renal  action  by  an  influence  reflex  in  mechanism.  From  the  intestinal 
mucous  membrane  an  impression  is  radiated  by  means  of  the  solar 
plexus  over  the  nerves  of  the  renal  system.  If,  however,  the  blood 
pressure  is  reduced  by  profuse  watery  evacuations,  the  kidneys  do  not 
act  as  strongly.  It  would  seem,  on  first  view,  that  the  compound 
jalap  powder  acts  in  a  manner  opposed  to  the  explanation  just  given, 
for  it  produces  watery  evacuations  and  also  diuresis,  but  the  renal 
action  is  a  consequence  of  the  bitartrate. 

The  misconception  of  the  action  of  mercurials  on  the  liver  has 
prevailed  chiefly  because  of  the  peculiar  evacuations  produced  by  it. 
The  true  explanation  of  the  nature  of  these  stools  has  been  given 
above,  but  the  subject  should  not  be  dismissed  without  further  refer- 
ence to  the  experimental  work  devoted  to  the  elucidation  of  this  subject 
within  the  past  few  years.  The  experiments  of  Rohrig,  Rutherford, 
and  Scott  on  animals,  and  the  observations  of  Westphale,n  and  Ranke 
in  cases  of  biliary  fistulas  in  man,,  have  thrown  a  flood  of  light  on  the 
actions  of  mercurials,  and  there  seems  to  be  no  longer  any  reason  to 


g§4  AGEXTS   INCREASING   WASTE. 

doubt  the  accuracy  of  the  conclusions  reached.  It  has  been  shown 
that  calomel  lessens  the  physiological  activity  of  the  liver,  and  conse- 
quently diminishes  the  production  of  bile.  Instead  of  stimulating  the 
liver,  or  acting  as  a  cholagogue,  calomel  must  be  regarded  as  a  seda- 
tive, and  as  having  the  power  to  allay  an  irritable  state  of  the  liver. 
Oddly  enough,  this  fact  harmonizes  in  the  most  satisfactory  way  with 
clinical  experience,  for  calomel  has  always  been  regarded  as  useful  in 
the  highest  degree  in  those  cases  of  "  biliousness,"  characterized  by  a 
surplusage  of  bile,  due  to  an  over-acting  liver.  Under  such  circum- 
stances an  active  cholagogue,  stimulating  the  productive  capacity  of 
the  organ,  would  only  increase  the  existing  complications. 

While  the  sedative  action  of  mercurials,  including  calomel  and  its 
congeners,  on  the  hepatic  functions  has  been  established,  by  the  same 
kind  of  investigation  it  has  demonstrated  that  the  corrosive  chloride 
is  to  some  extent  a  cholagogue  increasing  the  production  of  bile  (Ruth- 
erford), and  as  its  stimulating  action  must  include  the  glycogenic 
function  as  well,  it  may  be  supposed  that  its  tonic  and  reconstituent 
power  is  thus  produced.  If  we  add  to  the  cholagogue  properties  of 
mercury,  which  it  possesses  in  common  with  resinous  purgatives,  the 
action  on  the  pancreas  and  the  increased  elimination  of  the  products 
of  waste  by  the  intestinal  glands,  we  obtain  a  satisfactory  explanation 
of  those  powers  which  have,  under  the  term  alterative,  been  heretofore 
ascribed  to  mercury. 

Mercury  is  eliminated  by  the  salivary  and  the  intestinal  glands,  by 
the  liver,  but  chiefly  by  the  kidneys.  As  a  result  of  the  changes  in 
the  composition  of  the  blood,  and  of  the  direct  action  of  the  metal  on 
the  renal  epithelium,  albuminuria  is  one  of  the  symptoms  present  in 
cases  of  mercurialism.  Without  the  use  of  special  means  to  render  it 
soluble,  and  despite  the  use  of  such  means,  sometimes  mercury  remains 
permanently  in  the  organism.  When  extremely  severe  cases  of  saliva- 
tion were  not  uncommon,  permanent  damage  to  the  osseous  structures 
often  occurred,  and  globules  of  mercury  could  be  shaken  out  of  the 
dried  bones  of  such  subjects.  Happily,  nowadays,  such  cases  do  not 
occur.  The  moderate  use  of  mercury,  short  of  ptyalism,  does  not  ap- 
pear to  affect  the  human  system  injuriously. 

There  are  but  few  chronic  affections  of  the  nervous  system  not 
imitated  in  the  multiform  examples  of  chronic  mercuriaiism.  From 
the  most  trifling  affections  of  sensibility  and  motility  up  to  complete 
anaesthesia  and  paralysis,  there  are  numerous  gradations  in  the  impor- 
tance of  the  lesions.  From  slight  headache  and  impaired  memory  up 
to  complete  dementia  there  are,  also,  immense  variations  in  the  gravity 
of  the  mental  and  cerebral  symptoms.  The  most  frequently  encount- 
ered nervous  lesion  is  "  trembling,"  and  to  this  symptom  more  atten- 
tion has  been  given,  from  the  period  of  Ktissmaul's  elaborate  essay,  up 
to  the  present. 

It  has  been  suDnosed.  hitherto;  that  the  mercurial  trembling  is  ac- 


MERCURY.  285 

companied  by  muscular  paresis,  but  recent  observations  have  shown  that 
this  view  of  their  absolute  association  is  incorrect,  the  two  conditions 
not  necessarily  being  present  together  (Letulle).  The  paresis,  which 
is  usually  more  pronounced  in  the  upper  extremities,  is  not  attended 
by  trophic  changes,  as  a  consequence — the  muscles  flaccid,  but  not  de- 
generating. At  the  beginning  of  the  structural  changes  the  reflexes 
are  rather  heightened,  but,  as  the  paresis  increases,  they  decline.  The 
electrical  reactions  are  normal  in  character,  but  a  quantitative  decline 
sometimes  occurs.  Disorders  of  sensibility  accompany  the  motor  de- 
rangements. A  characteristic  of  the  disordered  sensibility  is  its  locali- 
zation to  defined  areas,  the  whole  member  not  being  affected,  and  the 
restriction  to  the  extremities,  the  trunk  remaining  unaffected.  The 
actual  disorders  of  sensibility  consist  in  lessening  the  tactile  and  pain 
sense,  and  in  an  aberration  of  the  sense  of  temperature  ;  but  rarely  is 
there  a  complete  abolition  of  the  sensibility,  and  usually  the  changes 
are  rather  of  a  fugitive  character.  Corresponding  disorders  of  func- 
tion appear  in  the  organs  of  special  sense,  and  are  due  to  atrophic  de- 
generation of  the  nerve- elements.  Huskiness  of  voice,  even  complete 
aphonia,  have  been  the  result  of  paralysis  of  the  laryngeal  muscles. 

From  the  point  of  view  of  pathology,  the  motorial  and  sensory  dis- 
turbances caused  by  mercury  are  due  to  a  direct  action  on  the  proto- 
plasm of  a  destructive  character,  and  in  respect  to  the  nerve-elements 
(Hallopeau)  the  initial  changes  occur  in  the  most  highly  specialized. 
Like  arsenic,  lead,  and  other  metals,  mercury  sets  up  a  fatty  degenera- 
tion of  the  gland-cells. 

EFFECTS  OF  THE  DIFFERENT  PREPARATIONS. — Hydrargyrum  cum 
creta,  calomel,  and  blue-pill  are  very  similar  in  action.  Calomel,  being 
insoluble,  probably  escapes  solution  and  combination  in  the  stomach, 
and  is  decomposed  by  the  alkaline  contents  of  the  small  intestine,  the 
oxide  of  mercury  being  precipitated.  It  follows,  from  this  reaction, 
that  the  effects  of  blue-pill  and  calomel  must  be  similar,  and  in  practice 
it  is  found  that  they  correspond  closely  therapeutically.  Salivation 
more  frequently  results  from  the  use  of  blue-pill  than  from  the  other 
mercurials  ;  and  calomel  comes  next  in  point  of  activity  in  this  respect. 

The  corrosive  chloride,  the  red  iodide,  and  the  cyanide,  are  pow- 
erful irritant  and  corrosive  poisons.  When  a  poisonous  dose  of  cor- 
rosive sublimate  has  been  swallowed,  the  mucous  membrane  of  the 
mouth  has  usually,  but  not  invariably,  a  whitish,  glazed  appearance, 
as  if  it  had  been  washed  over  with  a  strong  solution  of  the  nitrate  of 
silver.  A  sense  of  constriction  of  the  throat  and  a  strong  styptic  and 
metallic  taste  are  experienced.  The  toxic  symptoms  follow  in  a  few 
minutes  the  ingestion  of  the  poison.  Usually,  violent  pain  is  felt  in  the 
abdomen,  but  this  is  not  invariable.  Vomiting  follows,  and  the  vom- 
ited matters  consist  at  first  of  the  contents  of  the  stomach,  and  after- 
ward of  mucus  streaked  with  blood.  There  are  usually  purging,  tenes- 
mus,  intestinal  cramp,  and  not  unfrequently  dysenteric  dischargea 


AGENTS  INCREASING  WASTE. 

These  evidences  of  violent  gastro-intestinal  irritation  are  accompanied 
by  small,  weak  pulse,  coldness  of  the  surface — but  sometimes  by  a 
swollen  and  flushed  face — sighing  respiration,  syncope,  insensibility,  or 
convulsions.  If  the  patient  survive  a  few  days,  ptyalism  may  occur. 

The  following  are  the  symptoms  of  chronic  poisoning  stated  in  the 
most  concrete  form  :  abdominal  pains  ;  nausea  ;  vomiting  ;  dysenteric 
diarrhoea  ;  general  weakness,  trembling,  or  paralysis,  and  other  nerv- 
ous affections  ;  ptyalism  ;  fever  ;  emaciation,  etc.  There  sometimes 
occurs  a  blue  line  along  the  margin  of  the  teeth,  not  unlike  that  pro- 
duced by  lead.  Suppression  of  urine  is  a  not  infrequent  symptom 
in  acute  poisoning,  and  albuminuria  is  very  often  present  in  cases  of 
chronic  mercurialismus. 

The  corrosive  chloride  and  the  red  iodide  of  mercury  are  the  most 
powerful  antiseptics  and  germicides  now  available.  Their  germicide 
powers  have  been  made  the  subject  of  investigation  in  the  only  way 
that  such  a  question  can  be  determined — by  ascertaining  the  degree 
and  character  of  their  effects  on  cultures  of  the  pathogenic  organisms. 
To  Miguel,  De  la  Croix,  Bucholtz,  and  others  in  Europe,  and  to  Stern- 
berg  and  Welch  in  this  country,  we  owe  the  very  accurate  knowledge 
now  possessed  of  the  character  and  limits  of  the  germicide  power. 
Any  difference  that  exists  between  the  chloride  and  iodide,  in  respect 
to  their  power  to  destroy  disease-germs,  is  in  favor  of  the  latter 
(Miguel).  An  effective  germicide  is  destructive  not  only  of  the  organ- 
ism but  of  its  ova.  Experience  has  demonstrated  that  the  germ — the 
microbe — may  be  killed  and  yet  the  ova  resist  the  action  of  the  germi- 
cide and  hence  pullulation  goes  on  as  actively  as  before.  No  antisep- 
tic is  entitled  to  be  so  designated  unless  its  power  is  equal  to  the  de- 
struction of  the  organism  and  of  its  ova  also. 

THERAPY. — The  acute  glandular  affections  of  throat  and  neck — 
tonsillitis,  parotitis,  inflammation  of  the  submaxillary  and  sublingual 
glands — are  often  speedily  removed  by  mercurial  preparations.  The 
one  twentieth  of  a  grain  of  calomel,  or  the  one  fifth  of  mercury  with 
chalk,  may  be  given  every  two  hours,  or  one  minim  of  the  following 
solution  may  be  administered  at  the  same  interval :  ]J  Hydrarg.  chlor. 
corrosiv.,  gr.  j  ;  aquae,  3  j.  M.  Sig.  :  Dose,  HJ,  j.  Chronic  affections 
of  these  organs  are  not  benefited  by  these  remedies,  and  the  so-called 
scrofulous  diseases  of  the  cervical  glands  are  made  worse  by  them. 

Corrosive  sublimate  is  an  effective  remedy  in  gastric  ulcer.  The 
thirtieth  to  the  sixtieth  of  a  grain,  three  times  a  day  before  meals,  is  a 
proper  quantity  and  occasion  for  this  purpose.  Certain  kinds  of  vom- 
iting are  quickly  cured  by  small  doses  of  calomel.  The  vomiting  of 
children,  caused  by  indigestible  food  or  by  constipation,  or  by  these 
causes  combined,  is  often  speedily  relieved  by  one-twelf th-of-a-grain 
doses  of  calomel  every  half -hour  or  hour,  dropped  on  the  tongue.  This 
remedy  is  the  more  efficacious  when  such  vomiting  is  accompanied  by 


MERCURY.  287 

great  heat  of  head,  restlessness,  and  fever.  The  vomiting  of  cholera 
infantum  is  often  stopped  by  the  same  means. 

It  has  long  been  held  that  mercurials  are  specially  indicated  in  that 
catarrhal  state  of  the  intestinal  mucous  membrane  and  of  the  hepatic 
duct,  manifested  by  nausea,  anorexia,  tympanites,  whitish  or  clay-col- 
ored stools,  and  jaundice.  The  use  of  mercury  in  these  cases  is  predi- 
cated on  its  supposed  power  to  promote  the  flow  of  bile.  It  is  true, 
no  doubt,  that  calomel  and  blue-pill  will  remove  these  symptoms,  but 
such  mild  salines  as  phosphate  of  soda,  sulphate  of  magnesia,  tartrate 
of  soda  and  potassa.  etc.,  will  usually  succeed  quite  as  well  and  with- 
out detriment  to  the  patient.  The  diarrhoea  and  dysentery  of  infants 
(ileo-colitis)  is  frequently  treated  by  minute  doses  of  calomel  or  hy- 
drargyrum cum  creta.  When  there  are  much  straining  and  bloody 
mucus,  it  is  said  that  small  doses  of  corrosive  chloride  prove  very 
effective,  but  the  author  is  convinced  that  mercurials  are  much  abused 
in  these  affections.  Children  are  quickly  poisoned  by  mercurials,  al- 
though they,  are  not  easily  salivated.  The  spinach-colored  stools 
which  so  frequently  occur  in  the  summer  complaint  of  children,  and 
which  are,  by  ignorant  practitioners,  supposed  to  be  produced  by  the 
mercury  administered,  really  belong  to  cases  of  ileo-colitis,  and  may, 
by  their  persistence  and  profuseness,  signify  an  increased  irritation  of 
the  intestinal  mucous  membrane  due  to  the  remedies  given.  While 
the  author  believes  that  other  medicines  are  more  useful  than  mercury 
in  the  ileo-colitis  of  children,  he  is  convinced  of  the  utility  of  minute 
doses  of  calomel  (one  twentieth  to  one  twelfth  of  a  grain  every  half- 
hour)  when  there  is  much  irritability  of  the  stomach.  Mercurials  are 
contraindicated  in  the  diarrhoea  and  dysentery  of  adults,  as  a  rule. 

It  was  formerly  an  article  of  faith  to  hold  that  mercury  was  a  sov- 
ereign remedy  in  hepatic  disorders.  The  state  known  as  biliousness, 
characterized  by  a  yellowish-coated  tongue,  yellow  conjunctive,  muddy 
skin,  nausea,  constipation,  may  be  removed  by  a  mercurial  purge  when 
these  symptoms  are  due  to  catarrh  of  the  duodenum,  excesses  of  the 
table,  sudden  checking  of  the  perspiration,  etc.  The  blue-pill,  or 
mercury  with  chalk,  or  calomel,  succeeds  in  these  cases  by  removing 
offending  substances  from  the  intestinal  canal,  by  relieving  a  catarrh- 
al state  of  the  mucous  membrane,  or  by  causing  elimination  of  waste 
products  by  the  intestinal  glandular  apparatus.  Less  objectionable 
agents  may  be  employed  with  equal  success. 

The  experience  of  the  India  medical  officers  has  shown  conclusively 
that  mercurials  are  harmful  in  acute  hepatitis,  hepatic  abscess,  jaundice 
from  gall-stones,  acute  yellow  atrophy,  etc.  As  these  affections  are 
very  rife  in  India,  an  experience  which  has  led  to  such  conclusions 
should  be  heeded.  There  is  no  evidence  to  show  that  mercurials  ren- 
der the  least  service  in  cirrhosis. 

Calomel  is  a  very  efficient  purgative.     It  will  be  retained  when 


288  AGENTS   INCREASING  WASTE. 

other  purgatives  are  rejected  by  the  stomach  ;  it  is  free  from  taste, 
and  may  therefore  be  given  easily  to  children.  "When  it  operates, 
nausea  and  tormina  may  be  experienced.  One  grain  of  calomel  at 
night  will  act  in  the  morning,  and  not  unfrequently  a  half-grain  will 
give  satisfactory  results.  A  full  purgative  dose  of  calomel  (five  grains) 
is  an  excellent  vermifuge  for  the  lumbricoid  worms.  It  may  be  given 
with  santonine.  At  the  onset  of  acute  febrile  diseases,  calomel  is  a 
useful  purgative  ;  it  hastens  waste,  and  causes  the  elimination  of  the 
products  by  the  intestine. 

Mercurials  were  formerly  much  esteemed  in  the  treatment  of  acute 
inflammation,  especially  of  serous  membranes.  As  calomel — the  mer- 
curial preparation  usually  employed — was  combined  with  opium,  it  was 
not  known  to  which  remedy  the  good  results  were  due,  but  the  mer- 
curial was  considered  to  have  the  larger  share  of  merit.  It  is  now 
admitted  that  opium  was  the  effective  agent.  An  apparent  exception 
to  this  statement  exists  in  the  case  of  iritis,  a  disease  in  which  the 
good  effects  of  mercury  are  most  conspicuous  ;  but  iritis,  probably,  is 
always  of  syphilitic  origin,  and,  in  syphilitic  inflammation  of  serous 
membranes,  it  is  not  disputed  that  mercurials  are  extremely  efficacious. 
In  these  days,  however,  although  opium  is  considered  indispensable  in 
peritonitis,  pleuritis,  pericarditis,  etc.,  mercury  is  no  longer  combined" 
with  it.  No  longer  is  it  considered  necessary  to  "  touch  the  gums  " 
in  order  to  cure  a  serous  inflammation,  and  only  the  most  prejudiced 
and  benighted  practitioners  insist  in  the  use  of  mercurials  in  these  in- 
flammatory affections. 

Large  doses  of  calomel — five  grains  every  four  hours — are  said  to 
be  very  efficacious  in  true  croup  or  membranous  laryngitis.  It  is 
claimed  that  it  allays  spasm  and  checks  the  formation  of  the  false 
membrane.  The  author  is  skeptical  in  regard  to  the  utility  of  calomel 
in  this  affection.  There  is,  however,  no  doubt  as  to  the  value  of  the 
yellow  subsulphate  (turpeth  mineral)  as  an  emetic  in  this  disease.  If 
given  early,  it  is  the  doubtful  statement  of  Dr.  Fordyce  Barker,  of  New 
York,  that  a  fatal  result  will  most  certainly  be  averted.  From  two 
to  four  grains  of  the  subsulphate  may  be  given  as  an  emetic  for  a  child 
with  croup.  Serious  results  might  be  produced  by  this  dose  if  emesis 
did  not  so  promptly  follow.  The  powder  comes  up  with  the  contents 
of  the  stomach,  in  from  five  to  fifteen  minutes  after  being  swallowed. 
But  little  depression  follows  the  emesis  produced  by  turpeth  mineral, 
in  which  respect  it  has  a  decided  advantage  over  sulphate  of  cop- 
per, tartar  -  emetic,  and  even  ipecacuanha.  As  it  is  insoluble,  this 
remedy  should  be  rubbed  up  with  sugar  and  placed  on  the  base  of 
the  tongue. 

Corrosive  sublimate  has  lately  been  used  with  very  distinct  advan- 
tage in  the  treatment  of  diphtheria.  Its  remarkable  germicide  prop- 
erty is  the  motive  for  its  employment,  and  clinical  experience  strongly 


MERCURY.  289 

supports  the  results  of  experiment.  The  dose  administered  in  the 
treatment  of  diphtheria  will  range,  according  to  the  age  of  the  sub- 
ject, from  T^  grain  to  ^  grain  every  four  or  six  hours. 

Liebermeister,  following  the  lead  of  Traube,  Wunderlich,  and  others, 
has  obtained  surprising  results  from  the  use  of  calomel  in  typhoid  fever. 
By  our  German  confreres  this  treatment  is  called  the  specific  treatment 
of  abdominal  typhus.  It  consists  in  the  administration  of  ten  grains 
of  calomel  in  a  single  dose  the  first  day,  and  eight  grains  a  day  for 
three  or  four  days  thereafter.  It  is  a  curious  fact  that  these  large 
doses  of  calomel  have  an  antipyretic  effect.  According  to  the  statis- 
tics of  Liebermeister,  the  "  specific  "  calomel  treatment  shortens  the 
duration  and  lessens  the  mortality  from  typhoid  fever,  as  compared 
with  the  non-specific,  expectant,  or  other  plans  of  medication. 

Calomel  is  one  of  the  numerous  remedies  used  in  the  treatment  of 
cholera  Asiatica.  Two  methods  are  pursued  :  large  doses  at  consider- 
able intervals  ;  small  doses  frequently  repeated.  The  latter  method  is 
nowadays  much  more  usually  practiced.  In  consists  in  giving  every 
fifteen  minutes,  half -hour,  or  hour,  the  one  sixth,  one  half,  or  one  grain 
of  calomel,  combined  with  opium,  chalk,  piperine,  etc.  The  author, 
who  has  had  considerable  experience  in  the  treatment  of  cholera,  can 
not  express  any  degree  of  confidence  in  the  efficacy  of  this  treatment. 
Large  doses  (a  scruple  to  a  drachm)  sometimes  appear  to  arrest  vomit- 
ing when  other  means  fail,  but  there  is  danger  of  excessive  ptyalism 
when  reaction  sets  in. 

All  the  salts  of  mercury  possess  the  diuretic  property  to  some  ex- 
tent, but  the  chlorides,  especially  calomel,  are  the  most  efficient.  In 
cardiac  dropsy  calomel  becomes  one  of  the  most  important  means  of 
relief.  When  the  action  of  the  heart  is  rapid  and  the  tension  of  the 
vessels  high,  and  the  breathing  is  embarrassed  by  the  accumulating 
fluid,  the  exhibition  of  a  daily  dose  of  two  or  three  grains  each  will 
often  procure  considerable  discharge  of  urinary  water,  and  by  unload- 
ing the  portal  circulation  will  in  this  way  also  rid  the  system  of  water. 
It  has  long  been  known  that  calomel  has  diuretic  effect,  but  it  was 
prescribed  in  fractional  doses  with  squill  and  digitalis.  Graves,  of 
Dublin,  and  G.  B.  Wood,  of  Philadelphia,  and  before  them  Rush, 
were  advocates  of  this  practice,  but  the  use  of  larger  doses  daily  is  a 
distinctly  modern  method.  The  experimental  evidence  showing  the 
effect  of  mercury  on  the  kidneys  is  conclusive.  Jendrassik  was  prob- 
ably the  first  to  demonstrate  the  action  ;  afterward  Cohnstein  showed 
that  the  hypodermatic  injection  of  a  solution  of  mercury  increases 
diuresis,  probably  by  an  action  on  the  epithelium,  and  by  raising  the 
pressure  in  the  renal  vessels,  the  mercury  itself  appearing  in  the  urine. 
Dr.  Pal  gives  a  summary  of  the  observations  made  experimentally, 
which  show  that  mercury  raises  the  blood  pressure  in  the  renal  sys- 
tem, that  it  acts  on  the  renal  epithelium,  and  may  even  cause  nephritis. 


29C  AGENTS   INCREASING  WASTE. 

In  tnese  physiological  actions  we  have  an  adequate  explanation  of  the 
nature  of  the  curative  power  of  mercury  in  dropsy.  As  regards  its 
action  in  the  cardiac  form  of  dropsy,  the  effect  may  be  in  part  referred 
to  its  influence  on  the  hepatic  secretions — to  the  formation  of  urea 
and  the  conversion  of  uric  acid ;  to  the  mechanical  and  reflex  results 
of  depletion  of  the  portal  circulation.  The  effect  on  the  heart  is  shown 
in  a  diminution  of  its  beats  and  in  a  lowering  of  the  general  vascular 
tension  ;  the  renal  effect  consists  in  an  increase  of  the  urinary  secretion 
through  stimulation  of  the  tubular  epithelium,  and  rise  of  tension  in 
the  kidney  vessels. 

The  good  effects  of  mercurials,  of  calomel  especially,  in  dropsy  are 
not  confined  to  the  cardiac  form.  It  is  often  highly  useful  in  dropsy 
strictly  of  renal  origin.  In  the  acute  form  of  tubular  nephritis,  with 
desquamating  epithelium  and  scanty  urine,  a  purgative  dose  of  calo- 
mel may  have  a  prompt  and  powerful  effect  in  relieving  the  head 
symptoms  and  starting  up  again  renal  excretion. 

The  preparations  of  mercury  must  be  used  with  caution  in  cardiac 
dropsy  when  coincident  with  renal  disease,  or  in  nephritis  when  a  spe- 
cial susceptibility  to  the  mercurial  action  exists.  Very  severe  ptyalism 
has  occurred  from  the  exhibition  of  even  small  doses  of  calomel  in 
cases  of  renal  albuminuria.  While  caution  is  necessary,  it  is  also  true 
that  mercury  is  often  most  useful  in  renal  dropsy.  The  dose  of  calo- 
mel as  above  given  is  rather  under  than  above  the  quantity  now  con- 
sidered necessary.  From  three  to  six  grains  a  day  in  single  doses  may 
be  regarded  as  the  most  efficient  mode  of  administration. 

The  most  important  application  of  mercury  therapeutically  is  in  the 
treatment  of  syphilis.  The  reaction  which  set  in  against  its  use  a  few 
years  ago  has  certainly  led  to  important  modifications  in  the  mode  and 
quantity  in  which  mercury  should  be  given;  but  the  fact  has  been  con- 
clusively established  that  mercury  in  a  certain  sense  is  antidotal  to 
syphilis.  As  mercury  exerts  a  germicide  action  on  the  organism  of 
syphilis,  this  agent  should  be  used  with  the  earliest  manifestations  of 
the  specific  character  of  the  infecting  sore.  Mercury  is  not  indicated 
in  chancroid,  or  non-infecting  chancre,  and  should  not  be  used.  If  the 
chancre  have  the  characteristic  quality  of  the  infecting  sore,  small  doses 
of  one  of  the  mercurial  preparations  should  be  begun  and  continued 
steadily  until  all  induration  has  disappeared.  The  important  point  is, 
not  to  induce  ptyalism.  It  is  now  conceded  that  the  danger  of  a  relapse 
will  be  very  much  lessened  by  continuing  the  mercurial  treatment  for 
some  time — for  several  months — after  local  manifestations  have  ceased. 
The  ill  effects  of  a  mercurial  course  may  be  prevented  by  the  use  of 
small  doses,  by  careful  attention  to  hygiene,  and  by  lessening  the  dose, 
or  discontinuing  the  remedy  entirely,  whenever  soreness  of  the  jaws 
can  be  developed  by  smartly  closing  the  teeth.  By  the  adoption  of 
these  precautions,  a  mercurial  course  may  be  continued  without  im- 


MERCURY.  291 

portant  interruptions  until  the  period  of  incubation  has  entirely  passed, 
and  through  the  so-called  secondary  or  constitutional  stage. 

Various  methods  are  resorted  to  for  the  introduction  of  mercury 
into  the  organism  : 

1.  Inunction. — Before  practicing  inunction,  the  patient  should  take 
a  warm  bath,  or,  at  least,  wash  the  part  to  be  operated  on  with  soap 
and  water.     From  fifteen  to  thirty  grains  of  mercurial  ointment  is  the 
quantity  required  for  each  inunction.     The  oleate  of  mercury  in  pro- 
portion of  fifteen  to  thirty  per  cent  in  the  solution  may  be  substituted 
for  the  ointment,  but  the  oleate  is  to  be  applied  with  a  'brush,  and  not 
be  rubbed  in.     Sigmund,  the  great  advocate  for  the  inunction  method, 
has  prescribed  certain  rules,  which  should  be  followed.     The  ointment 
should  be  rubbed  in  with  moderate  friction  by  the  palm  of  the  hand  : 
on  the  first  day  on  the  legs ;  on  the  second  day  on  the  thighs  ;  on  the 
third  day  on  the  abdomen  and  sides  of  the  chest ;  on  the  fourth  day 
on  the  back  ;  on  the  fifth  day  on  the  arms.     Mercurial  inunctions  are 
not  borne  equally  well  by  all  patients.     Some  are  easily  salivated,  and 
others  suffer  from  eczema  or  erythema.    Moreover,  the  inunction  treat- 
ment is  filthy  and  troublesome,  and  it  should,  therefore,  be  restricted 
to  those  cases  in  which  mercurials  are  badly  borne  by  the  stomach. 

2.  Fumigation. — Various  mercurial  preparations  may  be  used — the 
sulphuret,  the  iodide — but  calomel  is  the  best.     The  apparatus  consists 
of  a  spirit-lamp,  a  plate  to  hold  the  calomel,  surrounded  by  a  shallow 
vessel  containing  water,  a  blanket  large  enough  to  cover  the  patient 
and  the  apparatus.    The  calomel  is  volatilized  by  the  heat  of  the  lamp, 
and  is  deposited,  together  with  the  vapor  of  water,  on  the  skin  of 
the  patient.     About  fifteen  minutes  is  the  time  required  for  the  bath, 
and  the  quantity  of  calomel  used  ranges  from  eight  to  fifteen  grains. 
The  method  of  fumigation  is  especially  adapted  to  cases  of  the  con- 
stitutional, or  secondary,  and  to  the  tertiary,  with  ulcerations,  when 
the  state  of  the  patient  is  such  as  to  forbid  the  internal  administration 
of  mercurials. 

3.  Hypodermatic  Method. — This  consists  in  the  introduction  under 
the  skin  of  corrosive  chloride,  or  albuminate  of  mercury.    IJ   Hydrarg. 
chlor.  cor.,  gr.  j;  glycerini,  3  j;  aquae  destil.,  3  j-     M.     Sig. :  Ten  min- 
ims a  dose  once  a  day.     This  method  is  cleanly,  quick  in  results,  and 
more  successful  than  any  other  in  preventing  relapses. 

The  peptonate  of  mercury,  as  advocated  by  Bamberger,  has  been 
much  employed  lately  for  the  treatment  of  syphilis  by  the  subcutane- 
ous method  ;  but  the  albuminate  alone,  wLhout  pepsin,  is  both  more 
effective  and  less  likely  to  set  up  local  inflammation.  The  following 
formula  for  the  preparation  of  albuminate  of  mercury,  recommended 
by  Gourgues,  is  probably  the  best  now  available  for  this  purpose  : 
Bichloride  of  mercury,  gr.  xv  ;  distilled  water,  3  v.  To  this  solution 
is  added  five  drachms  of  white  of  egg,  and,  after  thorough  shaking 
21 


292  AGENTS  INCREASING   WASTE. 

the  mixture  is  incorporated  with  the  following  :  Chloride  of  sodium 
(common  salt),  gr.  xxx  ;  distilled  water,  f  3  ij.  This  mixture  is  then 
well  agitated,  and  afterward  filtered,  after  which  sufficient  distilled 
water  is  added  to  make  the  solution  up  to  four  fluid  ounces.  The  dose 
of  this  solution  for  hypodermatic  injection  is  from  m,  xv —  3  ss.  When 
finished,  the  solution  is  not  clear,  but  rather  semi-transparent  ;  but  it 
remains  longer  and  better  in  solution  than  most  of  these  preparations. 
The  peptonate  of  mercury  is  not  only  variable  in  composition,  but 
easily  undergoes  change,  and  is  liable  to  produce  violent  local  irrita- 
tion. The  albuminate  prepared  as  above  suggested  is  readily  admin- 
istered, is  not  painful,  and  is  rarely  followed  by  unpleasant  accidents 
at  the  site  of  the  injection.  As  regards  the  results  of  the  administra- 
tion on  the  progress  of  the  disease,  they  are  remarkable  (Gourgues). 
According  to  Martineau,  the  hypodermatic  mercurial  treatment  exer- 
cises on  syphilis  in  its  various  manifestations  an  action  much  more 
effective,  more  energetic,  and  more  rapid,  than  any  other  method  hith- 
erto proposed.  The  subcutaneous  areolar  tissue  of  the  back  is  the  best 
place  for  the  injections.  The  number  of  them  and  the  quantity  of 
fluid  used  will  depend  on  the  stage  of  the  disease,  the  severity  of  the 
manifestations,  and  the  condition  of  the  patient. 

Besides  the  preparations  above  mentioned,  other  solutions  of  corro- 
sive chloride  have  been  proposed.  Matthes  recommends  the  follow- 
ing :  Bichloride  of  mercury,  gr.  xv  ;  chloride  of  sodium,  gr.  xxx  ;  dis- 
tilled water,  f  f  iij.  Make  a  solution.  Matthes  had  observed  the 
action  of  this  during  two  years  at  Auspitz's  polyclinic.  The  usual  dose 
was  a  Pravaz  syringeful — fifteen  to  twenty  minims — every  two  days. 
No  irritation  is  produced  beyond  some  tumefaction,  and,  in  general, 
twenty  to  thirty  injections  sufficed  to  effect  a  cure. 

Recently,  Liebreich  has  brought  forward  the  formamide  of  mer- 
cury as  the  most  suitable  preparation  for  the  hypodermatic  method. 
It  is  neutral  in  reaction,  readily  soluble  in  water,  and  does  not  coagu- 
late albumen. 

4.  Internal. — This  method,  in  the  nature  of  things,  must  be  most 
frequently  resorted  to.  Various  mercurial  preparations  are  used  by 
different  syphilographers.  The  Ricord  school  prefer  the  green  iodide  ; 
Sigmund,  mercurial-ointment  inunctions  ;  Foerster,  the  yellow  iodide  ; 
Berkeley  Hill,  the  red  iodide  ;  Tilbury  Fox,  the  cyanide  ;  Bumstead 
advises  mercurial  pill,  the  green  iodide,  the  bichloride,  according  to 
circumstances,  but  his  preference  is  for  the  use  of  calomel  by  fumi- 
gation. That  preparation  of  mercury  is  to  be  preferred  which  best 
agrees  with  the  patient,  is  the  rule. 

The  indications  for  the  use  of  iodine  preparations  have  already  been 
stated,  but  it  may  be  useful,  now,  to  place  in  juxtaposition  the  com- 
parative utility  of  mercury  and  iodine  :  mercury  for  the  primary  in- 
fecting sore  ;  mercury  for  the  affections  of  the  skin,  especially  macular 


MERCURY.  293 

and  papular  exanthemata  ;  iodine  for  the  tertiary  symptoms  :  gummata  ; 
tubercular  syphilides  ;  serpiginous  ulcers  ;  affections  of  the  bones  and 
periosteum,  and  nervous  diseases. 

Hydrargyrum  cum  creta  is  usually  preferred  for  the  treatment  of 
congenital  syphilis.  Mr.  Marshall  recommends  the  twenty-per-cent 
ointment  (the  size  of  a  pea)  of  the  oleate  of  mercury,  to  be  placed  in 
the  axilla  night  and  morning  for  five  or  six  days. 

Local  Uses  of  Mercurials. — Recent  experimental  investigations  on 
the  action  and  comparative  germicide  properties  of  the  various  anti- 
septics have  shown  the  superiority  of  corrosive  sublimate  over  all 
others  ;  hence  it  has  come  to  be  largely  used  in  the  dressing  of  wounds, 
and  as  a  local  application  to  specific  ulcerations,  etc.  The  acid  nitrate 
of  mercury  is  one  of  the  best  caustics  for  the  destruction  of  chancroid. 
It  should  be  applied  with  a  glass  rod  after  the  surface  of  the  sore 
has  been  well  cleansed.  It  is  now  conceded  that  destruction  of  an 
infecting  chancre  does  not  prevent  systemic  infection.  /Syphilitic 
warts  and  vegetations  on  the  genitals  are  amenable  to  the  same  treat- 
ment. Erosions  and  ulcerated  indurations  are  best  treated  by 
"black -wash"  (calomel,  eight  grains  —  lime-water,  one  ounce),  or 
"  yellow-wash  "  (one  grain  of  corrosive  sublimate  to  an  ounce  or  two 
of  lime-water).  The  surface  of  the  sore  may  be  kept  wet  with  these 
lotions. 

Ricord's  treatment  of  condylomata  consists  in  washing  them  with 
a  solution  of  chlorinated  soda,  and  then  dusting  them  with  calomel. 
Mercurial  applications  are  of  very  great  service  in  cutaneous  affections 
of  syphilitic  origin.  A  drachm  of  calomel  to  an  ounce  of  lard  makes 
an  ointment  which  is  very  serviceable  in  herpes,  psoriasis,  and.  pruritus 
of  the  vulva  and  anus.  Ringer  speaks  of  calomel-ointment  in  terms 
of  great  praise  in  various  itching  affections,  especially  of  the  anus  and 
perinseum.  In  acne,  lotions  containing  corrosive  sublimate,  and  oint- 
ments of  green  and  red  iodide,  are  much  employed  :  $  Hydrarg. 
chlor.  cor.,  3  j  ;  glycerini,  §  ss  ;  spts.  vini  rect.,  f  vij  ;  spts.  rosmar., 
3  iv.  M.  For  acne  and  pityriasis  of  the  scalp  :  ^  Hydrarg.  iod. 
virid.,  gr.  x  ;  adipis,  f  j.  M.  ]J  Hydrarg.  iod.  rubri,  gr.  v  ;  adipis, 
3"  j.  M.  For  acne  indurata.  The  following  is  Startin's  lotion  of 
corrosive  sublimate  for  syphilitic  eruptions  :  $  Hydrarg.  chlor.  cor., 
gr.  iv  ;  acid,  nitric,  dil.,  3  j  ;  acid,  hydrocyan.  dil.,  3  j  ;  glycerini,  3  ij  ; 
aquae,  f  viij.  M.  For  pityriasis,  chloasma,  etc. 

Lotions  of  corrosive  sublimate  are  much  employed  in  the  treatment 
of  parasitic  skin-affections.  The  stronger  ones  must  be  used  with  cau- 
tion. It  is  rarely  necessary  to  use  a  lotion  stronger  than  two  grains  to 
the  ounce.  The  following  is  an  excellent  formula  of  Tilbury  Fox  :  $ 
Hydrarg.  chlor.  cor.,  grs.  iv  ;  alcohol,  3  vj  ;  ammonias  muriat.,  3  ss  ; 
aquae  rosse,  q.  s.  ad  3  vj.  M.  For  scabies,  ptheiriasis,  and  tinea  versi- 
color.  A  scruple  of  corrosive  sublimate  to  the  ounce  of  simple  oint- 


294  AGEXTS  INCREASING  WASTE.    ' 

ment  is  an  effective  application  in  favus  and  tinea  tonsurans,  when 
used  in  the  early  stages  of  these  affections. 

Calomel  finely  levigated  and  dusted  over  the  membrane  by  means 
of  a  camel's-hair  brush  is  an  excellent  local  application  \nphlyctenular 
ophthalmia.  Eczema  of  the  margin  of  the  eyelids  is  quickly  cured  by 
rubbing  in  every  night,  after  detaching  the  scales,  a  small  quantity  of 
the  brown  citrine-ointment.  Chronic  inflammation  of  the  external 
auditory  meatus  is  cured  by  the  same  application,  viz.,  by  allowing  a 
small  quantity  of  the  brown  citrine-ointment  to  remain  in  contact  with 
the  integument. 

Mr.  Marshall  strongly  recommends  the  oleates  in  parasitic  skin-dis- 
eases. He  employs  a  five-per-cent  solution  of  oleate  of  mercury  in 
oleic  acid,  adding  an  eighth  part  of  ether.  This  is  applied  by  means 
of  a  camel's-hair  brush.  It  is  used  in  sycosis,  tinea,  and  chloasma, 
porrigo,  pruritus  ani,  and  pruritus pudendi.  The  oleates  are  extremely 
serviceable  remedies  for  the  local  treatment  of  syphilitic  induration, 
but  they  are  not  advisable  when  ulceration  exists. 

The  oleate  of  mercury  and  morphia  (obtained  by  the  addition  of 
the  alkaloid  morphia)  is  an  elegant  and  efficient  application  in  super- 
ficial inflammations,  especially  of  joints  of  the  rheumatic  and  arthritic 
varieties.  Inflammatory  indurations,  left  after  the  subsidence  of  acute 
trouble,  are  removed  by  the  same  combination.  For  application  to 
these  purposes  Mr.  Marshall  employs  a  five-per-cent,  ten-per-cent,  and 
twenty-per-cent  solution  of  oleate  of  mercury  in  oleic  acid.  To  every 
drachm  of  such  solution  he  adds  one  grain  of  morphia. 

Mr.  C.  .Bader,  the  eminent  ophthalmologist  of  London,  advises  the 
following  ointment  in  conjunctivitis:  I£  Hydrargyri  oxidi  rubri, 
gr.  x  ;  atropise  sulph.,  gr.  j  ;  vaselin.,  3  j.  M.  Dr.  Seely,  of  Cincin- 
nati, strongly  urges  the  use  of  an  ointment  of  the  yellow  oxide,  eight 
or  ten  grains  to  the  ounce  of  vaseline.  He  directs  that  the  yellow 
oxide  be  triturated  to  the  utmost  degree  of  fineness,  and  then  thor- 
oughly incorporated  with  the  vaseline,  the  result  being  a  bright-yellow 
ointment.  A  portion  of  this  is  taken  on  a  probe,  the  lid  lifted  up,  and 
the  whole  is  wiped  off  on  the  mucous  membrane. 

For  pruritus  of  the  vulva,  the  following  lotion  is  recommended : 
Hydrarg.  chlor.  cor.,  one  part ;  alum,  20  parts  ;  starch,  100  parts  ;  and 
water,  2,500  parts.  The  official  ointment  of  the  red  iodide  of  mercury 
is  an  effective  application  in  simple  hypertrophy  of  the  thyroid  gland, 
and  an  enlarged  spleen,  or  ague-cake.  A  bit  of  ointment,  the  size  of 
a  large  pea,  is  thoroughly  rubbed  in  over  the  affected  organ,  the  sun's 
rays  falling  on  the  part  if  practicable,  or  the  friction  may  be  carried 
on  before  a  bright  fire,  or  without.  As  soon  as  the  skin  becomes  sore 
the  applications  are  suspended  until  it  recovers,  when  they  may  be  re- 
sumed. The  applications  should  be  made  daily. 

For  that  parasitic  affection  of  the  sb.in,pityriasis,  there  is  no  lotion 


MERCURY.  295 

so  effective  as  a  strong  solution  of  corrosive  sublimate — 3  j —  3  j —  §  iv 
of  rose-water.  It  need  hardly  be  observed  that  these  strong  solutions 
require  very  careful  handling.  Less  than  necessary  will  fail,  and  appli- 
cation to  an  abraded  surface  will  induce  toxic  symptoms. 

As  a  germicide,  corrosive  sublimate  now  occupies  the  first  place,  and 
is,  in  consequence,  largely  utilized  in  medical,  surgical,  and  obstetrical 
practice.  In  parasitical  diseases,  as  diphtheria,  typhoid,  gonorrhoea, 
etc.,  excellent  results  have  been  obtained  by  its  use  (Paul,  Martineau, 
Moutard-Martin).  To  destroy  the  infection  of  wounds,  to  sterilize  in- 
struments, to  remove  decomposing  materials,  and  to  prevent  systemic 
poisoning,  corrosive  sublimate  continues  to  be  employed  on  an  increas- 
ing scale — only  limited  by  the  danger  of  its  toxic  action.  It  must  be 
remembered  that  this  danger  is  by  no  means  remote.  An  early  mani- 
festation of  toxic  action  is  the  occurrence  of  enteritis,  examples  of  which 
have  been  recently  published  by  Fraenkel,  Peabody,  and  others,  when 
a  solution  of  one  part  to  one  thousand  only  had  been  applied  topically. 
Well-authenticated  instances  of  toxic  effects  have  become  so  numer- 
ous as  to  demand  intelligent  supervision  during  the  whole  period  of 
its  application. 

Authorities  referred  to  : 

ANDERSON,  DR.  McCALL.   On  (he  Treatment  of  Diseases  of  the  Skin,  London,  1872.  p.  98. 

BAUMLER,  PROF.  DR.  CHRISTIAN.   Ziemssen's  Cyclopedia,  vol.  iii,  p.  280,  American  edition. 

BUCHOLTZ,  DR.     Archiv  f.  experiment.  Pathol.  u.  Pharm.,  Band  4,  p.  1. 

BUMSTEAD,  DR.  FREEMAN  J.     On  the  Pathology  and  Treatment  of  Venereal  Diseases. 

Fox,  DR.  TILBURY.     On  Diseases  of  the  Skin,  Syphilodcrmata,  p.  277,  second  Amer.  ed. 

FRAENKEL,  DR.     Virchow  und  Hirsch,  Jahresbericht  for  1885. 

GOMBAULT,  M.     Arch,  de  Nevrologie,  vol.  i,  1880. 

HALLOPEAD,  M.  Archives,  de  Phys.  et  Path.,  p.  140,  1878. 

HERMANN,  PROF.  DR.  L.  Lehrbuch  der  experimentellen  Toxicoloaie,  Berlin,  1874,  p.  211. 
Quecksilbersalze.  • 

KUSSMAUL,  A.      Untersuchungen  uber  den  constit.  Mcrcurialismus  (quoted). 

LANCEREAUX,  DR.  E.     Treatise  on  Syphilis.     Sydenham  Society  edition,  vol.  ii,  p.  291. 

LETULLE,  M.  Recherches  din.  et  exper.  sur  les  Paralys.  Mercurial.  Archives  de  Phy- 
siol.,  etc.,  No.  3,  1887. 

MARECHAL,  PH.     These  de  Paris,  1886  (quoted) 

MARSHALL,  MR.  JOHN,  F.  R.S.     The  Lancet,  vol.  i,  1872,  p.  709. 

MARTINEAU,  DR.  Therapeut.  Society  Discussion,  1885.  In  Revue  de  Therap. ;  Bui. 
Gen.  de  Therap.,  and  other  periodicals. 

MIGUEL,  DR.     Bui.  Gen.  de  Therap.,  vol.  cvii,  p.  80. 

MOUTARD-MARTIN,  DR.     Ibid. 

NOTHNAGEL,  PROF.  DR.  HERMANN.    Handbuch  der  Arzneimittellehre,  p.  225. 

PAUL,  DR.  C.     Ibid. 

PEABODY,  DR.     New  York  Medical  Record  for  1885. 

Ross,  DR.  JAMES.      On  the  Action  of  Mercury.     The  Practitioner,  vol.  v,  p.  211. 

RUTHERFORD,  PROF.  WILLIAM.  An  Experimental  Research  on  the  Physiological  Actions 
of  Drugs  on  the  Secretion  of  Bile,  Edinburgh,  1880. 

SCHMIDT'S  JAHRBUCHER.  Ueber  subcutane  Injection  von  Quecksilberpraparaten  bei 
Syphilis,  vol.  cliii,  p.  153.  Abstract  of  papers  and  works  by  Hansen,  Taylor,  Schiitzen- 
berger,  Caspari,  Paqvalin,  Lewin,  Sigmund,  etc. 


296  AGENTS  INCREASING   WASTE. 

SCOTT,  DR.  GEORGE.     Scale's  Archives  of  Medicine,  vol.  i,  p.  209. 

TAYLOR,  DR.  A.  S.     Treatise  on  Poisons,  p.  897,  American  edition. 

TAYLOR,  DR.  R.  W.     Bone  Syphilis  in  Children,  New  York,  1875,  p.  155. 

THE  EDINBURGH  COMMITTEE,  BRITISH  MEDICAL  ASSOCIATION.  On  tlie  Cholagogue  Ac- 
tion of  Mercury.  Medical  Times  and  Gazette,  vol.  ii,  1869,  p.  418. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Matiere  Medicale,  huiti&me 
Edition,  vol.  i,  p.  228. 

Aumm. — Gold.      Or,  Fr.  ;   Gold,  Ger. 

Auri  et  Sodii  Chloridum. — Gold  and  sodium  chloride.  A  mix- 
ture of  equal  parts  by  weight  of  dry  gold  chloride  and  sodium  chlo- 
ride. An  orange-yellow  powder,  odorless,  having  a  saline  and  metal- 
lic taste,  and  very  soluble  in  cold  water.  Dose,  gr.  ^ — gr.  ^.  The 
chloride  of  gold  is  not  official,  and  is  not  suitable  for  internal  admin- 
istration. 

ANTAGONISTS  AND  INCOMPATIBLES. — Eggs,  albumen,  milk,  flour,  are 
chemical  antidotes.  The  contents  of  the  stomach  should,  of  course, 
be  evacuated.  The  principles  of  treatment  are  the  same  as  for  poison- 
ing by  corrosive  sublimate. 

SYNEKGISTS. — The  salts  of  mercury,  especially  the  corrosive  chloride, 
are  very  similar  in  action  to  the  chlorides  of  gold,  and  are  therefore 
synergistic. 

PHYSIOLOGICAL  ACTION. — The  chloride  of  gold  is  a  caustic  in  its 
local  action.  In  toxic  dose  it  excites  violent  gastro-enteritis,  accom- 
panied by  such  nervous  phenomena  as  cramps,  convulsive  trembling, 
insomnia,  priapism,  insensibility,  etc.  In  small  medicinal  doses  these 
auric  preparations  promote  the  appetite  and  the  digestive  capacity.  If 
long  continued,  especially  if  the  dose  be  a  full  medicinal  one,  epigastric 
pain  and  distress  are  excited,  nausea  is  induced,  and  loss  of  appetite 
follows.  Constipation  is  usually  produced  by  the  preparations  of  gold, 
and  this,  notwithstanding  an  increased  secretion  of  the  intestinal 
glandular  apparatus  is  one  of  the  results  of  their  administration. 
These  preparations  do  not  probably  entirely  enter  the  blood  from  the 
stomach,  but  part  passes  to  the  intestinal  canal,  is  there  decomposed, 
and  is  absorbed  as  oxide  in  combination  with  albumen.  This  is,  how- 
ever, conjectural.  They  are  readily  soluble  and  are  very  diffusible 
substances.  What  particular  influence  they  exert  on  the  composition 
and  function  of  the  blood  is  at  present  quite  unknown.  A  form  of 
fever,  known  as  auric  fever,  is  caused  by  their  prolonged  adminis- 
tration. This  fever  is  accompanied  by  profuse  sweats,  a  very  abundant 
flow  of  urine,  and  increased  salivary  secretion.  The  salivation  caused 
by  the  preparations  of  gold  differs  from  the  mercurial  in  that  there  is 
no  tenderness  nor  ulceration  of  the  gums. 

Peculiar  effects  on  the  mental  state  are  produced  by  the  adminis- 
tration of  the  auric  preparations.  The  functions  of  the  mind  become 
more  active,  and  even  excited,  and  a  state  of  cheerfulness  is  induced. 
In  men,  marked  aphrodisiac  effects  are  produced,  and  the  erections  are 


GOLD.  297 

often  painful ;  in  women,  increased  venereal  desires  and  augmentation 
of  the  menstrual  flow  are  observed. 

The  elimination  of  the  auric  preparations  takes  place  by  the  liver, 
the  intestinal  canal,  but  chiefly  by  the  kidneys.  The  urine  assumes  a 
bright-yellow  color. 

Prolonged  administration  of  medicinal  doses  induces  epigastric  heat 
and  oppression,  headache,  dryness  of  the  throat  and  mouth,  gastro- 
intestinal irritation,  fever. 

THERAPY. — The  chloride  of  gold  and  sodium,  in  small  doses  (-^ 
grain)  three  times  a  day,  will  relieve  nervous  dyspepsia.  A  red  and 
glazed  tongue,  epigastric  pain,  increased  by  taking  food,  and  a  tend- 
ency to  relaxation  of  the  bowels  after  eating,  are  indications  for  the 
use  of  this  salt.  Catarrh  of  the  duodenum,  catarrh  of  the  bile-ducts, 
and  jaundice  dependent  thereon,  are  symptoms  which  may  usually  be 
removed  by  the  salts  of  gold  if  given  in  small  doses. 

Injections  of  gold  and  sodium  chloride  are  strongly  advocated  by 
Drs.  Shurley  and  Gibbes,  of  Michigan,  in  cases  of  pulmonary  tuber- 
culosis. 

In  certain  convulsive  neuroses  of  the  respiratory  organs,  the 
chloride  of  gold  and  sodium  has  seemed  to  be  very  effective  ;  for  ex- 
ample in  laryngismus  stridulus,  whooping-cough,  etc. 

Amenorrhcea,  dependent  on  torpor  of  the  ovaries,  may  be  removed 
by  the  persistent  use  of  auric  preparations.  Chronic  metritis,  with 
scanty  menstruation,  is  often  remarkably  benefited  by  them.  Sterility, 
dependent  on  these  states,  or  due  to  coldness,  is  more  certainly  cured 
by  these  agents  than  by  any  other  merely  medicinal  means.  It  is  said 
by  Martini  that  the  tendency  to  habitual  abortion  may  be  averted 
by  the  use  of  chloride  of  gold. 

Decline  of  the  sexual  power  in  man  may  be  prevented  by  the  use 
of  gold  salts,  and  the  following  are  symptoms  which  may  be  removed 
sometimes  by  them  :  diurnal  seminal  losses,  weak  and  inefficient  erec- 
tions, inability  for  the  sexual  congress,  due  to  irritability  of  the  sexual 
organs.  They  increase  the  frequency  of  the  nocturnal  losses  in  those 
who  are  suffering  from  plethora  of  these  organs.  Cases  that  are 
benefited  by  the  bromide  of  potassium  are  increased  by  the  chloride 
of  gold,  and  vice  versa. 

The  author  calls  especial  attention  to  the  use  of  the  salts  of  gold  in 
chronic  BrlgMs  disease — granular  and  fibroid  kidney.  His  experience, 
narrated  in  successive  editions  of  this  work,  has  continued  to  be  highly 
favorable,  and  various  confirmatory  observations  have  been  published 
by  others.  The  double  chloride — of  gold  and  sodium — is  the  prepara- 
tion to  use,  and  the  dose  will  vary  from  ^ — -fa  grain. 

The  nature  of  the  curative  action  consists  in  the  impression  made 
on  the  connective-tissue  elements  ;  it  prevents  or  lessens  the  over- 
growth, and  hence  it  is  now  utilized  in  the  treatment  of  the  various 


298  AGENTS   INCREASING   WASTE. 

scleroses — of  the  liver,  of  the  kidney,  of  the  arterial  system  (arterio- 
sclerosis), and  of  the  nervous  system. 

Excellent  results  are  obtained  from  the  use  of  the  double  chloride 
in  certain  forms  of  mental  disorder  :  e.  g.,  melancholia,  hypochondria, 
and  allied  mental  states,  accompanied  by  depression.  Vertigo  and 
vertiginous  sensations,  when  due  to  stomach -disorders,  are  often  re- 
moved by  minute  doses,  but  plethora  and  increased  intracranial  blood- 
pressure  contraindicate  their  use  ;  on  the  other  hand,  they  have  a 
high  degree  of  utility  when  there  is  present  the  condition  of  cerebral 
anaemia.  The  author  has  been  favored  with  a  private  communication 
from  Dr.  Bauduy,  of  St.  Louis,  in  which  this  experienced  and  able 
physician  expresses  his  confidence  in  the  value  of  this  remedy  in  the 
treatment  of  hypochondriasis  and  melancholia.  In  Chaucer's  "  Can- 
terbury Tales,"  which  appeared  near  the  close  of  the  fourteenth  cent- 
ury, we  find  the  following  couplet : 

"  For  gold  in  physic  is  a  cordial, 

Therefore,  he  loved  gold  in  especial." 

Also,  in  that  curious  mixture  of  scholastic  learning  and  whimsical 
suggestion,  the  "  Anatomy  of  Melancholy,"  gold  is  recommended  as 
the  best  remedy  for  mental  depression. 

Authorities  referred  to  : 

GUBLER,  DK.  ADOLPH.     Commentaires  du  Codex  Medicamentarius,  Paris,  1868,  p.  506, 

NOTHNAGEL,  DR.  HERMANN.     Handbuch  der  ArzneimiUellehre,  Berlin,  1870,  p.  310. 

MARTINI,  DR.  LUDWIG.  Schmidfs  Jahrbucher  der  gesammten  Medicin,  etc.,  vol.  cxlvi, 
p.  263. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Mature  Medicale,  huitieme  edi- 
tion, vol.  i,  p.  388. 

Argentum. — Silver.     Argent,  Fr.;  Silber,  Ger. 

Argenti  Oxidum. — Silver  oxide.  An  olive-brown  powder,  very 
slightly  soluble  in  water.  Dose,  gr.  ss. — grs.  ij,  in  pill. 

Argenti  Nitraa. — Silver  nitrate.  A  heavy,  colorless,  anhydrous 
salt,  wholly  soluble  in  distilled  water,  and  crystallizing  in  shining, 
rhombic  plates.  Dose,  gr.  \ — gr.  ss,  in  pill,  or  in  solution. 

Argenti  Nitras  Fusus. — Fused  silver  nitrate.  In  cylindrical  pieces. 
It  is  only  used  for  topical  applications. 

Argenti  Nitras  Dilutus. — Diluted  (mitigated)  silver  nitrate.  Sil- 
ver nitrate,  30  grm.;  potassium  nitrate,  60  grm.  Formed  in  pencils 
or  cones. 

Argenti  Cyanidum. — Silver  cyanide.  Is  a  white  powder,  insolu- 
ble in  water.  Dose,  gr.  ^ — gr.  -fa,  in  pill-form. 

Argenti  lodidum. — Silver  iodide.  An  amorphous  powder,  yel- 
lowish in  color,  without  taste,  and  insoluble  in  water  or  alcohol. 
Dose,  gr.  ^— gr.  f 

ANTAGONISTS  AND  INCOMPATIBLES. — The  soluble  chlorides  and  all 


SILVER.  299 

substances  containing  them  are  incompatible  with  the  nitrate  of  silver ; 
hence  most  of  the  natural  waters  decompose  it,  because  they  contain 
more  or  less  common  salt.  An  insoluble  chloride  of  silver  is  the  result 
of  the  decomposition.  The  following  mineral  acids  and  their  salts 
are  chemically  incompatible  :  Sulphuric,  muriatic,  tartaric,  and  sul- 
phurous. Alkalies  and  their  carbonates,  astringent  infusions,  and 
lime-water  are  incompatible.  In  cases  of  poisoning  by  nitrate  of 
silver,  common  salt  is  the  appropriate  antidote.  This  should  be 
given  in  solution  very  freely,  to  act  as  an  emetic  as  well  as  chemical 
antidote. 

Therapeutically  the  salts  of  silver  are  antagonized  by  all  those 
agents  which  promote  constructive  metamorphosis. 

SYNEKGISTS. — All  agents  promoting  waste,  as  mercury,  iodides,  etc., 
favor  the  action,  therapeutically,  of  nitrate  of  silver. 

PHYSIOLOGICAL  ACTIONS. — Nitrate  of  silver  acts  chemically  on  the 
tissue  to  which  it  is  applied.  It  combines  with  the  albumen,  and  ex- 
cites a  superficial  inflammation,  producing  in  some  subjects  vesication, 
in  all  a  whitish  eschar.  It  is,  therefore,  an  escharotic,  but  of  very 
limited  activity.  The  white  eschar  produced  by  it,  subsequently — 
under  the  influence  of  light — becomes  brownish-black. 

Nitrate  of  silver  has  a  strong  metallic,  styptic  taste.  A  strong  solu- 
tion, brushed  over  the  mucous  membrane,  whitens  it.  In  the  stomach, 
the  salts  of  silver  produce  a  sense  of  warmth  at  the  epigastrium,  and, 
in  large  (toxic)  doses,  excite  a  violent  gastro-enteritis.  Meeting  in  the 
stomach  soluble  chlorides,  undoubtedly  the  insoluble  chloride  of  silver 
is  formed,  but  a  portion  of  the  salt,  probably,  at  once  enters  into  com- 
bination with  albumen  and  peptones.  That  the  action  of  nitrate  of 
silver,  when  swallowed,  is  not  that  of  the  chloride,  has  been  experi- 
mentally shown  ;  hence  the  conversion  of  the  nitrate  salt  into  chloride 
does  not  suffice  to  explain  the  effects  which  ensue.  Increased  secre- 
tion from  the  intestinal  glandular  apparatus  is  produced  by  the  silver 
salts,  and  the  alvine  dejections  are  softer  and  more  frequent.  Long- 
continued  use  of  these  agents  will  cause  gastro-intestinal  catarrh. 

The  salts  of  silver  most  probably  enter  the  blood  as  albuminates 
and  peptonates.  They  effect  very  important  changes  in  the  blood, 
which  becomes  darker  and  more  fluid,  the  red  corpuscles  paler  and 
altered  in  outline,  the  haemoglobin  converted  into  haematin.  A  slight 
lowering  of  the  temperature  is  a  result  of  these  changes  in  the  com- 
position of  the  blood.  Various  tissues  of  the  body  undergo  patho- 
logical alterations.  The  epithelium  of  the  intestinal  mucous  membrane, 
of  the  kidneys  and  liver,  becomes  swollen  and  cloudy,  and  sometimes 
fatty.  The  amount  of  bile  is  increased,  and  albumen  frequently  ap- 
pears in  the  urine.  The  nutrition  of  the  body  is  impaired  and  a  pro- 
gressive diminution  in  weight  and  strength  takes  place.  The  venous 
system  is  found  in  a  state  of  stasis  ;  transudations  take  place,  the 


300  AGENTS  INCREASING  WASTE. 

action  of  the  heart  is  rapid  and  irregular,  and  the  respiration  is  embar< 
rassed. 

The  nervous  system  participates  in  the  general  impairment  of 
structure  ;  tetanic  convulsions,  paralysis,  and  insensibility,  ensue.  The 
paralysis  is  not  due  to  alterations  in  the  muscular  system — for  the 
muscles  preserve  their  irritability — but  is  centric  in  origin.  It  is  true 
the  muscles,  in  poisoning  by  silver,  become  granular  and  their  striae 
obliterated,  but  their  contractility  is  not  destroyed. 

Only  a  minute  part  of  the  silver  administered  is  eliminated  by  the 
kidneys  ;  most  of  it  escapes  by  the  liver  and  the  intestinal  glands  ;  but 
a  portion  remains  permanently  deposited  in  the  tissues  if  its  adminis- 
tration has  been  protracted.  Rarely  is  it  safe  to  continue  the  use  of 
the  preparations  of  silver  longer  than  six  weeks,  and  occasional  purga- 
tives should  be  given  to  promote  elimination.  An  olive,  slate-colored, 
or  grayish-brown  discoloration  of  the  various  tissues  of  the  body  results 
from  a  deposition  of  silver.  This  is  usually  first  seen  at  the  margin 
of  the  teeth  or  on  the  inside  of  the  lips  and  cheeks,  and  is  an  indica- 
tion that  the  system  is  becoming  saturated.  I  find  in  Sieveking,  "  On 
Epilepsy,"  the  following  instructive  instance  of  argyria  :  "  The  pa- 
tient, a  man  aged  sixty,  became  epileptic  in  March,  1856,  and  was 
treated  with  nitrate  of  silver  almost  from  the  commencement ;  for 
nine  months  he  took  a  daily  pill  containing  six  grains,  so  that,  during 
that  time,  he  swallowed  nearly  three  and  a  half  ounces.  Toward  the 
end  of  July  the  skin  began  to  be  discolored,  but,  in  spite  of  gastric 
symptoms,  the  remedy  was  persevered  in.  In  1857  haematemesis  and 
other  symptoms  of  gastric  ulceration  supervened,  while  the  severity 
of  the  epilepsy  had  abated,  and,  having  in  the  mean  time  come  to 
England,  he  was  admitted  to  the  German  Hospital,  where  he  soon 
died.  The  special  interest  attaching  to  the  autopsy  is  connected  with 
the  extent  to  which  the  silver  had  been  deposited  in  the  tissues.  The 
parts  in  the  face  which  had  exhibited  the  greatest  intensity  of  dis- 
coloration, owing  to  their  containing  more  blood,  now  presented  a  tint 
uniform  with  the  rest.  In  the  brain  the  choroid  plexuses  presented 
a  uniform  grayish-blue  tint.  The  lungs  were  tuberculous  and  pneu- 
monic, the  heart  hypertrophic.  The  stomach  contained  a  large  quan- 
tity of  acid,  brown  liquid  streaked  with  blood,  and  at  the  upper  part 
of  the  posterior  wall  was  a  large  ulcer,  at  the  base  of  which  was  an 
orifice  blocked  up  by  the  adherent  pancreas.  The  mucous  membrane 
of  the  duodenum  and  jejunum  was  dotted  over  with  many  small  black 
granules,  most  closely  aggregated  along  the  folds.  In  the  ileum  these 
spots  became  more  and  more  scanty.  .  .  .  The  spleen  was  small,  its 
veins  had  an  ashen  hue,  which  was  due  to  a  finely-granular  precipitate 
upon  their  coats.  The  liver  was  small,  congested,  and  fatty  ;  the  small 
branches  of  the  vena  portae  and  of  the  hepatic  veins  presented  the 
same  precipitate  of  silver  throughout,  but  the  capillaries  were  free  from 


SILVER.  301 

it.  Fine  sections  of  the  hepatic  tissue  showed  numerous  black  dots, 
each  of  which  occupied  the  center  of  an  acinus,  corresponding  to  the 
point  of  exit  of  a  central  vein,  and  the  color  was  produced  by  a  black 
margin  surrounding  the  caliber  of  the  artery.  The  largest  argentine 
deposit  was  in  the  kidneys.  ...  The  pyramids  all  exhibited  a  dark- 
gray  color,  which  was  deepest,  and  all  but  black,  near  the  papillae. 
The  tubules  in  these  parts  were  entirely  invested  with  a  dense  precipi- 
tate. .  .  .  Parts  of  the  skin  taken  from  the  temporal,  axillary,  and 
digital  regions,  were  examined.  Transverse  sections  showed  a  pale, 
purplish  streak  immediately  underneath  the  rete  Malpighii,  following 
the  undulations  of  the  cutis.  .  .  .  The  glandular  epithelium  uniformly 
presented  fatty  degeneration." 

A  persistent  and  long-continued  use  of  the  iodide  of  potassium  and 
of  the  hyposulphite  of  soda  has,  in  a  few  fortunate  instances,  caused 
the  absorption  and  excretion  of  the  silver  deposits.  The  action  of  these 
systemic  remedies  for  the  discoloration  may  be  aided  by  baths  of  the 
hyposulphites  and  by  the  cautious  use  of  lotions  containing  the  cyanide 
of  potassium,  which  possess  a  decided  solvent  power  over  the  silver 
deposits. 

THERAPY. — The  oxide  and  the  nitrate  of  silver  are  extremely  ser- 
viceable remedies  in  the  so-called  nervous  dyspepsia,  and  in  chronic 
gastric  catarrh.  They  are  indicated  in  the  following  state  of  things  : 
Pain  after  taking  food,  lasting  for  an  hour  or  more  (gastralgia),  the 
digestion,  although  slow,  being  good  ;  burning  pain,  with  pyrosis,  com- 
ing on  after  the  completion  of  the  stage  of  stomach  digestion  ;  eructa- 
tions of  food,  with  sour  and  acrid  matters — the  first  being  a  gastralgia, 
and  the  other  states  being  caused  by  gastric  catarrh,  and  consequent 
fermentation  of  the  starch,  sugar,  and  fats.  $  Argenti  oxidi,  grs.  v  ; 
ext.  hyoscyami,  grs.  v.  M.  Ft.  pil.  no.  x.  Sig. :  One  three  times  a  day 
before  meals.  In  chronic  gastric  catarrh,  Frerichs  recommends  the 
following  formula  :  $  Argenti  nitrat.,  grs.  xv  ;  aq.  destil.,  q.  s.  ;  ext, 
belladonna,  grs.  x  ;  ol.  caryophylli,  gtt.  x  ;  rad.  gentian  pulv.,  ext. 
gentianae,  aa  q.  s.  ut  ft.  pil.  no.  Ix.  Sig.  :  One  pill  three  times  a  day. 
When  there  is  much  pain  present,  Wilson  Fox  highly  commends  the 
combination  of  nitrate  of  silver  and  opium  in  chronic  gastric  catarrh, 
but,  as  constipation  so  frequently  attends  this  state,  belladonna  or 
hyoscyamus  is  usually  to  be  preferred.  Notwithstanding  the  strong 
opinion  which  Brinton  has  given  adversely  to  the  use  of  the  salts  oi 
silver  in  ulcer  of  the  stomach,  the  author  agrees  with  Fox  that  these 
agents  are,  in  this  affection,  next  in  value  to  bismuth.  The  oxide,  or 
the  nitrate,  may  be  given  in  pill-form,  as  above,  or  the  nitrate  in  solu- 
tion. In  these  stomach-affections,  as  a  rule,  the  oxide  of  silver — being 
free  from  the  causticity  of  the  nitrate — is  preferable. 

In  jaundice  dependent  on  catarrh  of  the  biliary  ducts,  especially 
when  there  are  present  considerable  pain  and  stomach-disorder,  the 


302  AGENTS   INCREASING   WASTE. 

salts  of  silver  not  only  give  relief  to  some  of  the  more  distressing 
symptoms,  but  assist  materially  in  restoring  the  functional  activity  of 
the  liver.  As  respects  these  hepatic  disorders,  silver  has  an  action  simi- 
lar to  arsenic,  manganese,  mercury,  and  some  other  mineral  remedies. 

Frequently  nitrate  of  silver  is  remarkably  beneficial  in  cholera  in- 
fanturn,  after  the  acuter  symptoms  have  subsided.  The  following  is 
an  excellent  formula  for  a  child  a  year  old  :  I£  Argenti  nitrat.,  gr.  j  ; 
acid,  nitric,  dil.,  m  viij  ;  tinct.  opii  deod.,  in  viij  ;  mucil.  acaciae,  f  ss  ; 
syrup,  simplicis,  3  ss  ;  aquae  cinnamomi,  3  j.  JVI.  Sig. :  A  teaspoonf  ul 
every  three,  four,  or  six  hours.  The  nitrate  of  silver  is  also  an  efficient 
remedy  in  that  form  of  diarrhoea  in  children  in  which  the  stools  are 
white,  pasty,  and  offensive,  and  the  urine  is  high-colored  and  acrid.  In 
dysentery,  both  of  children  and  adults,  after  the  acute  symptoms  have 
ceased,  and  in  chronic  dysentery,  the  nitrate  of  silver  is  a  most  efficient 
remedy.  In  some  epidemics  of  acute  dysentery,  when  the  constitutional 
condition  is  one  of  depression,  it  is  equally  effective.  In  these  mala- 
dies it  is  better  to  prescribe  the  nitrate  in  pill-form  (gr.  \ — gr.  j)  com- 
bined with  opium.  With  the  stomach  administration  of  the  nitrate 
may  be  conjoined  its  local  application  to  the  rectal  mucous  membrane, 
and  even  in  favorable  instances  to  the  descending  colon.  In  using 
nitrate  of  silver  by  enema,  the  application,  to  be  effective,  should  be 
made  through  a  flexible  tube  passed  cautiously  to  the  sigmoid  flexure 
or  beyond.  The  bowel,  previous  to  the  introduction  of  the  silver  solu- 
tion, should  be  as  thoroughly  washed  out  as  possible  by  tepid  water. 
From  ten  to  twenty  grains  of  the  nitrate  of  silver,  to  a  pint  of  water, 
is  a  suitable  proportion  for  an  enema. 

Obstinate  dysenteric  discharges,  either  alone  or  mixed  with  healthy- 
formed  faeces,  are  not  unfrequently  caused  by  an  ulcer  of  the  rectum. 
The  most  effective  treatment  for  such  an  ulcer  consists  in  the  applica- 
tion to  it,  through  a  suitable  speculum,  of  the  solid  stick  of  nitrate  of 
silver. 

The  author's  experience  justifies  him  in  asserting  that  the  most 
effective  remedy  for  the  diarrhoea  of  phthisis  is  nitrate  of  silver  com- 
bined with  opium.  When  the  diarrhoea  of  typhoid  fever  resists  bis- 
muth, Hope's  mixture,  and  laudanum  enemata,  a  satisfactory  result 
may  often  be  obtained  by  nitrate  of  silver,  as  follows  :  $  Argenti 
nitrat.,  grs.  iij;  pulv.  opii,  pulv.  ipecac.,  aa  grs.  vj.  M.  Ft.  pil.  no.  xij. 
Sig.  :  One  every  four  or  six  hours.  The  nitrate  of  silver  is  one  of  the 
numerous  remedies  which  have  been  used  in  the  treatment  of  cholera. 

Formerly  nitrate  of  silver  was  much  employed  in  the  treatment  of 
epilepsy,  but  it  has  justly  fallen  into  disuse,  for,  besides  the  danger  of 
tinting  the  skin,  it  is  not  as  effective  as  much  less  objectionable  reme- 
dies. Iodide  of  silver  has  proved  very  useful  in  the  treatment  of 
whooping-cough,  in  the  hands  of  Dr.  Bell,  of  Glasgow.  He  gives  one 
eighth  of  a  grain.  Since  proposed  by  Wunderlich,  this  agent  has  been 


SILVER.  303 

fairly  tested  in  the  treatment  of  posterior  spinal  sclerosis  (progressive 
locomotor  ataxia),  and  seems  to  have  some  influence  in  retarding  the 
progress  of  the  disease. 

LOCAL  USES. — Nitrate  of  silver  is  largely  used  as  an  external  appli- 
cation. A  case  has  recently  been  reported  in  which  argyriasis  was 
produced  by  the  free  application  of  this  salt  to  the  fauces,  hence  some 
care  should  be  exercised  in  applying  it  to  the  mucous  membranes.  For 
external  use,  the  cylinder  and  solutions  of  various  strengths  are  em- 
ployed. The  "  mitigated  "  stick  is  used  chiefly  by  ophthalmologists. 
The  most  satisfactory  solution  for  local  application  to  the  skin  is  ob- 
tained by  dissolving  the  salt  in  nitrous  ether  (gr.  v — 3  j —  3  j  of  ether). 
This  solution  acts  more  energetically  than  the  aqueous  solution,  and 
will  readily  vesicate. 

Solutions  of  nitrate  of  silver  are  much  less  frequently  applied  than 
formerly  to  inflamed  tonsils,  diphtheritic  affections  of  fauces,  acute 
laryngeal  troubles,  oedema  of  the  glottis,  etc.  In  the  incipiency  of 
tonsillitis,  a  strong  solution  (3j — 3  j — §  j)  may  sometimes  avert  the 
attack,  but  if  the  inflammation  be  well  established  the  irritant  action 
of  the  caustic  increases  the  morbid  process.  The  most  enlightened 
modern  authorities  (Oertel)  condemn  the  use  of  caustics  in  diphtheria  ; 
forcible  detachment  of  the  exudation  only  increases  the  chances  of 
systemic  infection,  and  injury  done  to  the  surrounding  healthy  mu- 
cous membrane  invites  the  extension  of  the  false  membrane.  A  suffi- 
cient quantity  of  silver  solution,  to  be  effective,  can  not  be  applied  to 
the  larynx,  nor  even  to  the  aryteno-epiglottidean  folds,  without  the 
aid  of  the  mirror,  and  this  manipulation  is  hardly  available  when  a 
state  of  acute  inflammation  exists.  Follicular  pharyngitis  is  one  of 
the  affections  which  can  be  successfully  treated  by  systematic  local 
applications  of  silver  solution.  Catarrh  and  ulcer ation  of  the  poste- 
rior nares  may  be  cured  by  persistent  use  of  the  same  remedy,  the 
application  being  made  by  a  suitable  sponge  probang,  or  brush,  passed 
behind  the  veil  of  the  palate.  The  appropriate  strength  for  these  pur- 
poses will  depend,  in  part,  on  habit  (grs.  v — 3j — f  j).  Very  weak 
solution  of  nitrate  of  silver  (gr.  j —  §  j)  is  sometimes  used  by  the 
spray-douche  (glass  tube)  in  chronic  inflammation  of  the  pharynx, 
larynx,  and  trachea.  Besides  the  ineffectiveness  of  this  method,  it  is 
objectionable  because  the  silver  spray  stains  the  face  and  clothing  of 
the  patient,  unless  a  shield  is  very  carefully  used.  To  ulcers  of  the 
tonsils,  tongue,  syphilitic  and  otherwise,  the  solid  nitrate  is  often  used. 
It  is  a  very  painful  application,  and  possesses  but  slight,  if  any,  advan- 
tages over  carbolic  acid,  which  is  anaesthetic  after  the  first  contact. 

A  strong  solution  of  nitrate  of  silver,  especially  in  nitrous  ether,  is 
a  most  efficient  application  to  check  inflammation  in  superficial  parts, 
e.  g.,  boils,  felon  (paronychia),  thecal  abscess,  orchitis,  synovitis,  etc. 
It  is  essential  to  the  success  of  this  treatment  that  the  application  be 


304  AGENTS  INCREASING   WASTE. 

made  early.  According  to  the  method  of  Mr.  Furneaux  Jordan,  it  is 
better  to  make  these  applications  to  the  adjacent  "  vascular  territory," 
than  to  the  inflamed  part  directly.  To  illustrate  :  In  the  case  of  orchitis, 
instead  of  painting  the  silver  solution  over  the  testicle,  it  is  better  to 
apply  it  along  the  groin  and  inner  face  of  the  thigh,  over  the  course 
of  the  great  vessels. 

Mr.  Higginbottorn,  who  is  the  author  of  this  method  of  treatment, 
says  that  "  we  have  no  therapeutic  agent  so  safe,  powerful,  or  effica- 
cious, as  the  nitrate  of  silver  in  subduing  external  inflammation  when 
properly  applied.  It  has  been  invariably  successful  in  my  hands  for 
nearly  the  last  forty  years."  Such  unstinted  praise  from  so  eminent 
an  authority  deserves  our  most  respectful  consideration.  As  the 
proper  application  of  the  remedy  is  so  important,  it  Were  better  to 
follow  literally  the  method  of  Mr.  Higginbottom  :  "  The  affected  part 
should  be  well  washed  with  soap  and  water,  then  with  water  alone,  to 
remove  every  particle  of  soap,  as  the  soap  would  decompose  the 
nitrate  of  silver  ;  then  to  be  wiped  dry  with  a  soft  towel.  The  con- 
centrated solution  of  four  scruples  of  the  nitrate  of  silver  to  four 
drachms  of  distilled  water  is  then  to  be  applied  two  or  three  times  on 
the  inflamed  surface  and  beyond  it,  on  the  healthy  skin,  to  the  extent 
of  two  or  three  inches.  The  solution  may  be  applied  with  a  small 
piece  of  clean  linen,  attached  to  the  end  of  a  short  stick  ;  the  linen  to 
be  renewed  at  each  subsequent  application.  ...  In  about  twelve 
hours  it  will  be  seen  whether  the  solution  has  been  well  applied.  If 
any  inflamed  part  be  unaffected,  the  solution  must  be  immediately  re- 
applied." 

The  method  of  Mr.  Higginbottom  is  extremely  effective  in  trau- 
matic erysipelas.  The  common  facial  erysipelas  rarely  requires  any- 
thing but  the  simplest  application.  The  concentrated  solution  of  ni- 
trate of  silver  should  be  thoroughly  applied  to  malignant  carbuncle  of 
the  lip,  and  to  the  adjacent  healthy  skin  for  a  short  distance.  The  pit- 
ting of  small-pox  may  be  prevented  by  rupturing  each  pustule  and  in- 
serting into  it  a  sharply-pointed  pencil  of  the  nitrate  of  silver.  Ac- 
cording to  Mr.  Higginbottom,  the  same  result  may  be  accomplished, 
and  with  greatly  less  labor,  by  applying  his  solution  in  the  manner 
above  indicated. 

The  solution  of  nitrate  of  silver  in  nitric  ether  ^ij —  §  j)  is  recom- 
mended by  Fox  in  the  chronic  forms  of  erythema,  eczema,  psoriasis,  and 
ringworms.  Indolent  ulcers,  discharging  sores  with  flabby  granula- 
tions, are  improved  in  character  and  made  to  heal  by  application  of 
Higginbottom's  concentrated  solution,  or  of  solid  caustic. 

Ulceration  of  the  cervix  uteri,  endo-cervicitis,  granular  cervicitis, 
endo-metritis,  are  effectively  treated  by  nitrate  of  silver  applications. 
The  solid  caustic  may  be  quickly  brushed  over  the  mucous  membrane, 
or  a  concentrated  solution  may  be  applied  with  a  suitable  "  applicator." 


SILVER.  305 

There  is  no  doubt  that  solid  caustic  may  be  applied  with  safety  in 
chronic  cases  to  the  interior  of  the  uterine  cavity,  after  preliminary 
dilatation  of  the  cervical  canal.  This  is  a  most  effective  treatment, 
but  injury  is  often  done  by  over-stimulation  and  too  prolonged  con- 
tact of  the  caustic.  Induration  of  the  cervix  and  narrowing  of  the 
cervical  canal  are  sometimes  produced  by  injudicious  use  of  the  solid 
caustic.  That  troublesome  affection,  pruritus  of  the  vulva,  may  often 
be  removed,  even  when  due  to  pregnancy,  by  washing  the  neck,  and 
the  cervical  canal  so  far  as  it  is  accessible,  with  a  strong  solution  of 
the  nitrate  of  silver  ^] —  §  j).  When  the  pruritus  is  due  to  a  vesic- 
ular eruption  on  the  genitals,  the  application  should  be  made  to  the 
affected  part.  Gonorrhoea  (vaginal)  of  the  female  is  most  quickly 
removed  by  applying  through  the  speculum,  and  to  every  part  of  the 
canal,  a  concentrated  solution  of  silver  nitrate  (3  j —  3  j).  In  the  male, 
gonorrhoea,  at  its  first  appearance,  may  sometimes  be  aborted  by  a 
strong  injection  (  3  j —  3  j),  but  unfortunately  the  period  is  usually 
past  when  this  violent  practice  may  be  advised.  Weak  solutions  (gr. 
j — grs.  v —  3  j)  are,  as  a  rule,  more  efficient,  as  they  are  unquestionably 
safer.  Cauterization  of  the  prostatic  part  of  the  urethra  was  at  one 
time  vulgarized  in  the  treatment  of  spermatorrhoea  by  the  influence  of 
Lallemand,  but  this  dangerous  practice  is  rarely  necessary.  The  au- 
thor coincides  with  Mr.  Furneaux  Jordan  in  the  expression  of  the  be- 
lief that  a  vesicating  solution  of  nitrate  of  silver  applied  to  the  peri- 
neum is  as  generally  useful  and,  of  course,  entirely  without  danger. 

Solutions  of  nitrate  of  silver  are  much  used  in  ophthalmic  and  au- 
ral surgery.  To  granular  lids,  a  strong  solution  (3j — §  j)  is  ap- 
plied ;  to  acute  conjunctivitis,  a  weak  solution  (gr.  j — grs.  iv — §  j  ); 
but  generally  ophthalmologists  prefer  the  zinc  and  copper  salts  in  the 
treatment  of  tiiese  affections.  The  incautious  use  of  silver  salts,  when 
there  are  corneal  ulcers,  may  result  in  unsightly  deposits  and  opaci- 
ties. Otorrhoea,  eczema  of  the  external  auditory  meatus,  and  chronic 
inflammation  of  the  external  ear,  may  be  cured  by  silver  solutions 
properly  applied.  A  commencing  furuncle  of  the  external  canal  may 
sometimes  be  aborted  by  application  of  Mr.  Higginbottom's  solution. 

Dr.  Mays,  of  Philadelphia,  has  lately  published  a  method  of  treat- 
ing phthisis  by  injecting  a  solution  of  nitrate  of  silver  along  the 
course  and  above  the  pneumogastric  nerve.  This  counter-irritant 
thus  used  is  an  application  of  Dr.  Mays'  theory  that  consumption  is  a 
neurosis,  and  to  be  affected  most  favorably  by  acting  on  the  diseased 
organ  through  irritation  of  its  principal  nerve. 

Besides  the  above-mentioned  external  applications  of  nitrate  of  sil- 
ver, this  salt  is  also  used  according  to  the  method  of  Luton,  entitled 
"  parenchymatous  substitution."  This  consists  in  injecting,  with  a 
hypodermatic  syringe,  a  few  drops  of  concentrated  solution  into  the 
parenchyma  of  oagans — an  irritant  injection.  Cystic  tumors  (wens), 


306  AGENTS  INCREASING   WASTE. 

small  fatty  tumors,  abscesses,  and  hydrocele,  may  be  cured  by  inject- 
ing  five  to  ten  drops  of  a  strong  solution  (3j —  3  ij).  In  the  case  of 
cysts  and  hydrocele,  the  contents  may  be  allowed  to  escape  through 
the  needle,  and  then  the  irritant  solution  be  injected.  More  or  less 
active  inflammation  follows,  and  the  sac,  after  a  variable  stage  of  sup- 
puration, becomes  entirely  obliterated. 

Old  and  intractable  cases  of  sciatica  that  resist  other  means,  includ- 
ing hypodermatic  injection  of  anodynes,  are  sometimes  permanently 
relieved  by  injecting  deeply  into  the  neighborhood  of  the  affected 
nerve  ten  to  twenty  drops  of  a  solution  of  nitrate  of  silver.  Suppura- 
tion usually  follows,  and  the  local  inflammatory  process  terminates  the 
previously-existing  nerve-lesion  (parenchymatous  substitution). 

Authorities  referred  to  : 

BARTHOLOW,  DR.  ROBERTS.  Manual  of  Hypodermatic  Medication,  fourth  edition,  arti- 
cle, Irritant  Injections. 

BOGOLOWSKY,  DR.  Virchow's  Archiv  fur  pathologische  Anatomic,  vol.  xlvi,  1869, 
p.  409. 

Fox,  DR.  TILBURY.     On  Diseases  of  the  Skin,  second  edition,  1873. 

Fox,  DR.  WILSON.  On  Diseases  of  the  Stomach,  revised  edition,  London  and  New 
York,  1872,  pp.  93,  142,  179. 

HIGGINBOTTOM,  JOHN,  F.  R.  S.     The  Practitioner,  vol.  ii,  p.  34. 

JORDAN,  FURNEAUX.     The  Practitioner,  vol.  ii,  p.  74. 

REYNOLDS,  DR.  RUSSELL.     On  Epilepsy,  London,  1861,  p.  333. 

SIEVEKING,  DR.  EDWARD  H.     On  Epilepsy,  second  edition,  London,  1861. 

SCATTERGOOD,  D^.  THOMAS.     British  Medical  Journal,  May  20,  1871. 

New  Silver  Preparations. — Although  the  new  silver  remedies 
are  in  the  experimental  stage,  some  reference  should  be  made  to 
their  employment.  Instead  of  the  silver  nitrate  as  a  topical  agent, 
combinations  of  silver  with  ethylene-diamine,  as  a  phosphate,  and 
known  as  argentamine,  or  as  a  proteid  product  called  protargol,  or 
in  combination  with  casein,  and  known  as  argonin,  have  come  into 
use. 

Argentamine  is  an  8-per-cent  solution  of  silver  phosphate.  This 
occurs  as  an  alkaline  liquid,  which  becomes  yellow  on  exposure.  It 
has  antiseptic  properties,  and  is  a  valuable  injection  in  gonorrhoea,  in 
the  proportion  of  1  to  4,000. 

Argonin  is  a  white  powder  not  soluble  in  cold  but  soluble  in  hot 
water.  It  contains  4*25  per  cent  of  silver.  It  is  an  antiseptic  and 
topical  remedy,  chiefly  used  in  the  treatment  of  gonorrhoea,  in  a  1-  or 
2-per-cent  solution. 

Protargol  is  like  argonin,  but  it  contains  8  per  cent  of  silver,  and 
is  soluble  in  water.  The  strength  of  the  solution  to  be  used  is  from 
^  to  1  per  cent.  It  is  said  to  be  an  effective  remedy  for  gonorrhoea, 
and,  according  to  Prof.  Neisser,  the  best  of  all  that  has  been  proposed 
for  this  purpose. 


SILVER.  307* 

Grade's  Silver  Preparations. — The  distinguished  professor  at  Dres- 
den has  brought  forward  a  system  of  treatment  in  which  salts  of  silver 
are  chiefly  employed. 

Argenti  Citras. — Citrate  of  silver.  This  occurs  as  an  odorless 
white  powder,  but  little  soluble  in  water,  but  more  freely  soluble  in 
albuminous  fluids,  so  that  when  used  as  a  dusting  powder  on  wounds 
it  diffuses  through  exudations  and  neighboring  tissues,  forming  an 
antiseptic  application  of  great  permeability. 

Argenti  Lactas.—  Lactate  of  silver  is  a  white  odorless  powder, 
soluble  in  water  in  the  proportion  of  1  to  15.  For  disinfecting  the 
skin  it  is  used  in  the  strength  of  1  to  1,000 ;  for  irrigating  wounds, 
1  to  10,000  ;  for  sterilizing  ligatures,  1  to  200. 

Soluble  Metallic  Silver — Argentum  Colloidale. — Collargolum  is 
possessed  of  the  most  valuable  properties.  This  preparation  is  an 
allotropic  modification  of  metallic  silver,  and  is  soluble  in  water  and 
albuminous  fluids  generally.  When  introduced  by  inunction  or  hypo- 
dermatically,  or  by  application  to  wounded  surfaces,  or  when  swal- 
lowed, it  enters  the  vascular  system,  the  blood,  and  lymphatics,  and 
becomes  an  active  germicide  or  antitoxic  agent.  Although  so  dif- 
fusible, permeating  all  parts  of  the  tissues,  it  seems  never  to  induce 
argyria. 

Collargolum,  or  soluble  metallic  silver,  occurs  in  the  form  of  hard 
pieces,  having  a  somewhat  metallic  luster.  The  dose  for  internal 
administration  in  pill  form  is  -£  to  1  gr.  The  gastro-intestinal  catarrhs, 
tuberculosis  of  the  intestine,  infectious  entero-colitis,  and  other  septic 
states,  are  successfully  treated  by  this  remedy.  It  may  also  be  em- 
ployed subcutaneously  in  the  proportion  of  \  to  200  parts  of  distilled 
water,  repeated  once  or  twice  a  week. 

As  a  topical  agent,  it  may  be  used  in  surgical  diseases,  wounds, 
injuries,  and  in  cases  of  septic  decomposition.  Wherever  diseases — 
either  pure  or  mixed  infectious — are  caused  by  the  staphylococcus, 
the  streptococcus,  and  other  forms  of  low  organisms,  this  remedy  is 
effective  in  a  high  degree. 

Unguentum  Crede  is  the  proprietary  form  in  which  this  remedy  is 
now  offered  to  the  medical  public.  Rubbed  into  the  skin,  collargolum 
diffuses  readily  into  the  lymphatics  and  blood,  acting  powerfully  on 
septic  processes.  It  is  recommended  that  three  grammes  be  used  for 
adults.  The  remedy  should  be  applied  by  inunction  to  the  thoroughly 
cleansed  skin  for  twenty  or  thirty  minutes.  Where  inunctions  are  not 
feasible,  collargolum  should  be  given  in  pill  form,  made  up  with  sugar 
of  milk  and  some  glycerin  and  water.  It  is  also  recommended  in 
solution,  thus  :  ^  Argenti  colloid  (Crede),  0'5  or  2  ;  distilled  water, 
50  to  200  grammes  ;  egg  albumin,  0'5  to  2. 

Of  this  a  teaspoonful  to  a  tablespoonful  is  to  be  taken  with  a  glass 

of  water  or  a  cup  of  tea  a  quarter  to  a  half  an  hour  before  meals. 
22 


308*  AGENTS   INCREASING   WASTE. 

These  methods — in  pill  or  solution — are  said  to  be  especially  appli- 
cable to  the  chronic  infectious,  general  tuberculosis,  gonorrhreal  rheu- 
matism, gonorrhosa,  etc. 

For  subcutaneous  injection,  a  solution  of  argentum  colloidale — 1  to 
200  of  distilled  water — of  which  one  half  to  two  syringef uls  (seven  to 
thirty  grains)  are  to  be  given  in  one  or  several  places  according  to  the 
size  of  the  lesion.  Very  little  pain  is  caused  by  the  injection.  It  is 
to  be  repeated  once  a  week  or  once  in  two  weeks. 

Collargolum  is  also  used  in  bougie  form  for  the  treatment  of 
infectious  fistulae,  uterine,  and  urethral  diseases.  The  mass  is 
made  of  sugar  of  milk,  gum,  albumin,  and  glycerin,  molded  into 
the  desired  shapes.  Each  bougie  may  contain  three  grains  of 
the  medicament.  Collargolum  may  also  be  dissolved  in  sterilized 
water  (seven  to  fifteen  grains  to  the  pint  of  water)  and  used  as  a 
topical  application,  or  as  a  rectal  enema  by  the  addition  of  some  al- 
bumin. 

The  extraordinary  claim  is  made  that  the  various  applications  con- 
taining the  soluble  silver  diffuse  into  the  system  by  the  lymph  stream, 
preventing  all  growth  of  the  staphylococci  and  streptococci.  The  evi- 
dence as  furnished  by  Prof.  Crede  and  his  friends  seems  to  justify  the 
claims  they  have  put  forth. 

That  such  results  are  possible  may  be  held,  seeing  that  the  ac- 
tions of  mercury  are  similar,  and  that  the  metallic  mercury  and  mer- 
curial salts  thus  diffuse  through  the  lymph  channels. 

Cuprum. — Copper.     Cuivre,  Fr.  ;  Kapfer.,  Ger. 

Cupri  Acetas. —  Copper  acetate.  (Not  official.)  Deep -green, 
prismatic  crystals,  yielding  a  bright-green  powder,  efflorescent  on  ex- 
posure to  air,  odorless,  having  a  nauseating,  metallic  taste  and  an 
acid  reaction.  Soluble  in  15  parts  of  water,  and  in  135  parts  of  alco- 
hol at  60°  Fahr.  Dose,  gr.  -& — gr.  J. 

Cupri  Sulphas. — Copper  sulphate.  Blue  vitriol.  In  blue  crys- 
tals, slightly  efflorescent  in  the  air,  and  soluble  in  2 '6  water  at  60° 
Fahr.  Ammonia  throws  down  from  the  solution  a  precipitate,  which 
is  wholly  dissolved  when  the  alkali  is  added  in  excess.  Dose,  gr. 
i — gr.  ss. 

Cuprum  Ammoniatum. — Ammoniated  copper.  (Not  official.)  A 
deep,  azure-blue  powder,  having  an  ammoniacal  odor,  and  a  styptic, 
metallic  taste.  It  is  soluble  in  water.  Dose,  gr.  £ — gr.  j. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alkalies  and  their  carbonates, 
lime-water,  mineral  salts  (except  the  sulphates),  iodides,  and  most 
astringent  vegetables,  are  chemically  incompatible  with  the  salts  of 
copper.  In  cases  of  poisoning,  white  of  eggs  and  milk  should  be  given 
freely,  but  evacuation  of  the  contents  of  the  stomach  is  necessary,  for 
the  albuminate  of  copper  is  not  devoid  of  toxic  power.  The  most 


COPPER.  307 

effective  chemical  antidote  is  said  to  be  the  ferrocyanide  of  potassium, 
forming  the  insoluble  ferrocyanide  of  copper.  Magnesia  has  also  been 
proposed,  but  it  should  not  be  relied  on  to  the  exclusion  of  albumen 
and  ferrocyanide  of  potassium,  nor  should  any  antidote  be  used  with- 
out evacuating  the  stomach  contents  by  emetics  or  the  stomach-pump. 

SYNERGISTS. — The  salts  of  lead,  tin,  zinc,  mercury,  silver,  gold, 
favor  the  therapeutic  action  of  the  copper-salts.  All  of  these  agents 
agree  in  this  :  they  promote  waste,  and  affect  the  functions  of  the  nerv- 
ous system  secondarily.  All  unfavorable  hygienic  conditions,  which 
depress  the  functions  of  the  body,  increase  the  activity  of  the  copper- 
salts. 

PHYSIOLOGICAL  ACTIONS. — The  salts  of  copper  have  a  styptic,  me- 
tallic taste.  When  a  poisonous  dose  of  a  copper-salt  has  been  taken 
the  following  symptoms,  referable  to  the  digestive  organs,  appear  :  A 
strong  metallic  taste,  burning  and  constriction  of  the  throat,  increased 
flow  of  saliva,  burning  pain  at  the  epigastrium,  with  griping  and  colic- 
pain  of  the  intestines,  nausea  and  vomiting.  The  vomited  matters 
have  usually  a  bluish  or  greenish  color,  and  the  intestinal  evacuations, 
which  begin  in  a  few  minutes  after  the  poison  has  been  swallowed,  are 
dark-greenish  and  frequently  bloody.  These  are  the  symptoms  pro- 
duced by  the  irritant  poisons,  and  have  no  special  characters,  except, 
it  may  be,  the  color  of  the  evacuations.  The  salts  of  copper,  being 
diffusible  substances,  quickly  enter  the  blood,  and  the  systemic  symp- 
toms which  follow  are  referable  to  the  nervous  system  and  the  organs 
of  excretion.  In  the  blood,  as  is  the  case  with  the  other  metallic  poi- 
sons, copper  probably  exists  in  the  form  of  an  albuminate  in  close  re- 
lation to  the  red  blood-globules.  The  breathing  becomes  short,  hur- 
ried, and  labored  ;  the  pulse  small,  quick,  and  weak ;  the  skin  cold 
and  perspiring,  and  restlessness,  headache,  trembling,  cramps,  vertigo, 
and  stupor,  are  followed  by  convulsions  (clonic  or  tetanic),  paralysis, 
and  insensibility. 

Inhalation  of  cupreous  fumes,  as  in  certain  occupations  in  the  arts, 
the  slow  introduction  of  small  quantities,  as  occurs  sometimes  from 
cooking  acid  fruits  in  copper  vessels,  or  the  prolonged  medicinal  ad- 
ministration of  moderate  doses  of  a  copper-salt,  will  produce  the  symp- 
toms of  chronic  or  slow  poisoning.  When  inhaled,  the  symptoms  first 
observed  are  those  of  bronchial  irritation  and  bronchial  catarrh  (Hirt). 
Internally  administered,  a  gastro-intestinal  catarrh  is  produced,  epigas- 
tric pain  is  experienced,  nausea,  vomiting,  colic,  tenesmus,  and  dysen- 
teric discharges,  and  complete  anorexia  occur.  The  loss  of  appetite, 
and  the  interference  with  digestion,  as  well  as  the  injury  done  to  the 
red  blood-globules,  impair  the  strength  and  increase  the  waste  of  the 
tissues.  A  purplish  line  along  the  margin  of  the  gum  has  been  ob- 
served, salivation  and  ulceration  of  the  gums  not  unfrequently  occur, 
and  occasionally  jaundice  is  present  as  one  of  the  symptoms.  As  re- 


308  AGENTS   INCREASING   WASTE. 

gards  the  nervous  system,  headache,  muscular  trembling,  paresis  of  the 
limbs,  and  sometimes  paralysis,  altered  sensations,  defects  of  co-ordi- 
nation, impaired  mind,  result.  These  nervous  symptoms,  with  bron- 
chial and  gastro-intestinal  catarrh,  are  usually  grouped  together  in  the 
case  of  chronic  cupreous  poisoning  in  artisans. 

Copper  is  eliminated  by  the  liver,  intestinal  canal,  salivary  glands, 
and  kidneys.  As  is  the  case  with  the  other  metallic  poisons,  copper 
tends  to  accumulate  in  the  liver. 

THERAPY. — The  sulphate  of  copper  is  one  of  the  remedies  some- 
times effective  in  the  vomiting  of  pregnancy.  For  this  purpose  not 
more  than  one  twentieth  of  a  grain,  three  times  a  day,  is  admissible. 
B  Cupri  sulphat.,  grs.  ij  ;  aquae  destil.,  f  ss.  M.  Sig.:  Six  drops  a 
dose. 

As  sulphate  of  copper  is  a  very  prompt  and  effective  emetic,  it  is 
frequently  resorted  to  in  cases  of  narcotic  poisoning.  R  Cupri  sul- 
phat., grs.  vj  ;  aquae  destil.,  §  ij.  M.  Sig.  :  A  tablespoonful  every  fif- 
teen minutes  until  vomiting  ensue.  It  may  be  used  under  the  same 
circumstances,  but  is  by  no  means  so  desirable  an  emetic,  in  croup,  as 
subsulphate  of  mercury.  Minute  doses  of  sulphate  of  copper  render 
excellent  service  in  gastro-intestinal  catarrh,  especially  when  the  bow- 
els are  relaxed.  R  Cupri  sulphat.,  gr.  j  ;  ext.  nucis  vom.,  grs.  iv.  M. 
Ft.  pil.  no.  xvj.  Sig. :  One  three  times  a  day  before  meals.  When  the 
food  taken  gives  rise  to  colic,  which  is  quickly  followed  by  the  incli- 
nation to  stool,  there  should  be  combined  with  the  above  prescription 
one  grain  of  morphine  sulphate.  When  the  constipation  coexists 
with  intestinal  catarrh,  the  following  prescription  is  useful :  R  Cupri 
sulphat.,  gr.  j  ;  ext.  physostigmae,  ext.  belladonnas,  ext.  nucis  vom.,  aa 
grs.  iv.  M.  Ft.  pil.  no.  xvj.  Sig.  :  One  pill,  three  times  a  day,  be- 
fore meals. 

The  sulphate  of  copper  is  a  most  useful  remedy  in  acute  dysentery. 
R  Cupri  sulph.,  gr.  ss  ;  magnesias  sulph.,  f  j ;  acid,  sulph.  dil.,  3  j  ; 
aquae,  §  iv.  M.  Sig.  :  A  tablespoonful  every  four  hours.  After  the 
acuter  symptoms  have  subsided,  the  sulphate  of  copper  may  be  given 
with  morphine  and  opium.  Of  all  the  metallic  astringents  employed 
for  this  purpose,  sulphate  of  copper  is  the  most  effective  in  chronic 
diarrhoea  and  chronic  dysentery.  R  Cupri  sulphat.,  grs.  j  ;  morphinte 
sulph.,  gr.  j;  quininae  sulph.,  grs.  xxiv.  M.  Ft.  pil.  no.  xij.  Sig.:  One 
pill  three  times  a  day.  Sulphate  of  copper  is  indicated  when  there  are 
present  colic-pains,  tenesmus,  and  the  stools,  partly  feculent,  contain 
mucus  streaked  with  blood.  When  tolerance  is  established,  the  quan- 
tity of  copper  in  the  above  formulae  may  be  increased  slowly  to  one 
fourth  of  a  grain.  Rarely  can  more  than  one  twelfth  of  a  grain  be 
given  to  an  adult  unaccustomed  to  its  use,  without  causing  very  un- 
pleasant nausea  and  depression. 

The  dysentery  and  cholera  infantum  of  children,  and  the  chronic 


COPPER.  309 

enter  o-colitis  which  sometimes  succeeds  to  measles,  are  often  remark- 
ably benefited  by  minute  doses  of  sulphate  of  copper.  IJ  Cupri  sul- 
phat.,  gr.  j  ;  tinct.  opii  deodor.,  gtt.  viij  ;  aquae  destil.,  §  iv.  M.  Sig.  : 
A  teaspoonful  every  tico,  three,  or  four  hours,  for  a  child  from  one  to 
two  years  of  age. 

The  sulphate  of  copper  is  a  useful  palliative  astringent  in  the  diar- 
rhoea of  phthisis.  It  should  be  combined  with  opium. 

Kissel  regards  the  salts  of  copper  as  curative  in  pneumonia,  and 

the  preparation  which  he  prefers  is  the  tincture  of  the  acetate  (Phar. 

Ger.).    The  mortality  under  this  treatment  was  only  4'3  per  cent.    Am- 

moniated  copper  has  been  used  recently  with  remarkable  success  in 

.the  treatment  of  facial  neuralgia.     It  must  be  pushed  (Fere'ol). 

The  salts  of  copper,  especially  the  cuprum  ammoniatum,  are  among 
the  numerous  remedies  employed  in  the  treatment  of  epilepsy,  chorea, 
and  hysteria.  Successful  results  have,  it  is  true,  been  obtained  by  the 
use  of  these  remedies,  but  at  the  present  time  they  are  rarely  employed. 

EXTERNAL  USES. — The  salts  of  copper  do  not  act  very  energeti- 
cally on  the  unbroken  integument.  Applied  to  wounds  they  are  as- 
tringent— that  is,  they  combine  with  albumen,  contract  the  tissues, 
and  coagulate  the  blood.  A  crystal  of  sulphate  of  copper  may  be  used 
to  arrest  bleeding  from  small  wounds,  e.  g.,  from  leech-bites.  Indolent 
ulcers  with  flabby  granulations  can  be  stimulated  to  a  renewed  and 
more  healthy  activity  by  touching  the  affected  surface  with  a  crystal 
of  sulphate  of  copper,  or  by  frequent  application  of  a  solution  (grs.  ij 
— grs.  x —  §  j).  The  following  is  an  excellent  injection  in  gonorrhoea 
after  the  acute  stage  :  IJ  Cupri  sulph.,  grs.  iv  ;  morphinae  sulph.,  grs. 
viij ;  liq.  plumbi  subacetat.,  3  j  ;  aquae  rosae,  §  iv.  M.  Sig. :  As  an 
injection.  In  that  troublesome  affection,  granular  lid$,  the  sulphate 
of  copper  may  be  rubbed  over  the  everted  lid  once  a  day  with  advan- 
tage. The  application  gives  great  pain,  and  is  immediately  followed 
by  intense  hyperaemia,  which,  however,  subsides  in  a  few  hours,  leav- 
ing the  conjunctiva  in  much  better  condition  than  before. 

In  scabies,  a  solution  of  sulphate  of  copper  (  §  j — Oj)  has  been  used 
with  great  success,  the  lotion  being  applied  after  the  crusts  have  been 
thoroughly  removed  with  soap  and  water.  An  ointment  of  acetate  of 
copper  (grs.  x —  f  j)  is  a  very  effective  application  in  herpes  circinatus 
(ringworm).  The  following  formula  has  been  recommended  in  menta- 
gra  :  IJ  Cupri  sulph.,  3  j  ;  zinci  sulph.,  |  ss  ;  aquae  laur.-cerasi,  |  jss  ; 
aquae  destil.  ad  f  xvj.  M.  Sig. :  Lotion.  The  acetate  and  carbonate 
of  copper  are  very  effective  remedies  in  tinea  sycosis.  IJ  Cupri  carb., 
3  ij  ;  adipis,  f  j.  M. 

Authorities  referred  to  : 

HIRT,  DR.  LTJDWIO.     Die  Krankheiten  der  Arbeiter,  erste  Abtheilung,  p.  79,  et  seq. 
Breslau,  1871. 

HERMANN,  DR.  L.     Lehrbuch  der  experimentellen  Toxicologie,  Berlin,  1874,  p.  209. 


310  AGENTS   INCREASING  WASTE. 

GCBLER,  PROF.  ADOLPH.  Commcntaires  Therapeutiq'ucs  du  Codex  Medicamentariut, 
Paris,  1868,  p.  435. 

NOTHNAGEL,  DR.  HERMANS.     Handbuch  der  Arzneimittellehre,  Berlin,  1870,  p.  291. 

TARDIEC,  AMBROISE.  Dictionnaire  d1  Hygiene  Publiqiie  et  de  Salubrite,  deux.  Edition. 
Paris,  1862,  vol.  i,  article  Cuivre. 

TAYLOR,  DR.  A.  S.     On  Poisons,  p.  458,  et  seq. 

Plumbum. — Lead.     Plomb,  Fr.  ;  JBlei,  Ger. 

Plumbi  Oxidum. — Lead  oxide.  Litharge.  In  small  yellowish  or 
orange-colored  scales,  insoluble  in  water,  but  almost  wholly  soluble, 
with  slight  effervescence,  in  dilute  nitric  acid.  The  solution  is  affected 
by  potassa,  like  that  of  carbonate  of  lead  in  the  same  acid. 

Emplastrum  Plumbi. — Lead-plaster.     Litharge  and  olive-oil. 

Plumbi  Acetas. — Lead  acetate.  Sugar  of  lead.  In  colorless  crys- 
tals which  effloresce  on  exposure  to  the  air.  It  is  dissolved  by  distilled 
water,  with  a  slight  turbidness,  which  is  removed  by  the  addition  of 
vinegar.  With  this  solution  carbonate  of  sodium,  produces  a  white, 
iodide  of  potassium  a  yellow,  and  hydrosulphuric  acid  a  black  pre- 
cipitate. Upon  the  addition  of  sulphuric  acid,  vapor  is  evolved,  hav- 
ing the  smell  of  vinegar.  Dose,  gr.  ss — gr.  v. 

Liquor  Plumbi  Subacetatis.  —  Solution  of  lead  subacetate.  A 
colorless  liquid  of  the  specific  gravity  of  1*267.  It  is  decomposed  by- 
exposure  to  the  air,  carbonate  of  lead  being  formed.  When  added  to 
a  solution  of  gum  it  occasions  a  dense  white  precipitate. 

Liquor  Plumbi  Subacetatis  Dilutus. — Diluted  solution  of  subace- 
tate of  lead.  (Solution  of  subacetate,  30  c.  c.  ;  distilled  water  to  make 
1,000  c.  c.) 

Ceratum  Plumbi  Subacetatis. — Cerate  of  lead  subacetate.  (Solution 
of  subacetate  of  lead,  200  grm.  ;  camphor  cerate,  800  grm.) 

Plumbi  Carbonas. — Lead  carbonate.  A  white  substance  in  pow- 
der or  pulverulent  masses,  insoluble  in  water,  but  soluble,  with  effer- 
vescence, in  dilute  nitric  acid.  Potassa  added  to  the  solution  pro- 
duces a  white  precipitate,  which  is  wholly  dissolved  by  an  excess  of 
the  alkali.  Used  in  the  preparation  of  the  unguent,  and  also  applied 
topically. 

Unguentum  Plumbi  Carbonatis. — Ointment  of  carbonate  of  lead. 
(Carbonate  of  lead,  10  grm.  ;  benzoinated  lard,  90  grm.) 

Plumbi  Nitras. — Lead  nitrate.  In  white,  nearly  opaque,  octahe- 
dral crystals,  permanent  in  the  air,  and  of  a  sweet  astringent  taste. 
It  is  soluble  in  seven  and  a  half  parts  of  cold  water,  and  in  alcohol. 
Its  solution  is  precipitated  black  by  hydrosulphate  of  ammonium, 
white  by  ferrocyanide  of  potassium,  and  yellow  by  iodide  of  potassium. 

Plumbi  lodidum. — Lead  iodide.  A  bright-yellow,  heavy,  inodor- 
ous powder,  fusible  and  volatilizable  by  heat,  and  soluble  in  1,235 
parts  of  cold  and  194  parts  of  boiling  water.  A  hot  saturated  solu- 
tion, on  cooling,  deposits  the  salt  in  brilliant,  golden  scales. 


LEAD.  311 

Unguentum  Plumbi  lodidi. — Ointment  of  iodide  of  lead.  (Iodide 
of  lead,  10  grm.;  benzoinated  lard,  90  grm.) 

ANTAGONISTS  AND  INCOMPATIBLES.  —  Natural  waters  containing 
lime,  sulphates,  carbonates,  carbonic  acid,  mineral  acids  and  mineral 
salts,  vegetable  acids,  alkalies,  iodide  of  potassium,  the  vegetable 
astringents  in  general,  albuminous  solutions,  and  the  preparations  of 
opium,  are  incompatible.  In  cases  of  poisoning  by  acetate  of  lead, 
the  proper  antidotes  are  the  sulphates  of  soda  or  magnesia,  phosphate 
of  soda,  milk,  and  albuminous  solutions.  Emetics  and  the  stomach- 
pump  should  be  used. 

SYNERGISTS. — Cold,  digitalis,  ergot,  veratrum  viride,  and  agents 
acting  similarly,  favor  the  influence  of  acetate  of  lead  over  the  circu- 
latory system.  Copper,  mercury,  antimony,  and  remedies  promoting 
waste,  increase  the  depressing  effects  of  lead  on  the  nutrition  of  the 
body. 

PHYSIOLOGICAL  ACTIONS. — The  acetate  is  astringent  ;  that  is,  it 
combines  with  albumen  to  form  compounds,  for  the  most  part  insolu- 
ble in  water  and  in  acids.  All  the  salts  of  lead  are  more  or  less  toxic. 
As  the  acetate,  which  is  most  frequently  the  preparation  taken,  has  a 
sweetish  taste,  mistakes  not  unfrequently  happen  ;  but  the  after-taste 
is  decidedly  astringent  and  slightly  metallic.  As  the  combination  of 
the  salts  of  lead  with  albumen  takes  place  on  contact,  this  action  en- 
sues in  the  mouth  in  part,  and  is  completed  in  the  stomach.  Any 
part  of  the  lead  reaching  the  intestinal  canal  must  be  converted  into 
the  insoluble  sulphide.  A  very  large  quantity  of  the  acetate  of  lead 
is  required  to  produce  a  fatal  effect ;  not  less  than  an  ounce.  When 
swallowed  in  this  quantity  and  retained,  it  produces  intense  gastric 
irritation,  sometimes  cholerif orm  symptoms,  numbness,  paralysis,  coma, 
collapse.  Owing  to  the  fact  that  so  large  a  quantity  of  acetate  of 
lead  will  be  rejected  by  vomiting,  cases  of  acute  poisoning  rarely 
terminate  fatally,  and  are  infrequent.  On  the  other  hand,  chronic  poi- 
soning by  lead  is  very  common,  owing  to  the  use  of  cosmetics  and 
hair-dyes  containing  lead,  the  use  of  food  preserved  in  tin  cans  sol- 
dered with  lead,  and  to  the  contamination  of  drinking-water.  Very 
rarely  is  the  acetate  of  lead  so  persistently  used  in  medical  practice  as 
to  produce  toxic  symptoms. 

When  lead  is  slowly  introduced  into  the  organism  in  small  doses, 
the  first  symptoms  usually  observed  are  loss  of  appetite,  failure  of 
strength,  more  or  less  wasting,  paleness  of  the  face  and  of  the  integu- 
ment generally,  and  constipation.  The  joints  become  the  seat  of 
rheumatoid  pain  ;  there  is  dry  colic,  the  pain  of  which  is  assuaged  by 
pressure  ;  and  the  muscles  of  the  abdominal  parietes  are  also  seized 
with  neuralgia.  At  the  same  time  the  liver  diminishes  in  size,  the 
abdominal  fat  disappears,  the  intestines  are  contracted,  the  belly  is 
drawn  in  toward  the  spinal  column.  Coincidently  with  the  contrae- 


312  AGENTS   INCREASING   WASTE. 

tion  of  the  liver,  the  skin  assumes  an  icteroid  hue,  the  conjunctive  be- 
come yellow,  and  the  urine  is  tinged  with  the  biliary  coloring  matters. 
At  this  time  may  be  observed  the  so-called  "  blue  line "  along  the 
margin  of  the  incisor  teeth  —  a  slate-colored  line,  probably  due  to  a 
deposition  of  the  sulphide  of  lead,  and  found  only,  according  to  the 
author's  experience,  in  those  not  accustomed  to  the  use  of  a  tooth- 
brush. The  mucous  membrane  of  the  lips  and  mouth  has  often  a  blu- 
ish or  slate-colored  tint,  and  sometimes  brownish  pigment-deposits  are 
seen  on  the  lips  near  the  teeth,  and  on  the  gums.  Albuminuria  may 
exist  at  this  time,  but  it  is  commonly  present  further  on  in  the  history 
of  these  cases.  Lead  may  cause  that  condition  of  hyperalbuminosis 
which  eventuates  in  albuminous  urine,  but  probably  it  in  most  cases 
hastens  the  development  of  changes  in  the  kidneys  already  impending. 
As  Garrod  has  conclusively  shown,  the  use  of  lead,  or  its  slow  intro- 
duction through  unknown  channels,  hinders  the  conversion  of  uric 
acid  into  urea,  and  favors  the  deposition  of  urate  of  soda  about  the 
joints  :  hence  the  arthritic  pains  which  accompany  the  other  symp- 
toms of  chronic  lead-poisoning,  and  the  intimate  relation  of  the  pres- 
ence of  lead  in  the  organism  and  gouty  attacks. 

The  symptoms  thus  far  sketched  are  chiefly  those  due  to  the  influ- 
ence of  the  agent  over  the  oxidation  processes  of  the  body  in  general. 
It  is  necessary  now  to  consider  the  action  of  lead  on  the  nervous  sys- 
tem. Lead  gastralgia  is  an  early  symptom,  in  part  due  to  the  fact 
that  the  metal  acts  directly  on  the  nerves  of  the  stomach,  but  it  is  also 
a  symptom  of  the  action  of  the  poison  on  the  central  nervous  system. 
Lead  arthralgia,  already  referred  to,  is  frequently  an  affection  of  the 
intra-muscular  nerves,  and  has  its  seat  more  especially  in  the  flexor 
muscles.  The  swelling  of  the  joints  and  the  joint-pains  are  doubtless 
due,  as  already  explained,  to  the  deposition  of  the  urates  in  the  joints 
themselves,  but  the  term  arthralgia  is  used  to  describe  that  form  of 
pain  about  the  joints  produced  by  lead.  Impaired  sensibility  to  touch 
is  also  one  of  the  phenomena  of  lead-poisoning.  This  lead-anaesthesia 
is  found  about  the  neck,  chest,  the  forearms  (their  palmar  face),  hands, 
and  fingers,  and  is  symmetrically  distributed  on  the  two  sides.  An- 
aesthesia of  the  optic  (amaurosis)  is  also  a  result  of  the  direct  action 
of  lead,  but  dimness  of  vision  and  a  sluggish  pupil  may  also  be  due  to 
the  albuminuria  which  is  so  frequently  present.  Paralysis  of  the  com- 
mon extensors  of  the  fingers  and  of  the  supinators,  while  the  power  of 
the  flexors  and  pronators  is  much  less  diminished,  constitutes  that 
very  striking  symptom  of  lead-poisoning,  "  the  drop-wrist."  When 
the  arms  are  raised  the  hands  drop  forward  and  to  the  palmar  face 
of  the  forearm,  from  an  inability  of  the  extensors  to  hold  them  up. 
Paralysis  may  invade  the  laryngeal  muscles,  producing  aphonia. 
Sometimes  the  paralysis  has  the  hemiplegic  form,  and,  still  more 
rarely,  the  paraplegic.  At  the  beginning  of  the  paralysis,  the  mus- 


LEAD.  313 

cular  irritability  is  preserved,  but  it  soon  lessens,  and  is  lost  finally, 
so  that  the  muscles  cease  to  respond  to  the  faradic  current.  For  some 
time  after  the  induction  current  fails  to  excite  contraction,  muscu- 
lar movements  may  be  obtained  by  a  slowly -interrupted  galvanic 
current. 

Death  may  result  from  the  saturnine  cachexia,  by  the  gradual  fail- 
ure of  nutrition,  and  by  the  extension,  finally,  of  the  muscular  paraly- 
sis to  the  muscles  of  respiration.  Death  may  occur  much  earlier,  by 
the  development  of  those  symptoms  to  which  has  been  applied  the 
term  lead-encephalopathy — a  form  of  disease  characterized  by  delirium 
and  convulsions,  ending  in  fatal  coma. 

Lead  is  very  fatal  to  the  life  of  the  foetus,  and  women  the  subjects 
of  the  saturnine  cachexia  abort  early,  or  produce  stillborn  children. 

After  death,  lead  is  found  in  various  organs  of  the  body,  and  rela- 
tively in  large  amount  in  the  brain.  It  is  also  largely  deposited  in  the 
substance  of  the  affected  muscles  and  nerves,  and  the  destruction  of 
the  Hallerian  irritability,  the  disappearance  of  the  striation  and  the 
granular  condition  of  the  nerves,  are  probably  due  to  the  direct  action 
of  the  metal.  Lead,  also,  like  the  other  minerals,  tends  to  accumulate 
in  the  liver  ;  much  of  it  is  probably  eliminated  by  the  intestinal  glands 
and  skin,  and  some  passes  out  by  the  kidneys. 

The  treatment  of  lead-poisoning  is  prophylactic  and  curative. 
Among  the  former  are,  personal  cleanliness,  frequent  bathing,  the  use 
of  sulphuric-acid  lemonade,  the  habitual  employment  of  milk  in  large 
quantity  as  a  food,  and  the  avoidance  of  all  sources  of  contamination. 
Among  the  curative  measures  must  be  placed  first,  large  doses  of  the 
iodide  of  potassium,  purgative  doses  of  Epsom  salts,  and  sulphur-baths. 
The  affected  muscles  should  be  early  faradized  to  prevent  atrophic 
changes.  When  they  fail  to  respond  to  a  faradic  current,  a  slowly- 
interrupted  galvanic  current  should  be  used,  and  after  a  time  the  fara- 
dic irritability  may  be  recovered. 

THERAPY. — Acetate  of  lead  is  one  of  the  astringent  remedies  em- 
ployed to  arrest  hcematemesis.  It  is  more  especially  adapted  to  the 
vomiting  of  blood  which  accompanies  gastric  ulcer.  This  salt  exercises 
a  favorable  influence  over  the  course  and  progress  of  gastric  ulcer ;  it 
allays  pain  and  local  inflammation,  and  modifies  the  ulcerated  surface. 
In  chronic  gastric  catarrh  with  gastralgia  and  pyrosis,  it  has  given 
great  relief.  Notwithstanding  the  chemical  incompatibility,  it  may  be 
advantageously  combined  with  morphine  in  painful  stomach-affections. 
The  most  frequent  use  of  the  acetate  of  lead  in  gastro-intestinal  dis- 
orders is  in  the  treatment  of  the  various  forms  of  diarrhoea.  It  is  an 
excellent  remedy  in  the  summer  diarrhoea  of  children.  $  Plumbi 
acetat.,  grs.  viij  ;  acid,  acetic.,  gtts.  vj  ;  tinct.  opii  deodor.,  gtts.  iv  ; 
aquae  destil.,  §  j.  M.  Sig.  :  A  teaspoonful  every  two,  three,  or  four 
hours  for  a  child  two  years  of  age.  In  choleraic  diarrhoea,  acetate  of 


3U  AGENTS   INCREASING   WASTE. 

lead  is  one  of  the  most  useful  astringents  :  r£  Plumbi  acetat.,  grs. 
xxiv  ;  pulv.  opii,  grs.  xij  ;  pulv.  camphorae,  3  ss  ;  sacch.  alb.,  q.  s.  Ft. 
pulv.  no.  xii.  Sig.  :  One  powder  every  hour  or  two.  It  is  sometimes 
preferable  to  administer  the  acetate  of  lead  in  solution,  when  the  for- 
mula above  given  for  children  may  be  used  in  corresponding  dose  fof 
adults.  Probably,  the  most  generally  successful  remedy  for  the  diar 
rhoea  of  phthisis  is  a  pill  containing  equal  parts  of  acetate  of  lead  and 
opium.  The  diarrhoea  of  typhoid  may  also  be  restrained  by  acetate 
of  lead  and  opium  ;  but  generally  bismuth  is  more  suitable  than  acetate 
of  lead.  In  acute  and  chronic  dysentery  lead  is  often  a  useful  astrin- 
gent. Enemata  of  lead  and  morphine  (IJ  Plumbi  acetat.,  grs.  iv  ; 
morphinae  acetat.,  gr.  ss;  aquae  fervid.,  §  j)  allay  the  tenesmus  of  acute 
dysentery.  Enemata  of  corresponding  strength  t&  age,  of  the  same 
composition,  are  very  useful  in  the  cholera  infantum  of  children. 

Although  the  salts  of  lead  undergo  important  chemical  changes  in 
the  intestinal  canal,  and  are  probably  very  much  modified  in  composi- 
tion before  they  enter  the  blood,  yet  there  is  no  doubt  about  their 
power  to  affect  remote  parts.  The  value  of  acetate  of  lead  in  various 
forms  of  hcemorrhage  has  been  attested  by  an  immense  clinical  expe- 
rience. Thus,  in  haemoptysis,  it  is  a  most  useful  haemostatic.  Careful 
observations  on  a  case  of  severe  and  protracted  pulmonary  haemorrhage 
demonstrated  that  five  grains  of  the  acetate,  every  three  hours,  exer- 
cised a  remarkable  influence  over  the  arterial  tension  and  the  action 
of  the  heart.  Its  effects  are  similar  to  those  of  digitalis  :  it  slows  the 
action  but  increases  the  power  of  the  heart,  while  at  the  same  time  it 
elevates  the  tension  of  the  arterioles.  The  astringent  is,  however,  a 
dynamical  and  not  a  chemical  action,  doubtless.  There  is,  therefore, 
a  fitness  in  the  prescription  of  Oppolzer  for  caseous  pneumonia :  1$  Inf. 
digitalis,  §  iv  ;  plumbi  acetat.,  3  j  ;  tinct.  opii,  3  j.  M.  Sig.  :  A  table- 
spoonful  twice  a  day.  A  similar  combination  is  serviceable  in  hcemop- 
tysis:  P>  Plumbi  acetat.,  3ij  ;  pulv.  digitalis,  ^j  ;  pulv.  opii,  grs.  x. 
M.  Ft.  pil.  no.  xx.  Sig.  :  One  every  four  hours. 

By  virtue  of  its  astringent  action  acetate  of  lead  restrains  secretion, 
and  hence  its  utility  in  bronchorrhcea.  It  is  also  serviceable  in  humid 
asthma  and  whooping-cough. 

Formerly  acetate  of  lead  was  used  to  quiet  the  action  of  the  heart 
in  hypertrophy,  and  to  favor  coagulation  of  the  blood  in  the  case  of 
internal  aneurism.  It  might  often  be  usefully  employed  in  these  af- 
fections now. 

In  prescribing  the  preparations  of  lead  for  internal  use,  the  danger 
of  producing  plumbism  should  not  be  overlooked.  When  it  is  used 
for  any  considerable  period,  the  gums  should  be  frequently  inspected, 
and  on  the  slightest  appearance  of  a  blue  line,  or  on  the  occurrence  of 
constipation  and  abdominal  pain,  the  remedy  should  be  at  once  discon- 
tinued. 


LEAD.  315 

EXTERNAL  APPLICATION  OF  LEAD  PREPARATIONS. — The  uses  of 
lead  preparations  for  external  diseases  are  numerous  and  important. 
An  excellent  application  to  burns  is  white-lead  paint — carbonate  of 
lead  and  linseed-oil.  This  may  be  objectionable  when  the  surface  is 
very  large,  lest  a  dangerous  amount  of  absorption  take  place,  but  for 
burns  of  small  extent  it  is  safe  and  gives  great  relief.  The  surface  of 
the  burn  is  thickly  coated  with  the  paint.  Lead-lotion  (liquor  phtmbi 
subacetatis  dilutus]  is  a  good  application  to  eczema  when  there  is  much 
weeping.  The  following  ointment  has  been  recommended  in  this  af- 
fection :  $  Plumbi  acetat.,  f  ss  ;  camphor,  pulv.,  grs.  xv  ;  ol.  amyg- 
dal.,|ij;  cene  flavae,  f  j.  M.  Ft.  cerat.  An  excellent  formula  for 
eczema,  when  there  are  great  heat  and  redness,  and  profuse  discharge, 
consists  of  liquor  plumbi  subacetatis,  §  j  ;  glycerinse,  f  ss  ;  and  cherry- 
laurel  water,  f  iijss.  The  following  formula  is  recommended  by  Fox 
in  eczema  and  lichen:  $  Acid,  nitrici  dil.,  3  ss  ;  plumbi  acetat.,  grs.  v  ; 
aquae,  f  vj.  M.  In  erythema  the  carbonate  of  lead  is  used  with  advan- 
tage :  fy  Plumbi  carb.,  grs.  iv  ;  glycerinse,  3  j  ;  cerat.  simplicis,  §  j.  M. 
In  impetigo  the  following  :  $  Plumbi  acetat.,  grs.  xv  ;  acid,  hydro- 
cyan,  dil.,  TH  xx  ;  alcoholis,  §  ss  ;  aquae,  §  vss.  M. 

Lead  lotions  are  much  used  to  cure  muco-purulent  and  purulent 
discharges  from  the  ear,  the  vagina,  and  the  urethra.  They  may  be 
employed  at  any  stage,  and  the  existence  of  inflammation  does  not 
contraindicate  their  use.  The  following  is  a  useful  formula  for  gonor- 
rhoea: !£,  Liq.  plumbi  subacetat.  dil.,  3  iv  ;  zinci  sulphat.,  grs.  viij.  M. 
Sig.  :  As  an  injection.  A  chemical  change,  of  course,  takes  place,  but 
clinical  experience  is  in  favor  of  the  combination. 

The  ointment  of  the  iodide  of  lead  is  often  a  useful  application  to 
enlarged  lymphatic  glands  and  to  enlarged  spleen.  It  is  also  employed 
with  benefit  in  cases  of  chronic  eczema,  porrigo,  and  psoriasis. 

A  solution  of  the  nitrate  of  lead  in  pure  glycerin  (grs.  x —  §  j)  is 
an  effective  application  to  fissured  nipples.  It  need  hardly  be  re- 
marked that  the  nipple  should  be  well  washed  before  the  child  is  per- 
mitted to  suck.  Nitrate  of  lead  in  form  of  powder,  dusted  over  the 
unhealthy  granulations,  gives  great  relief,  and  hastens  the  healing  of 
onychia. 

Authorities  referred  to  : 

GARROD,  DR.  A.  B.     TJie  Nature  and  Treatment  of  Gout,  London,  1869. 

GUSSKROW,  PROF.  DR.     Archiv  fur  pathologische  Anatomic,  xxi,  443. 

HERMANN,  DR.  L.  Lehrbuch  der  experimentellen  Toxicologie,  Bleisal.ze,  p.  196, 
et  seq. 

HIRT,  DR.  LUDWIG.     Die  Krankheiten  der  Arbeiter,  p.  92,  et  seq. 

NOTHNAGEL,  DR.  HERMANN.  Handbuch  der  Arzneimittellehre,  Blei-Praparate,  p.  268, 
et  seq. 

ROSEXSTEIN,  PROF.  DR.     Archiv  fur  pathologische  Anatomie,  xxxix,  1  und  174. 

SCHMIDT'S  Jahrbucher  der  gesammten  Medicin,  vol.  cxliv,  p.  279.  Mittheilungen 
ueber  Bleivergiftung,  von  L.  Pappenbeim ;  E.  Clapton ;  A.  Bobiene ;  E.  Buchner ;  Alois 


316  AGENTS   INCREASING  WASTE. 

Gruber ;  Stamm ;  Bucquoy;  A.  Gubler;  Nicaise ;  E.  Meyer;  Murchison;  Palean;  Pan- 
thiel. 

Second  Annual.  Report  of  the  State  Board  of  Health  of  Massachusetts,  1871,  p.  21. 

TARDIEU,  AMBROISK.  Dictionnairc  d1  Hygiene  p-ublique  et  de  Salubrite,  deux,  edition, 
tome  troisit-me,  p.  334. 

Zincum. — Zinc.     Zinc,  Fr.  ;  Zink,  Ger. 

Zinci  Oxidum. — Zinc  oxide.  A  yellowish-white  powder,  insoluble 
in  water,  but  soluble  in  dilute  sulphuric  and  muriatic  acids  without 
effervescence.  The  solutions,  when  neutral,  yield  white  precipitates 
with  ferrocyanide  of  potassium  and  hydrosulphate  of  ammonium. 
Dose,  gr.  ss — grs.  v. 

Zinci  Carbonas  Precipitatus. — Precipitated  zinc  carbonate.  A 
light,  white  powder,  odorless  and  tasteless,  and  insoluble  in  water  or 
alcohol. 

Ceratum  Zinci  Carbonatis. — Cerate  of  carbonate  of  zinc.  (Not 
official.)  (Carbonate,  f  ij  ;  ointment,  §  x.) 

Zinci  Sulphas. — Zinc  sulphate.  In  colorless  crystals,  which  ef- 
floresce on  exposure  to  air.  It  is  soluble  in  water,  and  the  solution 
affords  white  precipitates  with  ammonia,  chloride  of  barium,  ferrocya- 
nide of  potassium,  and  hydrosulphate  of  ammonium.  The  precipitate 
thrown  down  by  ammonia  is  wholly  soluble  in  an  excess  of  the  alkali. 
Dose,  gr.  £— gr.  vj. 

Zinci  Acetas. — Zinc  acetate.  In  micaceous  crystals,  which  efflo- 
resce in  a  dry  atmosphere.  It  is  soluble  in  2-7  parts  of  water,  and 
its  solution  yields  white  precipitates  with  ferrocyanide  of  potassium 
and  hydrosulphate  of  ammonium.  The  salt  is  decomposed  by  sul- 
phuric acid,  with  the  escape  of  acetous  vapors.  Dose,  gr.  ss — gr.  ij. 

Liquor  Zinci  Chloridi. — Solution  of  zinc  chloride.  An  aqueous 
solution,  containing  about  50  per  cent  by  weight  of  the  salt. 

Zinci  Chloridum. — Zinc  chloride.  A  white  deliquescent, salt, 
wholly  soluble  in  water,  alcohol,  and  ether.  Its  aqueous  solution 
yields  with  nitrate  of  silver  a  white  precipitate,  insoluble  in  nitric  acid. 
(These  preparations  are  for  external  use  only.) 

Zinci  Valerianas. — Zinc  valerianate.  A  white  anhydrous  salt,  in 
the  form  of  pearly  scales,  having  a  faint  odor  of  valerianic  acid,  and  a 
metallic  styptic  taste.  It  dissolves  in  one  hundred  parts  of  water, 
and  in  forty  of  alcohol  of  the  specific  gravity  of  0*833.  Dose,  gr.  £ 

— gr-  j- 

Uhguentum  Zinci  Oxidi. — Ointment  of  zinc  oxide.  (Zinc  oxide, 
200  grm.  ;  benzoinated  lard,  800  grtn.) 

ANTAGONISTS  AND  INCOMPATIBLES. — Lime-water,  the  alkalies  and 
their  carbonates,  nitrate  of  silver,  and  the  vegetable  astringents,  are 
incompatible  with  zinc-salts.  The  acetate  of  lead  is  also  incompatible, 
but  a  solution  containing  sulphate  of  zinc  and  acetate  of  lead,  not- 
withstanding the  double  decomposition  which  ensues,  is  an  effective 


ZINC.  317 

injection  in  gonorrhoea.  With  valerianate  of  zinc,  acids,  many  of  the 
metallic  salts,  soluble  carbonates,  and  vegetable  astringents,  are  incom- 
patible. The  antidotes  to  be  used  in  cases  of  poisoning  by  the  zinc- 
salts  are  lime-water,  mucilaginous  drinks,  milk,  tannic  acid,  the  carbon- 
ated alkalies,  common  soap,  etc. 

SYNERGISTS. — The  mercurial,  silver,  antimonial,  and  copper  prepa- 
rations favor  the  action  of  the  zinc-salts. 

PHYSIOLOGICAL  ACTIONS. — The  preparations  of  zinc  are  active  in 
proportion  to  their  solubility  and  power  of  diffusion.  The  chloride, 
the  sulphate,  and  the  acetate,  are  the  most  active,  and  in  the  order  in 
which  they  are  placed  ;  the  carbonate  and  the  oxide  being  insoluble, 
have  very  feeble  diffusive  power,  and  possess  consequently  very  slight 
activity.  The  chloride  is  a  very  active  escharotic.  Applied  to  the 
denuded  integument,  it  sets  up  decided  inflammation,  and  produces  an 
intense  burning  pain,  followed  by  sloughing.  Owing  to  its  great  affin- 
ity for  water  and  power  of  combination  with  albumen,  it  penetrates 
deeply  and  widely,  and  the  eschar  which  it  produces  is  thick,  hard, 
and  white.  The  dried  sulphate  of  zinc  (deprived  of  its  water  of  crys- 
tallization by  heat)  is  also  feebly  escharotic  when  applied  to  an  open 
wound.  Solutions  of  the  sulphate  and  acetate  act  locally  as  astringents 
by  combining  with  albumen. 

The  soluble  salts  of  zinc  have  a  styptic  metallic  taste,  which  is  very 
disagreeable.  The  sulphate  of  zinc  is  a  very  prompt  and  eflicient 
emetic,  acting  without  much  preliminary  nausea,  and  without  much 
constitutional  depression.  It  is  a  specific  emetic ;  it  acts  to  produce 
emesis  when  injected  into  the  veins.  Long-continued  use  of  the  sul- 
phate, even  in  small  medicinal  doses,  may  excite  ulceration  of  the  mu- 
cous membrane.  The  oxide  and  carbonate,  although  insoluble  and  in- 
active, slowly  produce  systemic  effects.  The  chloride  is  a  powerful 
irritant  poison,  causing  heat  and  a  sense  of  constriction  of  the  throat, 
a  strong  metallic  taste,  burning  at  the  stomach,  nausea,  vomiting, 
great  depression  of  the  pulse,  coldness  of  the  surface,  cold  sweat, 
cramps  of  the  legs,  etc.  The  mind  is  unaffected.  In  a  few  instances 
nervous  symptoms  have  followed,  besides  the  cramps,  and  in  one  no- 
table case  there  was  loss  of  the  senses  of  taste  and  smell. 

All  of  the  salts  of  zinc,  when  long  continued,  may  produce  a  train 
of  symptoms  not  unlike  those  caused  by  lead,  viz.,  emaciation,  pallor, 
loss  of  strength,  constipation  and  colic,  muscular  weakness  and  trem- 
bling, paralysis,  etc.  The  oxide  in  large  doses,  and  used  for  a  long 
period,  has  produced  wasting,  a  fetid  breath,  gastro-intestinal  catarrh, 
weakness,  and  feeble  mind. 

The  zinc-salts  most  probably  exist  in  the  blood  in  the  form  of  al- 
buminate,  and  in  close  relation  to  the  red  blood-globules.  They  mani- 
fest much  less  tendency  to  accumulate,  and  are  excreted  much  more 
rapidly  than  mercury,  lead,  and  copper.  They  diffuse  out  of  the  blood 


318  AGENTS   INCREASING   WASTE. 

chiefly  by  the  liver  and  intestinal  glandular  apparatus,  and  are  found 
in  great  quantity  in  the  faeces.  To  a  slight  extent  they  are  also  ex 
creted  by  the  kidneys. 

THEBAPY. — The  sulphate  of  zinc  is  much  employed  as  an  emetic  in 
cases  such  as  narcotic  poisoning,  where  prompt  and  efficient  action  is 
necessary.  Six  grains  will  generally  prove  sufficient.  It  may  be  re- 
peated every  fifteen  minutes,  well  diluted  with  water,  until  emesis  oc- 
curs. It  was  formerly  much  employed  as  an  emetic  in  croup,  but  now 
tartar-emetic,  but  especially  the  subsulphate  of  mercury,  is  preferred. 

The  oxide  of  zinc  is  an  excellent  remedy  for  gastralgia.  It  is  indi- 
cated also  in  the  following  state  of  things  :  pain  after  taking  food, 
nausea,  intestinal  pain,  succeeded  by  prompt  alvine  discharges,  the 
faeces  being  made  up  largely  of  undigested  food.  From  five  to  ten 
grains  mixed  with  aromatic  powder  and  combined  with  morphine,  if 
need  be,  may  be  given  before  each  meal.  In  the  summer  diarrhoea  of 
children,  it  is  a  very  efficient  remedy.  It  may  be  administered  with 
bismuth  and  pepsin.  IJ  Bismuthi  subnitrat.,  3  j  —  3  ij  ;  pepsinas 
sacch.  (Sheffer's),  3  ss;  zinci  oxidi,  grs.  vj — grs.  xij.  M.  Ft.  pulv.no. 
xii.  Sig.  :  One  powder  every  four  to  six  hours.  In  the  chronic  diar- 
rhoea both  of  children  and  adults  the  oxide  of  zinc  (from  two  to  ten 
grains)  is  serviceable  under  the  same  circumstances  in  which  bismuth 
is  presumed  to  be  indicated,  but  it  is  a  less  pleasant  remedy  in  action 
than  the  latter.  The  sulphate  (gr.  ss — grs.  ij)  often  gives  great  relief 
in  that  form  of  dyspepsia  which  is  the  cause  of  oxaluria.  In  small 
doses,  the  sulphate,  like  most  of  the  mineral  remedies  of  this  group, 
increases  for  a  time  the  appetite  and  digestive  capacity,  but  this  effect 
is  soon  succeeded  by  gastro-intestinal  catarrh,  nausea,  and  loss  of  appe- 
tite. The  sulphate,  as  well  as  the  oxide,  is  an  astringent  ;  it  arrests 
the  peristaltic  movements  and  causes  constipation,  and  is  therefore 
an  appropriate  remedy  in  chronic  diarrhoea  and  chronic  dysentery. 
In  its  action  and  results  it  is  similar  to  but  less  efficient  than  sulphate 
of  copper.  It  may  be  combined  with  opium  and  ipecacuanha  :  Ijfc 
Zinci  sulphat.,  pulv.  opii,  pulv.  ipecac.,  aa  grs.  xij.  M.  Ft.  pil.  no.  xij. 
Sig.  :  One  pill  three  or  four  times  a  day. 

The  zinc  preparations  possess  undoubted  efficacy  in  certain  disorders 
of  the  thoracic  organs.  The  night-sweats  of  phthisis  are  often  pre- 
vented by  a  pill  of  oxide  of  zinc  and  extract  of  belladonna  (three 
grains  of  the  former  and  half  a  grain  of  the  latter)  given  at  bedtime. 
The  zinc  is  serviceable  without  the  belladonna,  but  the  combined  action 
is  more  efficient.  The  sulphate  of  zinc,  by  virtue  of  its  astringency, 
has  been  prescribed  in  bronchorrhcea,  but  other  agents  are  now  pre- 
ferred. The  oxide  of  zinc  is  a  serviceable  prophylactic  against  the 
recurrence  of  the  attacks  of  spasmodic  asthma.  It  is  also  one  of  the 
numerous  remedies  which  has  been  used  with  a  varying  degree  of  suc- 
cess in  whooping-cough :  IJ  Zinci  oxidi,  3  j  ;  ext.  belladonnae,  grs.  v. 


ZINC.  319 

M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill  three  times  a  day  as  a  prophylactic 
for  asthma,  and  as  a  remedy  for  whooping-cough.  The  sulphate  of 
zinc  (gr.  £ — gr.  j)  and  extract  of  belladonna  (gr.  £ — gr.  ss)  may  be 
used  in  combination  for  the  relief  of  the  same  cases.  It  is  highly 
probable  that  the  sulphate  of  zinc,  being  more  soluble,  is  much  more 
efficient  in  the  treatment  of  these  neuroses  of  the  digestive  organs  than 
the  oxide. 

The  preparations  of  zinc  exert  an  influence  upon  the  nervous  system 
which  has  been  and  is  called  antispasmodic.  In  certain  disorders  of 
the  nervous  system,  of  which  the  chief  manifestations  are  spasm  and 
convulsion  (clonic),  they  are  sometimes  very  serviceable.  Much  has 
been  said  for  and  against  the  oxide  of  zinc  as  a  remedy  for  epilepsy. 
A  few  cases  are  improved  by  it ;  in  the  great  majority  it  fails  utterly. 
When  favorable,  it  acts  by  allaying  irritability  of  the  terminal  fila- 
ments of  the  pneumogastric,  and  probably  also  by  removing  a  dis- 
eased state  of  the  gastric  mucous  membrane.  Epileptiform  vertigo 
and  epileptiform  angina  pectoris,  when  they  arise  (as  they  not  unfre- 
quently  do)  from  gastric  disorder  of  some  kind,  are  sometimes  cured 
by  the  oxide  of  zinc.  The  so-called  nervous  headache  of  hysterical 
women,  nervous  cough,  and  aphonia,  due  to  uterine  and  ovarian  irri- 
tation, are  often  relieved  by  the  valerianate  of  zinc.  Sulphate  of  zinc 
is  one  of  the  numerous  remedies  for  chorea,  acting  in  a  manner  similar 
to  arsenic,  but  inferior  to  this  agent  in  curative  power.  In  neuralgia 
due  to  reflex  irritation  from  the  female  pelvic  organs,  the  preparations 
of  zinc,  notably  the  valerianate,  are  often  extremely  beneficial.  1J 
Zinci  valerianat.,  3  j  ;  ext.  gentianae,  3  j  ;  ext.  nucis  vom.,  grs.  v.  M. 
Ft.  pil.  no.  xx.  Sig.  :  One  pill  three  or  four  times  a  day.  In  chronic 
alcoholismus,  to  relieve  the  trembling,  to  diminish  the  appetite  for 
strong  drink,  and  to  relieve  the  gastric  catarrh,  the  oxide  of  zinc  is 
very  useful  :  1^  Zinci  oxidi,  3  j  ;  piperin.,  3  j.  M.  Ft.  pil.  no.  xx. 
Sig.  :  One  pill  three  or  four  times  a  day. 

EXTERNAL  USES. — The  interstitial  injection  of  a  solution  of  zinc 
chloride  has  lately  been  brought  forward  as  a  remedy  for  pulmonary 
tuberculosis,  and,  it  is  alleged,  with  a  large  measure  of  success.  Lan- 
nelongue  was  the  first  to  practice  this  expedient,  and  he  continues  to 
advocate  it  as  a  valuable  curative  agent.  The  method  consists  in  in- 
jecting into  the  pulmonary  parenchyma  a  solution  of  zinc  chloride  of 
the  strength  of  1  to  50  to  20.  It  causes  no  injury  to  the  lung  tissues, 
and  it  is  not  painful.  The  needle  is  carried  into  the  area  occupied  by 
the  disease  and  three  drops  of  the  solution  are  slowly  injected. 

An  excellent  caustic  for  the  destruction  of  lupus,  epithelioma,  and 
unhealthy  ulcers  is  the  dried  sulphate  of  zinc,  which  may  be  freely 
dusted  over  the  affected  surface.  A  superficial  slough  forms,  the  sepa- 
ration of  which  may  be  aided  by  a  poultice.  The  most  efficient  escha- 
rotic  consistent  with  safety  is  the  chloride.  No  danger  is  to  be  ap- 


320  AGENTS  INCREASING  WASTE. 

prehended  from  its  absorption,  and  the  strength  of  the  application 
may  be  easily  regulated.  For  the  destruction  of  malignant  growths, 
chloride  of  zinc  is  applied  of  varying  strength,  by  the  admixture  of 
different  proportions  of  flour,  or  better,  of  powdered  althea-root,  so  as 
to  form  a  paste,  sufficient  water  being  added.  One  part  of  the  chloride 
to  two,  three,  four,  or  five  parts  of  flour  are  the  proportions  advised 
by  Dr.  Can  quoin.  Instead  of  flour,  the  chloride  may  be  mixed  with 
anhydrous  sulphate  of  lime.  A  very  convenient  and  useful  mode  of 
applying  chloride  of  zinc  is,  to  mix  it,  while  in  a  finely-powdered  state, 
with  its  weight  of  gutta-percha  melted  with  as  little  heat  as  possible. 
The  mixture  may  be  molded  into  any  desired  shape.  The  so-called 
"  caustic  arrows  "  are  nothing  more  than  chloride-of-zinc  paste,  dried 
and  cut  into  arrow-like  slips.  These  are  inserted  into  the  malignant 
growth,  usually  at  its  base,  in  order  to  separate  it  from  the  healthy 
tissues. 

The  salts  of  zinc  are  useful  applications  to  certain  forms  and  stages 
of  skin-diseases.  In  eczema,  during  the  secretory  stage,  the  following 
may  be  used  :  3  Zinci  oxidi,  3  ij  ;  glycerine,  §  ij  ;  liq.  plumbi  sub- 
acetat.,  3  jss  ;  aquae  calcis  ad  ^  vj.  M.  Sig.  :  Lotion  (Fox).  This 
formula  is  serviceable  also  in  impetigo  and  herpes.  An  excellent  ab- 
sorbent powder  for  excoriated  surfaces  is  the  following  :  3  Corn-meal, 
finely  sifted,  §  iv  ;  oxide  of  zinc,  §  j  ;  iris  powder,  |  ss  ;  oil  of  almonds, 
gtts.  x.  M.  The  following  is  recommended  by  Neumann  in  sebor- 
rhcea,  when  there  is  inflammation  :  r>  Zinci  oxidi,  3  j  ;  plumbi  car- 
bonat.,  3  j  ;  cetacei,  |  j  ;  ol.  olivae  q.  s.  ft.  ung.  Sig. :  Ointment. 
In  erythema,  intertrigo,  and  eczema,  the  following  lotion  is  useful :  ]J 
Aluminis,  3j ;  zinci  sulph.,  grs.  x;  glycerine,  3j  ;  aquae  rosae,  §  iv. 
M.  Sig.  :  Lotion.  For  erythema  and  herpes,  the  following  may  also 
be  used :  $  Zinci  acetat.,  grs.  ij  ;  aquae  rosae,  3  j  ;  ung.  aquae  rosae, 
|  j.  M.  Sig.  :  Ointment.  The  ointments  of  the  oxide  of  zinc  and 
the  cerate  of  the  carbonate  are  excellent  applications  in  many  of  the 
cutaneous  affections  above  named. 

Probably  the  most  efficient  means  for  treating  gonorrhoea  consists 
in  the  use  of  a  weak  zinc-injection  frequently  repeated.  r>  Zinci 
chloridi,  gr.  j  ;  aquae  rosae,  §  iv —  §  viij.  M.  Sig.  :  As  an  injection. 
$  Zinci  sulph.,  grs.  viij  ;  aquae  rosae,  §  viij.  M.  Sig.  :  As  an  injec- 
tion. After  the  acute  symptoms  have  subsided,  the  following  injec- 
tion is  very  effective  :  ^  Zinci  sulphat.,  plumbi  acetat.,  aa  grs.  viij  ; 
ammoniae  muriat.,  aluminis,  aa  grs.  iv  ;  aquae  rosae,  §  j.  M.  Sig.  :  As 
an  injection. 

The  sulphate  of  zinc  is  very  much  prescribed  by  the  ophthalmolo- 
gists in  conjunctivitis,  otorrhcea,  etc.  It  is  usually  associated  with  mor- 
phine and  atropine.  IJ.  Zinci  sulphat.,  grs.  ij — grs.  viij  ;  morphinae 
sulph.,  grs.  ij — grs.  iv  ;  atropinae  sulph.,  gr.  ss — gr.  j  ;  aquae  rosae,  §  j. 
M.  Sig.  :  For  the  eye. 


ANTIMONY.  321 

Authorities  referred  to  : 

Fox,  DR.  TILBURY.     On  Diseases  of  the  Skin,  second  American  edition. 

GUBLER,  DR.  ADOLPHE.     Commentaires  Therapeutiques  du  Codex  Medicamentarius. 

HIRT,  DR.  LCDWIQ.  Die  Krankheiten  der  Arbeiter,  erster  Theil,  Breslau,  1871,  p.  97, 
•ct  seq. 

NOTHNAGKL,  DR.  HERMANN.  Handbuch  der  Arzneimittellehre,  p.  281,  et  seq.,  ZinJc. 
Praparaie. 

SIMPSON,  SIR  JAMES  Y.  Clinical  Lectures  on  Diseases  of  Women,  American  edition, 
1872,  p.  195. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Matiere  Medicale,  eighth  edition, 
by  Paul. 

WALDENBURG  UNO  SIMON.  Handbuch  der  allgemeinen  und  speciellen  Arzneiverordnungs- 
Lehre,  Berlin,  1873. 

Antimonium. — Antimony.     Antimoine,  Fr.  ;  Antimon,  Ger. 

Antimonii  et  Potassii  Tartras. — Antimony  and  potassium  tartrate. 
Tartar-emetic.  In  transparent  crystals  which  become  white  and  opaque 
on  exposure  to  the  air.  It  is  wholly  soluble  in  twenty  parts  of  water. 
The  solution  yields  no  precipitate  with  chloride  of  barium,  or,  if  very  di- 
lute, with  nitrate  of  silver.  Hydrosulphuric  acid  causes  an  orange-red 
precipitate.  A  solution  containing  one  part  in  forty  of  water  is  not  dis- 
turbed by  an  equal  volume  of  a  solution  of  eight  parts  of  acetate  of  lead 
in  thirty-two  of  water  and  fifteen  of  acetic  acid.  Dose,  gr.  -fa — gr.  ij. 

Vinum  Antimonii. — Wine  of  antimony.  (Tartrate  of  antimony 
and  potassium,  4  grm.  ;  boiling  distilled  water,  65  c.  c.  ;  alcohol,  150 
c.  c.,  and  white  wine,  q.  s.  to  make  1,000  c.  c.)  Nearly  two  grains  to 
the  ounce.  Dose,  TTI  v —  3  ij. 

Mistitra  G-lycyrrhizce  Composita. — Compound  glycyrrhiza  mix- 
ture. (Brown  mixture.  Contains  extract  of  glycyrrhiza,  paregoric, 
nitrous  ether,  and  wine  of  antimony.)  Dose,  a  tea-  to  a  tablespoonful. 

Syrupus  Scillce  Compositus. — Compound  sirup  of  squill.  Hive- 
sirup.  (Squill,  seneka,  tartar-emetic.  Contains  about  three  fourths 
of  a  grain  of  tartar-emetic  to  the  ounce.)  Dose,  TTI,  v —  3  j. 

Antimonii  Oxidum. — Antimony  oxide.  A  grayish-white  powder, 
insoluble  in  water,  but  readily  and  wholly  soluble  in  muriatic  or  tar- 
taric  acid.  Dose,  gr.  j — gr.  iij. 

Antimonii  Sulphidum  Purificatum. — Purified  antimony  sulphide. 
A  dark-gray  powder,  odorless  and  tasteless,  and  insoluble  in  water  or 
alcohol.  Dose,  gr.  \ — gr.  j. 

Antimonii  Sulphuratum.  —  Sulphurated  antimony  is  a  reddish- 
brown  powder,  insoluble  in  water.  Dose,  gr.  j — gr.  v. 

Pilulce  Antimonii  Composite^.  —  Compound  pills  of  antimony. 
Plummer's  pills.  They  are  composed  of  sulphurated  antimony,  calo- 
mel, and  guaiac,  and  each  pill  contains  a  little  more  than  a  half-grain 
of  calomel.  Besides  the  utility  of  the  combination,  the  name  is  con- 
venient when  prejudices  exist  against  the  use  of  the  mercurial. 

In  the  remarks  which  follow,  tartar-emetic  is  the  only  antimonial 
23 


322  AGENTS  INCREASING  WASTE. 

preparation  referred  to,  unless  otherwise  stated.  None  of  the  other 
preparations  are  employed  by  modern  physicians. 

ANTAGONISTS  AND  INCOMPATIBLES. — Tannic  and  gallic  acids,  and 
vegetable  infusions  containing  them,  form  an  insoluble  tannate,  and 
are  therefore  incompatible.  Alkalies  and  the  salts  of  lead  decompose 
tartar-emetic.  It  follows  that  the  proper  antidotes  to  poisoning  by 
tartar-emetic  are  tannic  acid  and  substances  containing  it.  Opium, 
alcohol,  ether,  etc.,  and  the  antispasmodics  generally,  are  physiologi- 
cally antagonistic. 

SYNERGISTS.  — The  mineral  substances  of  this  group  promote  the  ac- 
tion of  the  antimonials  ;  also  the  emetics  and  cathartics,  and  depress- 
ing remedies  generally,  as  veratrum  viride,  etc. 

PHYSIOLOGICAL  ACTIONS. — Tartar-emetic  has  a  sweetish,  styptic, 
and  metallic  taste.  In  small  medicinal  doses,  it  excites  a  sensation  of 
warmth  in  the  stomach,  followed  by  nausea,  increased  flow  of  saliva 
and  buccal  mucus,  an  abundant  secretion  of  the  gastric  and  intestinal 
glandular  apparatus,  and  also  of  the  liver  and  pancreas.  In  somewhat 
larger  doses — a  half -grain  to  one  or  two  grains — it  excites  vomiting^ 
first  of  the  contents  of  the  stomach,  then  of  gastric  mucus,  and  after- 
ward of  mucus  and  biliary  matters.  The  alvine  dejections  are  more 
fluid  and  increased  in  number,  and  consist  at  first  of  fluidified  faces  ;. 
afterward  they  are  made  up  of  a  colored  liquid,  in  which  there  are 
present  biliary  matters  and  some  faeces  ;  and,  finally,  there  appears 
only  a  colorless  or  whitish  liquid,  having  flocculi  of  epithelium  floating 
in  it,  and  bearing  a  striking  resemblance  to  the  "  rice-water  discharges  " 
of  cholera. 

The  gastro-intestinal  symptoms  are  accompanied  by  systemic  dis- 
turbance— paleness  of  the  face,  coldness  of  the  surface  (sometimes  pre- 
ceded by  a  very  temporary  rise  of  temperature),  irregularity  and  fee- 
bleness of  the  pulse,  and  great  nervous  and  muscular  prostration. 
When  the  quantity  is  sufficient  to  cause  lethal  symptoms,  they  are  as 
follows  :  epigastric  pain,  vomiting  and  purging,  shrunken  features, 
cold  breath,  cyanosis,  arrest  of  the  urinary  secretion,  aphonia,  cramps 
— the  assemblage  of  symptoms  belonging  to  the  collapse  of  cholera. 

Tartar-emetic,  when  used  in  considerable  medicinal  doses,  sets  up 
an  irritation  of  the  fauces  followed  by  aphthous  ulcerations,  which  con- 
tinue along  the  oesophagus  to  the  stomach,  and  are  accompanied  by 
salivation  and  painful  deglutition. 

Applied  to  the  skin  by  friction,  tartar-emetic  excites  a  follicular 
inflammation,  succeeded  by  a  papule,  a  vesico-pustule,  a  surrounding 
inflammation  with  indurated  base,  a  central  umbilication,  and  finally 
desiccation,  terminating  in  a  brownish  scab.  These  antimony-pustules 
are  very  similar  to  those  of  vaccine  or  variola. 

When  applied  to  the  skin  or  injected  into  the  veins,  tartar-emetic 
is  absorbed,  and  manifests  a  selective  action  on  the  gastro-intestinal 


ANTIMOXY.  323 

mucous  membrane,  causing  the  same  irritant  effects  as  are  produced 
by  its  stomach  administration.  It  is,  therefore,  a  specific,  and  not  a 
merely  irritant  emetic. 

Tartar-emetic  readily  diffuses  into  the  blood.  In  what  form,  unless 
as  an  albuminate,  it  exists  in  the  blood,  is  not  understood.  It  dimin- 
ishes the  number  and  force  of  the  arterial  pulsations,  and  rapidly  low- 
ers the  blood-pressure.  The  pulse  may  fall  from  72  to  40,  but,  accord- 
ing to  Hirtz,  rarely  is  the  number  reduced  more  than  6  to  10  per  min- 
ute. In  the  healthy  subject,  the  normal  temperature,  even  when  a 
full  medicinal  dose  has  been  administered,  remains  unaffected  as  to 
the  trunk,  but  it  may  be  reduced  in  the  extremities.  In  fevers  and 
inflammations,  a  considerable  reduction  of  temperature  may  take 
place,  and  the  same  result  has  been  noted  in  the  physiological  state 
when  the  quantity  of  tartar-emetic  has  been  sufficient  to  produce 
choleriform  symptoms. 

In  man  delirium,  and  in  animals  paralysis,  motor  and  sensory,  but 
without  impairment  of  muscular  contractility,  have  been  observed  from 
lethal  doses  of  tartar-emetic. 

Tartar-emetic  promotes  waste  and  hastens  the  elimination  of  the 
products  of  waste — the  excretion  both  of  carbonic  acid  and  of  urea 
being  greatly  increased  by  it. 

The  antimonial  salts  are  found  in  the  blood,  in  the  liver,  and  other 
viscera,  and  are  excreted  by  the  bile,  the  milk,  the  perspiration,  and 
the  urine.  It  is,  doubtless,  also  largely  excreted  by  the  intestinal 
glandular  apparatus,  as  is  the  case  with  the  metals  generally. 

If  tartar-emetic  is  administered  in  small  doses,  and  the  quantity  be 
gradually  increased,  the  nauseating  effects  of  the  drug  may  be  en- 
tirely prevented.  When  emetic  doses  even  are  continued  in  some 
subjects,  this  effect  finally  ceases,  and  the  drug  is  borne  without  pro- 
ducing  any  gastric  symptoms.  To  this  state  has  been  applied  the 
term  tolerance,  by  the  contra-stimulant  school  of  practitioners.  It 
must  not  be  lost  sight  of,  that  this  tolerance,  on  the  part  of  the  stom- 
ach, of  large  doses  does  not  mean  an  indifference  to  the  action  of  the 
remedy,  but  very  serious  and  profound  anatomical  alterations  may 
result. 

THERAPY. — Tartar-emetic  was,  formerly,  much  more  frequently 
prescribed  than  at  present  as  an  emetic  in  cases  of  indigestion  charac- 
terized by  a  coated  tongue,  loaded  stomach,  and  anorexia  (Vembarras 
gastrique).  It  is  sometimes  used  as  an  emetic  in  cases  of  narcotic  poi- 
soning, but  sulphate  of  zinc  is  preferable.  It  was  formerly  used  as 
an  emetic  in  the  first  stage  of  typhoid  and  other  fevers,  but,  notwith- 
standing this  practice  is  frequently  followed  by  good  results,  it  is  now 
rarely  pursued.  If  emesis  is  desirable  in  these  cases,  a  less  irritating 
and  depressing  emetic  should  be  used. 

In  oroup  tartar-emetic  is  an  efficient  emetic,  but  it  must  be  used 


324  AGENTS   INCREASING'  WASTE. 

with  caution,  owing  to  the  great  depression  which  it  produces,  and  the 
fatal  result  which  has  occurred  in  many  instances.  It  is  not  a  suitable 
remedy  for  infants  and  very  young  children.  The  compound  sirup  of 
squills  is  a  domestic  remedy  for  croup,  but  the  incautious  use  of  this 
has  proved  fatal.  Tartar-emetic  is  used  in  laryngismus  stridulus  to 
produce  emesis  and  consequent  relaxation  of  the  muscles  of  the  larynx, 
and  in  true  croup  to  cause  the  expulsion  of  the  false  membrane.  The 
yellow  subsulphate  of  mercury  is  safer  and  quite  as  effective. 

Tartar-emetic  is  an  excellent  remedy  in  the  first  stage  of  acute  ca- 
tarrh, nasal,  pliaryngeal,  and  bronchial.  It  is  most  efficient  in  the 
first  stage,  when  the  mucous  membrane  is  dry  and  swollen.  It  pro- 
motes secretion,  diminishes  fever,  induces  diaphoresis,  and  hastens  the 
elimination  of  inflammatory  products.  In  these  cases,  from  one 
twentieth  to  one  twelfth  of  a  grain  is  usually  a  sufficient  quantity,  for 
it  is  not  necessary  that  nausea  be  excited.  When  cough  is  violent,  a 
little  opium  may  be  added  to  the  prescription.  3  Antimonii  et  po- 
tassii  tart.,  gr.  ss  ;  morphinae  acetat.,  gr.  ss  ;  aquse,  §  ij.  M.  Sig.  :  A 
teaspoonful  every  hour  or  two.  In  acute  bronchitis,  when  the  cough  is 
dry  and  hoarse,  this  agent  is  useful,  and  small  doses  (one  sixteenth  of 
a  grain),  frequently  repeated,  are  more  serviceable  than  large  doses 
at  longer  intervals. 

Formerly,  under  the  influence  of  the  contra-stimulant  school,  tartar- 
emetic  was  given  in  large  doses  in  pneumonia.  It  was  sought  to  es- 
tablish tolerance  at  an  early  period,  and  to  administer  the  largest  doses 
which  could  be  borne.  The  comparative  results  of  this  method  of 
treatment  and  of  the  expectant  and  restorative  plans  demonstrate  the 
impropriety  of  the  tartar-emetic  treatment,  and  it  is  now  abandoned. 
It  is  true  that  small  doses  of  tartar-emetic,  by  increasing  the  action  of 
the  skin,  kidneys,  and  intestinal  canal,  may  exert  a  favorable  influence 
over  the  temperature  and  diminish  the  plasticity  of  the  exudation  ;  but 
even  small  doses  must  be  employed  with  care,  lest  a  depression  should 
be  induced  which  may  interfere  seriously  in  the  natural  course  of  a 
disease  which  is  self-limited  and  has  its  period  of  crisis. 

Tartar-emetic  gives  great  relief  in  spasmodic  asthma  when  the  bron- 
chial secretion  is  deficient,  and  in  those  cases  brought  on  by  an  over- 
loaded stomach.  In  the  former  case  small  doses  frequently  repeated 
until  very  slight  nausea  is  produced,  and  in  the  latter  emetic  doses,  are 
necessary.  The  following  is  a  useful  form  of  expectorant  in  the  acute 
inflammatory  affections  of  the  air-passages  :  IJ  Antimonii  et  potassii 
tart.,  gr.  j  ;  ammonii  muriat.,  3iv  ;  ext.  glycyrrhizse,  3j  ;  morphinaB 
muriat.,  gr.  j  ;  syrup,  tolutan.,  aquae  lauro-cerasi,  aa  §  j.  M.  Sig.  : 
A  teaspoonful  every  two,  three,  or  four  hours. 

The  ointment  of  tartar-emetic  was  formerly  much  employed  to  pro- 
duce pustulation  of  the  chest  in  the  more  chronic  pulmonary  diseases. 
This  painful  and  disfiguring  form  of  counter-irritation  has  passed  out 


ANTIMONY.  325 

of  use.  To  produce  a  crop  of  variolus-like  pustules  on  the  skin  does 
not  cause  a  morbid  process  like  caseous  pneumonia  or  tuberculosis  to 
cease  its  ravages  ;  on  the  contrary,  such  extensive  suppuration  in  the 
skin  rather  favors  the  development  of  these  diseases. 

A  combination  of  tartar-emetic  and  opium  is  a  serviceable  hypnotic 
in  some  cerebral  disorders.  These  remedies  appear  to  be  most  useful 
when  wakefulness  and  delirium  are  due  to  cerebral  congestion,  and 
in  those  subjects  who  become  excited  and  wakeful  from  the  use  of 
opium  alone.  In  the  active  delirium  and  wakefulness  of  typhoid  fever, 
tartar-emetic  and  opium  are  prescribed  :  $  Antimonii  et  potassii  tart., 
gr.  j — grs.  ij ;  morphinae  sulph.,  gr.  jss  ;  aquae  lauro-cerasi,  3  j.  M. 
Sig.  :  A  teaspoonful  every  two,  three,  or  four  hours.  In  delirium  tre- 
mens,  when  the  same  conditions  exist,  the  same  combination  may  be 
prescribed.  Since  the  introduction  of  chloral  and  bromide  of  potas- 
sium, however,  the  use  of  these  drugs  for  the  purposes  just  indicated 
has  been  much  restricted. 

In  acute  inflammatory  and  febrile  diseases,  minute  doses  of  tar- 
tar-emetic (gr.  -jJg-),  frequently  repeated,  render  an  incontestable  ser- 
vice. Typhoid,  typho-malarial,  and  remittent  fevers,  acute  rheumatism^ 
erysipelas,  etc.,  are  maladies  thus  benefited.  This  remedy  is,  of  course, 
contraindicated  when  there  is  much  irritability  of  the  stomach  and 
intestinal  canal.  At  the  outset  of  fevers  it  was  formerly  the  custom 
to  prescribe  an  active  emetic,  and  good  results  certainly  followed  this 
practice.  The  author  believes  that  he  has  frequently  seen  impending 
attacks  of  malarial  fever  aborted  by  emetic  doses  of  antimony  and 
ipecaCc  Free  emeto-catharsis  moderates  the  severity  of  remittent  fever 
in  robust  subjects  when  produced  in  the  incipiency  of  this  disease,  and 
also  puts  the  mucous  membrane  in  a  better  state  for  the  disposition  of 
medicines  and  food. 

Before  the  days  of  anaesthesia  tartar-emetic  was  much  used  to  relax 
the  muscular  system  for  the  reduction  of  dislocations,  to  facilitate  the 
taxis  in  strangulated  hernia,  to  relax  rigid  os  and  perineum  in  labort 
etc.,  but  it  is  now  no  longer  employed  for  these  purposes. 

Authorities  referred  to : 

GUBLER,  DR.  A.    Commentaires  Therapeutiques  du  Codex  Medicamcntarius,  p.  624,  et  seq. 

HERMANN,  DR.  L.     Lehrbuch  der  experimentellen  Toxicologie,  p.  218,  Anlimonsalze. 

NOTHNAGEL,  DR.  HERMANN.  Handbuch.  der  Arzneimittelkhre,  p.  218,  et  seq.,  Antimon- 
Prdparaie. 

RADZIEJEWSKT,  DR.  S.  Schmidt's  Jahrbucher  der  gesammten  Median,  vol.  cliii,  p.  10, 
Zur  Wirkung  des  Antimon. 

TAYLOR,  DR.  A.  S.     On  Poisons,  American  edition,  p.  476. 

TROCSSEAC  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Matiere  Medicate,  edition  by 
Paul,  huitieme  edition,  vol.  ii,  p.  951. 

Cadmium. — Cadmium.  Cadmium,  Fr.  ;  Kadmium,  Ger.  (Not 
official.)  Cadmii  Sulphas. — Sulphate  of  cadmium. 


326  AGENTS   INCREASING   WASTE. 

ACTION  AND  USES. — There  is  a  strong  resemblance — an  identity 
of  action,  indeed — between  zinc  and  cadmium,  except  that  the  latter 
is  the  stronger.  Cadmium  has  a  decidedly  caustic  and  astringent 
taste  ;  it  is  powerfully  nauseant  and  emetic,  producing  great  depres- 
sion of  the  powers  of  life.  Locally  the  effects  are  those  of  an  irritant 
poison,  and  the  systemic  effects  correspond ;  although  there  are  pro- 
duced such  cerebro-spinal  symptoms  as  coma  and  convulsions.  This 
agent  is  not  administered  internally,  the  preparations  of  zinc  being 
preferred  for  all  purposes  to  which  cadmium  might  be  applied  as  a 
remedy. 

In  ophthalmic  practice,  cadmium  seems  to  be  much  esteemed  as  a 
collyrium.  It  is  held  to  possess  special  powers  in  causing  absorption 
of  opacities  of  the  cornea :  ^  Cadmii  sulph.,  grs.  ij  ;  aquae  rosse,  §  j. 
M.  Sig.  :  Collyrium.  A  solution  of  the  same  strength  is  said  to  be 
an  excellent  local  application  in  otorrhoea.  There  is  no  doubt  that 
cadmium  is  an  efficient  injection  in  gonorrhoea  ;  but  it  is  important  in 
the  application  of  this,  as  of  so  many  other  astringent  remedies,  that 
it  be  not  too  strong — one  grain  of  cadmium  sulphate  to  four  ounces  of 
water  being  sufficient  in  most  cases. 

An  ointment  of  cadmium  is  used  somewhat  by  French  physicians, 
in  the  treatment  of  external  affections.  For  this  purpose  we  may  di- 
rect ten  grains  of  the  sulphate  to  be  intimately  incorporated  with  an 
ounce  of  simple  ointment. 

Strontium  and  its  Salts. — Strontii  Bromidum.  —  Strontium  bro- 
mide. Colorless,  transparent,  hexagonal  crystals,  odorless,  and  having 
a  bitter,  saline  taste.  Very  deliquescent.  Soluble  in  1'05  parts  of 
water  at  59°  Fahr.  (15°  C.),  and  is  readily  soluble  in  alcohol.  Dose, 
gr.  v—  3  j. 

Strontii  lodidum. — Strontium  iodide.  Colorless,  transparent,  hex- 
agonal crystals,  and  having  a  bitterish,  saline  taste.  Soluble  in  0'6 
part  of  water  at  59°  Fahr.  (15°  C.).  Also  soluble  in  alcohol.  Dose, 
gr.  v —  3  ss. 

Strontii  Lactas. — Strontium  lactate.  A  white,  granular  powder  or 
crystalline  nodules,  odorless,  and  having  a  slightly  bitter,  saline  taste. 
Soluble  in  about  4  parts  of  water  at  59°  Fahr.  ;  soluble  in  alcohol. 
Dose,  gr.  v —  3  ss. 

ANTAGONISTS  AND  INCOMPATIBLES. — As  the  salts  of  strontium  form 
precipitates  with  solutions  of  the  sulphates  and  carbonates  of  soda, 
potassa,  and  calcium,  these  are  incompatible.  The  iodides  and  bro- 
mides are  not  incompatible  with  the  same  salts  of  the  alkalies.  As 
the  salts  of  strontium  are  soluble  in  alcohol,  they  can  be  prescribed 
with  alcoholic  tinctures. 

STNEBGISTS. — The  iodide  and  bromide  of  strontium  promote  the 
action  of  corresponding  bases. 


STRONTIUM  AND  ITS  SALTS.  327 

PHYSIOLOGICAL  ACTIONS. — According  to  Laborde,  who  has  made  the 
most  elaborate  investigation  of  the  actions  of  strontium,  it  is  a  non-toxic 
substance,  and  may  be  given  in  considerable  quantity  without  causing 
any  disturbance  of  a  local  or  systemic  character.  Most  of  the  salts, 
except  the  chloride,  which  appears  to  be  innocuous,  rather  improve 
the  appetite,  promote  the  activity  of  the  assimilation,  and  increase  the 
body  weight.  The  phosphate,  however,  more  especially  is  a  reconstit- 
uent — an  agent  having  the  power  to  increase  the  nutritive  energies. 
The  iodide  and  bromide  of  strontium  have  properties  analogous  to  the 
corresponding  salts  of  the  alkaline  bases,  but  they  are  more  easily 
borne  by  the  gastro-intestinal  organs.  The  iodide  possesses  resolvent, 
discutient,  or  alterant  properties.  The  bromide  acts  as  a  sedative  to 
the  nervous  system.  The  evidence  on  this  point  is  conclusive.  If  a 
solution  of  the  bromide  is  injected  into  a  member,  it  causes  more  or 
less  complete  anaesthesia,  followed  by  infiltration  and  oedema.  Ad- 
ministered in  suitable  doses,  it  causes  somnolence,  stupor,  and  paresis 
of  the  muscular  system.  It  also  lessens  and  finally  extinguishes  the 
reflexes,  and  it  diminishes  the  sensibility  of  the  mucous  membrane. 
In  fact,  the  bromide  of  strontium  acts  in  a  manner  similar  to  the 
bromide  of  potassium,  but  it  is  far  less  depressing. 

Most  of  the  salts  of  strontium  possess  a  diuretic  property,  but  this 
is  especially  true  of  the  lactate. 

THERAPY. — In  those  disorders  of  the  stomach  characterized  by 
acetic  or  lactic  fermentation,  loss  of  appetite,  and  nausea,  the  salts  of 
strontium  act  favorably.  When  nausea  of  stomachal  or  cerebral  origin 
is  to  be  treated,  the  bromide  is  especially  useful.  When  the  nutrition 
is  impaired  because  of  loss  of  appetite  and  inactivity  of  the  primary 
assimilation,  great  benefit  may  be  expected  from  the  use  of  the  phos- 
phate. Excellent  results  have  been  observed  from  the  use  of  salts  of 
strontium  (nitrate  and  bromide)  in  the  treatment  of  chronic  rheuma- 
tism. Yulpian  reported  successful  cases  thus  treated,  in  which  the 
iodide  of  potassium  and  salicylate  of  soda  had  failed.  He  reports  that 
tinder  the  action  of  the  nitrate  of  strontium  the  swelling  of  the  articu- 
lations rapidly  subsided,  that  the  local  heat  fell  to  normal,  and  the  de- 
posits of  urates  disappeared.  This  salt  acts  by  promoting  oxidation 
and  increasing  the  excretion  of  urea. 

The  usual  range  of  therapeutical  activity  exercised  by  the  iodides 
of  the  other  bases  is  equally  the  field  of  the  iodide  of  strontium.  The 
bromide  is  indicated  and  has  been  successfully  used  in  the  spasmodic 
neuroses,  as  epilepsy.  Fere  employed  it  in  cases  in  which  long  use  of 
the  potash  salt  rendered  the  patient  insusceptible  to  its  action.  He 
found  it  more  useful,  and  he  concludes  hence  that  bromide  of  stron- 
tium should  replace  bromide  of  potassium  in  the  treatment  of  that 
affection,  especially  when  the  latter  has  been  long  used. 

It  is  especially  as  a  remedy  in  Bright's  disease  that  the  salts  of 


328  AGENTS  INCREASING  WASTE. 

strontium  are  now  used.  When  the  symptoms  of  uraemia  are  due  to 
insufficient  urinary  discharge,  the  lactate  of  strontium  is  indicated. 
According  to  Constantin  Paul,  the  strontium  salts  give  the  best  results 
in  certain  forms  of  nephritis — in  parenchymatous  nephritis,  rheumatis- 
mal,  gouty,  etc. — but  is  not  useful  in  interstitial  nephritis.  In  these 
maladies  from  8  to  10  grm.  (  3  i j  —  3  ii j )  of  the  lactate  may  be  given 
daily.  Dujardin-Beaumetz  has  also  made  use  of  the  lactate  in  the 
treatment  of  albuminuria,  and  obtained,  uniformly,  a  reduction  in  the 
quantity  of  the  albumin  passed,  but  without  completely  arresting  ita 
excretion.  He  concludes  that  while  it  affects  favorably  the  most  im- 
portant symptom,  it  does  not  remove  the  pathological  condition.  It 
has,  however,  the  advantage  over  the  other  remedies  for  albuminuria, 
in  that  it  promotes  the  appetite  and  the  primary  assimilation,  and  can 
be  made  use  of  for  longer  periods. 
Authorities  referred  to  : 

CORONEDI,  GIUSTO.  Bromide  of  Strontium  in  Vomiting.  The  Practitioner,  July, 
1892,  p.  24. 

DOUGALL,  JOHN.  Strontium  Bromide  in  Vomiting.  The  British  Medical  Journal^ 
December  10,  1892. 

DUJARDIN-BEAUMETZ.     Journal  de  Pharm.     Virchow  u.  HirscKs  Jahresbericht,  1891. 

EGASSE,  ED.     Le  Sels  de  Strontiane.    Bui.  Gen.  de  Therap.,  November  30,  1891. 

GAUTIER,  A.  Le  Sels  de  Strontium  Comme  depl&teurs.  Virchow  und  HirscK's  Jahr- 
esbericht,  1891. 

LA  HORDE,  J.  V.  Etude  experimentale  de  V action  sur  f  organism  das  sels  de  Strontium. 
Ibid. 

RAUDNITZ,  R.  W.  Ueber  die  Kesorption  alkalischer  Erden  in  Verdauungstract.  Archiv 
fur  experimentelle  Pathologic  und  Pharmacologie,  Band  xxxi,  p.  343. 

Cerium. —  Cerii  Oxalas. — Cerium  oxalate.  A  white  powder,  in- 
soluble in  water,  alcohol,  and  ether.  Dose,  two  to  five  grains  in  pill 
form,  as  it  is  insoluble  in  the  ordinary  menstrua.  It  may  be  suspended 
in  mucilage. 

Sir  James  Simpson  was  the  first  to  propose  the  use  of  oxalate  of 
cerium  to  restrain  vomiting  arising  from  various  causes,  especially 
from  pregnancy ;  and  he  brought  forward  many  cases  illustrative  of 
its  value.  As  he  pointed  out,  it  sometimes  succeeds  immediately,  but 
usually  the  best  effects  are  experienced  after  several  days'  use.  The 
oxalate  of  cerium  sometimes  succeeds  remarkably  in  vomiting  due  to 
serious  organic  lesions,  as  in  cancer  (Peters).  It  has  been  narrated 
in  one  case  that  four  grains  were  administered  every  two  hours  until 
about  600  grains  were  taken.  The  good  result  which  followed  this 
large  administration  of  the  drug  indicates  that,  in  vomiting  from  simi- 
lar causes,  larger  doses  may  be  sometimes  necessary  to  secure  the  best 
curative  effects.  In  chronic  diarrhoea  cerium  may  take  the  place  of 
bismuth. 

In  cases  of  cough  associated  with  vomiting,  excellent  results  have 
been  obtained  from  the  oxalate  of  cerium.  It  is  probable  that  the 


URANIUM   AND   ITS   SALTS.  329 

cough  is  reflex  in  origin,  the  point  of  irritation  existing  in  the  termi- 
nal filaments  of  the  pneumogastric  in  the  gastric  mucous  membrane. 

Uranium  and  its  Salts. —  Uranii  Nitras. — Uranium  Nitrate.  Dose, 
gr.  j  to  gr.  v.  It  may  be  administered  in  pill  form  or  in  solution. 

ACTIONS  AND  USES. — According  to  Dr.  West,  Leconte  was  the 
first  to  observe  that  uranium  nitrate  given  to  dogs  caused  glycosuria. 
In  1888  Chittenden,  and  in  1889  Chittenden  and  Lambert,  published 
their  observations  on  the  physiological  action  and  toxic  effects  of  this 
substance.  In  1891,  Cartier  in  his  Th&se  de  Paris  gave  an  elaborate 
account  of  the  actions  of  the  salts  of  uranium.  Recently  (1895)  Dr. 
Samuel  West,  of  St.  Bartholomew's  Hospital,  London,  has  published  a 
clinical  study  of  the  nitrate.  There  is  unusual  unanimity  in  the  results 
of  these  studies.  The  various  researches  show  that  the  salts  of  ura- 
nium are  actively  toxic.  They  cause,  both  in  animals  and  in  man, 
gastro-intestinal  inflammation,  a  rapid  decline  in  flesh  and  strength, 
and  death  by  failure  of  respiration.  Their  poisonous  effects  are  due 
to  a  destructive  action  on  the  epithelial  structures  of  the  body,  on  the 
arrest  of  the  amylolytic  and  proteolytic  processes  whereby  the  ferment 
powers  of  pepsin  and  ptyalin'  are  destroyed,  on  the  combination  with 
albumin,  arresting  its  transformation,  on  the  liver  and  kidneys,  with 
the  production  of  albuminuria  and  diabetes,  and  in  the  final  production 
of  uraemia.  When  the  nitrate  of  uranium  is  injected  into  the  blood  in 
small  quantity  it  causes  rise  of  temperature,  and  increases  the  excre- 
tion of  carbonic  acid.  In  small  doses,  in  what  manner  soever  adminis- 
tered, it  acts  on  the  renal  epithelium,  and  albumin  appears  in  the  urine. 
In  larger  doses,  an  important  result  is  the  occurrence  of  diabetes.  The 
urine  is  otherwise  changed,  the  phosphates  increased,  the  chlorides 
lessened,  peptones,  acetone,  lactic  and  butyric  acids  appear  (Cartier). 
The  quantity  of  albumin  appears  to  be  considerable,  chiefly  according 
to  the  amount  given,  and  we  may  therefore  assume  according  to  the 
extent  of  the  changes  in  the  renal  epithelium.  After  the  albuminuria 
has  occurred  for  a  variable  period,  the  glycosuria  comes  on,  and  this 
also  has  close  relations  with  the  amount  taken.  The  uranium  salts  have 
not  been  detected  in  the  urine,  so  that  their  effects  must  be  exerted  on 
the  hepatic  and  pancreatic  secretions,  and  the  changes  in  the  renal 
epithelium  must  be  a  part  of  a  general  process  in  which  the  albumin, 
or  rather  the  protoplasm  of  the  body,  is  rendered  incapable  of  struc- 
tural metamorphosis. 

It  is  a  peculiarity  of  uranium  that  small  doses  seem  nearly,  if  not 
quite,  as  effectual  as  large  ones.  When  its  effects  are  produced  and  it 
is  then  discontinued,  much  larger  doses  than  those  originally  adminis- 
tered are  necessary  to  bring  about  the  same  results.  Hence,  it  is  sug- 
gested that  uranium  begets  a  certain  tolerance  by  continued  use. 

THERAPY. — The  therapeutical  uses  of  uranium  have  been  deduced 
from  its  physiological  actions.  It  is  said  that  Dr.  Hughes,  of  London, 


330  AGENTS   INCREASING   WASTE. 

a  homoeopathic  practitioner,  was  the  first  to  make  use  of  the  nitrate 
as  a  remedy  for  diabetes.  As,  however,  it  acts  by  destroying  the  amy- 
lolytic  and  proteolytic  ferments,  and  in  consequence  the  conversion  of 
glycogen  is  prevented,  the  law  of  similars  can  hardly  be  invoked  to 
explain  such  a  result.  The  first  scientific  application  of  nitrate  of 
uranium  to  the  treatment  of  diabetes  was  made  by  Dr.  West,  of  St. 
Bartholomew's  Hospital,  London.  He  reports  a  number  of  cases  in 
which  marked  improvement  took  place.  He  began  with  one  or  two 
grains  of  the  nitrate  twice  daily  after  the  principal  meals.  It  should 
be  freely  diluted  with  water.  He  increased  the  dose  slowly,  and  in 
some  cases  the  quantity  rose  to  as  much  as  fifteen  grains,  without  pro- 
ducing any  troubles  of  digestion,  nor  did  its  prolonged  administration 
bring  on  albuminuria.  It  does  not  appear  that  in  any  case  the  sugar 
disappeared  entirely  from  the  urine,  but  it  was  usually  greatly  reduced 
in  amount,  and  at  the  same  time  there  ensued  great  improvement  in 
the  general  state. 

As  uranium  causes  albuminuria  as  well  as  diabetes,  it  would  seem 
that  we  have  in  these  salts  a  remedy  for  that  state  also.  The  albumin 
is  present,  because  of  an  acute  parenchymatous  nephritis  which  it  in- 
duces. It  is  much  to  be  desired  that  further  careful  studies  be  made 
on  this  point. 

Uranium  Oxalate. 

Uranium  and  Barium,  Oxide  (Barium  Diuranate). 

Uranium  and  Strontium  Oxide  (Strontium  Diuranate). 

These  are  combinations  of  therapeutical  agents  hitherto  used  only 
in  the  arts,  notwithstanding  the  individual  components  of  them  have 
been  employed  successfully  in  the  treatment  of  disease. 

Uranium  oxalate  occurs  as  a  yellow  powder,  and  is  an  active  irri- 
tant poison.  The  initial  dose  should  not  be  greater  than  one  sixth 
of  a  grain.  As  oxalic  acid  has  been  administered  successfully  in  the 
treatment  of  amenorrhoaa,  and  as  it  causes  albumin  to  appear  in  the 
urine,  and  as  uranium  has  similar  actions,  inducing  glycosuria  as  well 
as  albuminuria,  the  combination  is  indicated  in  these  affections,  and 
probably  also  in  other  maladies  of  the  genito-urinary  apparatus. 

Uranium  and  barium  oxide  is  an  orange  powder,  and  is  an  irritant 
poison.  The  dose  of  this  should  not  be  greater  at  the  outset  than  one 
fourth  of  a  grain.  As  barium  has  a  selective  action  on  the  vascular 
system,  and  uranium  on  the  kidneys,  the  combination  is  indicated  in 
acute  renal  diseases  with  elevated  temperature. 

Uranium  and  strontium  have  similar  properties.  The  initial  dose 
may  be  one  grain,  and  this  may  be  increased  as  required. 

Authorities  referred  to  : 

CARTIER,  FRANSOIS.  Glycosuries  toxiques  et  en  particulier  intoxication  par  le  nitrate 
ifurane.  Thfcse  iv,  154  pp.,  Paris. 

WEST,  DR.  SAMUEL.     The  British  Medical  Journal,  August  24,  1895. 


METALLOTHERAPY.  331 

METALLOTHERAPY. 

Definition  and  Historical  Development, — By  the  term  metallother- 
apy  is  meant  a  curative  method  in  which  metals  are  applied  to  the 
affected  area. 

The  influence  of  the  noble  metals  over  the  bodily  functions  has  been 
believed  in  from  the  remotest  times  within  the  historical  period,  and 
this  belief  has  been  acted  on  by  many  influential  persons  down  to 
nearly  our  own  era.  The  action  of  magnetic  iron  contributed  to  this 
mystical  notion.  Then  came  the  wonder-working  Mesmer.  To  the 
action  of  magnets  'was  added  that  mysterious  force  evoked  by  the 
agencies  employed  by  the  Mesmerists.  From  such  elements  a  pre- 
tended method  of  cure  was  elaborated,  and  a  great  many  charlatans 
throve  on  the  profits  of  the  "system."  Probably  the  most  sustained 
success  in  this  department  of  popular  notions  was  effected  by  Dr.  Per- 
kins, of  Connecticut,  who  invented  a  combination  of  metals  arranged  in 
the  form  of  a  cylinder,  about  six  inches  in  length  and  two  inches  in 
circumference,  which  he  called  a  tractor.  Provided  with  a  suitable  han- 
dle, the  tractor  was  slowly  passed  over  the  affected  area,  and  the  morbid 
process  was  drawn  out  or  dispersed.  Perkins's  tractors  excited  great 
interest  in  this  country,  and  in  England  an  immense  enthusiasm.  An 
institution — known  as  the  Perkinian  Institute — was  established  in  Lon- 
don, and  many  of  the  nobility  and  gentry  resorted  to  it  to  be  cured  by  the 
application  of  the  tractors.  In  a  book  published  by  the  son,  there  may 
be  found  many  certificates  of  cures  thus  effected.  These  results  are  the 
less  surprising  when  interpreted  by  the  aid  of  subsequent  developments 
from  metallotherapy.  Mesmer,  Perkins,  Hahnemann,  appeared  nearly 
simultaneously,  and  the  theories  of  these  three  apostles  of  new  creeds 
were  developed  by  the  revolutionary  spirit  of  the  times,  rather  than 
by  original  study,  and  were  not  the  products  of  a  systematic  applica- 
tion to  the  truths  of  such  science  as  then  existed. 

Metallotherapy,  as  now  understood,  had  its  origin  in  the  experi- 
ments of  Dr.  Burq,  which  were  first  announced  in  a  note  addressed  to 
the  Academy  of  Sciences,  and  subsequently  embodied  in  his  thesis  for 
the  medical  doctorate  in  1851.  He  stated  that  a  plate  of  metal — a  sil- 
ver coin,  for  example — applied  to  the  skin,  may  remove  the  paralyses 
of  motility  or  of  sensibility  occurring  in  hysteria  ;  that  the  same  metal 
was  not  equally  successful  in  all  cases,  and  that  idiosyncrasies  exist,  so 
that  in  respect  to  each  individual  there  is  a  special  metal,  active  and 
curative.  In  one  subject  it  may  be  gold,  in  another  silver,  and  in  a  third 
copper,  which  has  the  power  to  restore  the  lost  motility  or  sensibility. 
Burq  also  maintained  that  the  same  metal  taken  internally,  whether  in 
the  form  of  a  natural  mineral  water  or  in  a  pharmaceutical  preparation, 
produced  the  same  result.  In  other  words,  when  a  piece  of  metal,  a 
coin,  selected  according  to  the  special  sensibility  of  the  subject,  is  ap- 


332  AGENTS   INCREASING   WASTE. 

plied  to  an  hysterical  patient  having  permanent  hemianaesthesia,  the 
return  of  the  normal  sensibility  is  effected  in  from  ten  to  twenty  minutes 
through  a  space  of  some  extent,  above  and  below  the  point  of  applica- 
tion. Xumbness,  tingling,  and  other  disorders  of  sensation,  dysaesthe- 
sia,  etc.,  precede  the  return  of  sensibility  to  the  anaesthetic  area.  The 
restoration  of  the  sensibility  proceeds  from  the  point  of  application  of 
the  metal,  and  enlarges  in  all  directions  until  the  whole  side  returns  to 
the  normal.  At  the  same  time,  an  elevation  of  the  temperature  recog- 
nizable by  the  thermometer,  and  an  increase  of  motor  power  as  shown 
by  the  dynamometer,  take  place.  These  changes  in  the  state  of  the  sen- 
sory nerves  are  coincident  with  dilatation  of  the  capillaries.  The  special 
senses  undergo  the  same  modifications.  Sight,  hearing,  taste,  and  smell, 
are  also  in  the  condition  of  anaesthesia,  and  as  the  general  sensibility 
is  restored,  these  special  organs  return  to  their  normal  state. 

Such,  in  brief,  were  the  facts  announced  by  M.  Burq.  A  commis- 
sion, with  M.  Charcot  at  its  head,  was  appointed  to  investigate  the 
phenomena  of  metallotherapy.  Hitherto  the  statements  in  regard  to 
the  effects  of  metals  had  been  received  with  positive  incredulity  ;  but 
the  commission  not  only  confirmed  the  accuracy  of  Burq's  observations, 
but  added  some  new  facts.  The  first  discovery  made  by  them  was  the 
phenomenon  of  "  transfer."  By  this  term  is  meant  a  transference  of 
functional  powers.  When  the  sensibility,  the  temperature,  and  the 
muscular  power  are  restored  to  the  side  which  had  been  anaesthetic,  the 
other  or  normal  side  loses  a  part  of  its  general  and  special  sensibility. 
The  commission  also  ascertained  that  when  metals  are  applied  for  the 
relief  of  hemianaesthesia  due  to  old  organic  lesions  of  the  nervous  cen- 
ters (such,  for  example,  as  cerebral  hemiplegia),  sensibility  is  restored 
also,  but  in  a  more  durable  manner.  Thus,  in  a  case  of  anaesthesia  of 
ten  years'  duration,  produced  by  a  cerebral  lesion,  this  symptom  yielded 
to  the  application  of  gold.  Other  instances  of  the  same  character,  and 
equally  significant,  were  reported  by  the  commission.  These  facts  led 
Charcot  to  entertain  the  supposition  that  the  effects  produced  by  the 
application  of  the  metals  are  really  due  to  electrical  action.  It  was 
ascertained,  indeed,  that  electrical  currents  measurable  by  the  galva- 
nometer are  caused  by  the  contact  of  the  metals,  and,  conversely,  that 
electrical  currents  of  corresponding  strength  induced  the  same  results 
as  the  metals,  including  the  phenomena  of  transfer.  The  intensity  of 
the  current  varies  with  the  metal.  In  the  case  of  a  patient  impressionable 
to  gold,  a  current  of  two  to  twelve  degrees  suffices  to  restore  the  sensi- 
bility and  the  muscular  force,  while  in  one  sensitive  to  copper,  a  current 
of  forty  to  fifty  degrees  is  required  to  effect  the  same  result  (Petit). 

As  was  above  stated,  when  the  metal  to  which  the  subject  is  found 
to  be  sensitive  when  applied  locally,  is  given  by  the  stomach,  the  same 
result  is  reached — that  is,  the  anaesthesia  is  replaced  by  normal  sensi- 
bility, the  temperature  rises  to  the  natural  level,  and  the  muscular 


METALLOTHERAPY.  333 

power  is  restored.  The  commission  discovered  the  remarkable  fact 
that  if,  after  the  normal  is  thus  resumed,  the  metal  is  again  applied,  the 
original  anaesthesia  comes  on.  To  this  return  anaesthesia  Charcot  has 
applied  the  term  metallic  anaesthesia.  A  feeble  electric  current  applied 
under  the  same  conditions  produces,  also,  a  return  anaesthesia,  which 
is  called  postelectric.  When  the  metallic  plates  applied  to  the  skin  are 
composed  of  metals  superimposed,  the  same  results  as  those  obtained 
by  a  single  metal  are  not  produced.  Thus,  if  in  a  patient  sensible  to 
gold  a  piece  of  silver  is  laid  on  the  gold,  the  effects  proper  to  the  latter 
do  not  follow.  The  results  due  to  the  application  of  gold  may  be  ren- 
dered durable  in  some  cases  by  superimposing  a  piece  of  silver.  If, 
after  the  effects  produced  by  the  application  of  a  metal  to  which  the 
patient  is  sensitive,  another  metal  is  placed  above  the  first,  the  results 
due  to  the  former  may  be  fixed  or  rendered  permanent. 

Notwithstanding  the  incredulity  with  which  these  observations  on 
the  action  of  metals  were  at  first  received,  they  have  come  to  be  gen- 
erally accepted.  Prof.  Westphal,  after  a  study  of  metallotherapy  at 
Paris,  made  some  investigations  at  Berlin,  which,  on  the  whole,  were 
confirmatory.  Charcot's  observations  were  also  sustained  by  the  ex- 
periences of  Thompson,  Horrocks,  and  Wilks.  An  important  contri- 
bution to  the  subject  was  made  by  Dr.  Hughes  Bennett,  when  he  found 
that  other  substances  besides  metals  caused  the  same  results.  In  this 
experience  we  have  an  illustration  of  the  old  and  well-known  fact  that 
discoveries  are  being  constantly  reproduced.  When  the  Perkins  ex- 
citement was  at  its  acme,  Dr.  Haygarth,  of  Bath,  announced  that 
wooden  cylinders  made  in  imitation  of  the  genuine  tractors  had  the 
same  curative  effects.  It  is  clear,  however,  as  M.  Vigouroux  has  well 
said,  that  not  all  substances  have  the  same  action.  This  fact  has  also 
been  demonstrated  by  Dr.  Hack  Tuke,  who,  having  caused  the  anaes- 
thesia to  disappear  by  the  action  of  a  metal,  substituted  a  piece  of  car- 
bon of  similar  size  and  appearance,  but  the  effect  did  not  follow. 

ACTIONS  AND  APPLICATIONS. — Charcot,  as  has  been  stated,  supposed 
that  the  effects  produced  by  the  application  of  metals  were  due  to  elec- 
trical action.  This  theory  does  not  suffice  to  explain  all  of  the  effects. 
By  Dr.  Tuke,  "  expectant  attention  "  was  invoked  to  explain  the  phe- 
nomena, but  this  theory  is  not  tenable.  Vigouroux  holds  that  the  dif- 
ference in  electrical  tension  of  some  point  of  the  organism  is  the  real 
explanation  of  the  phenomena  resulting  from  the  application  of  metals 
to  the  surface. 

According  to  Burq,  the  order  of  susceptibility  to  the  impression 
of  metals  is  as  follows,  each  individual,  as  a  rule,  being  susceptible  to 
one  metal  only  :  iron,  copper,  gold,  silver,  tin,  platinum  (only  rarely). 
These'  metals  are  applied  in  the  form  of  disks,  or  large  coins,  and  some- 
times disks  of  wood  coated  with  the  metals.  Some  other  substances, 
as  mentioned  above,  have  exhibited  the  same  phenomena,  but  the  met- 


334  AGENTS   INCREASING   WASTE. 

als  are  unquestionably  the  most  important.  The  metallic  disks  01 
coins  are  placed  as  a  bracelet  around  the  limb  to  be  acted  on,  or 
individual  disks  are  held  in  position  by  a  bandage.  The  effects  fol- 
low in  a  few  minutes.  The  skin,  previously  pallid,  cold,  and  without 
sensibility,  becomes  flushed,  warm,  and  acutely  sensitive,  and  in  a 
short  time  the  special  senses  are  restored  to  their  normal  functional 
activity.  As  has  been  described,  corresponding  losses  occur  on  the 
other  side. 

Metallotherapy  has  been  employed  chiefly  for  the  restoration  of 
sensibility  in  cases  of  the  hemiancesthesia  of  hysteria,  of  paralysis  of 
sensibility,  in  some  instances  of  hemiplegia,  and  of  certain  functional 
paralyses  of  motility.  It  is  not  possible  to  formulate  a  set  of  rules  for 
distinguishing  the  cases  which  will  be  benefited  by  these  applications. 
Sometimes  remarkable  results  are  reached  in  a  few  applications  ;  then, 
again,  unaccountable  failures  occur. 

Cases  of  writer's  cramp,  and  of  chorea,  among  the  spasmodic  af- 
fections, and  neuralgia,  have  been  suddenly  cured  by  the  use  of  the 
esthesiogenic  metal ;  but  failures  are  greatly  more  frequent  than  the 
successes.  When  the  metal  to  which  the  patient  is  sensitive  has  been 
ascertained,  the  further  treatment  may  be  conducted  by  the  internal 
use  of  the  same. 

Authorities  referred  to  : 

[The  literature  of  this  subject  is  now  so  extensive,  that  its  enumeration  would  occupy 
space  entirely  out  of  proportion  to  its  utility  here.  A  few  of  the  more  important  contri- 
butions are  given.] 

BURQ,  M.     These  de  Paris,  quoted  in  Bull.  Gen.  de  Therap.,  vol.  xcvii,  p.  33. 

PERKINS,  BENJAMIN  DOUGLAS,  M.  A.,  son  of  Dr.  Perkins  the  discoverer.  The  Effi- 
cacy of  Perkins's  Patent  Metallic  Tractors  in  Topical  Diseases,  etc.,  London,  1800. 

PETIT,  DR.  L.  H.  Sur  la  Metattotherapie.  Evil.  Gen.  de  Therap.,  vols.  xcvii,  xcviii.  A 
series  of  papers. 

TCKE,  DR.  HACK.  Metalloscopy  and  Expectant  Attention.  Journal  of  Mental  Science, 
January,  1879,  p.  598. 

VIGOUROUX,  DR.     Le  Progres  Medical,  December  7,  1878,  p.  944. 

WKSTPHAL,  PROF.  DR.      Berliner  klinische  Wochenschrift,  July  29,  1878. 

Alumen. — Alum.     Alun,  Fr.  ;  Alaun,  Ger. 

Large,  colorless,  octahedral  crystals,  sometimes  modified  by  cubes, 
and  possessing  an  acid,  sweetish,  astringent  taste.  It  dissolves  in  9 
parts  of  water  at  59°  Fahr.,  and  in  0*3  part  of  boiling  water,  but  is 
insoluble  in  alcohol.  On  exposure  to  the  air,  absorbs  ammonia  and 
acquires  a  whitish  coating. 

Alumen  Exsiccatum. — Dried  alum.  Alum  deprived  of  its  water  of 
crystallization  by  heat.  A  white,  granular  powder,  odorless,  but  hav- 
ing a  sweetish,  astringent  taste.  Slowly  but  completely  soluble  in 
twenty  parts  of  water  at  60°  Fahr. 

Aluminis  Sulphas. — Sulphate  of  aluminum.     Has  a  sour,  somewhat 


ALUM.  335 

sweetish,  and  astringent  taste,  and  an  acid  reaction.  It  is  soluble  in 
twice  its  weight  of  water. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alkalies  and  their  carbonates 
and  acetate  of  lead  are  chemically  incompatible. 

SYNERGISTS. — The  mineral  and  vegetable  astringents  promote  its 
therapeutical  activity. 

PHYSIOLOGICAL  ACTIONS. — The  sweetish  taste  of  alum  first  experi- 
enced is  quickly  followed  by  a  decided  astringency.  It  provokes  an 
abundant  flow  of  saliva,  and  the  albumen  of  the  saliva  and  buccal 
mucus  is  coagulated  in  whitish,  membrane-like  flakes.  Contraction  of 
the  capillaries,  blanching  of  the  mucous  membrane,  and  subsequent 
diminution  of  secretion,  take  place  ;  hence  the  dryness  of  the  throat, 
thirst,  and  constipation,  which  result  from  its  use.  In  doses  of  a  tea- 
spoonful,  or  more,  alum  is  an  efficient  emetic.  Under  certain  morbid 
states  it  also  proves  laxative.  Notwithstanding  its  power  to  coagulate 
albumen,  it  is  absorbed  into  the  blood,  as  was  shown  by  Orfila,  and 
may  be  found  in  the  liver  and  in  the  urine.  Circulating  in  the  blood, 
alum  affects  the  capillaries,  diminishing  their  caliber,  lessens  secretion, 
especially  of  the  mucous  membranes,  and  arrests  haemorrhage.  In  very 
large  doses  alum  produces  decided  irritant  effects — nausea,  vomiting, 
abdominal  pain,  diarrhoea,  etc. 

Dried  alum,  in  consequence  of  its  strong  affinity  for  water,  and  its 
power  to  coagulate  albumen,  is  a  mild  escharotic. 

THEKAPY. — Alum  is  one  of  the  remedies  which  may  be  used  in 
gastric  catarrh.  It  is  said  to  be  most  effective  when  there  is  vomiting 
of  glairy  mucus.  3  Aluminis,  3  ij  ;  extract,  gentian.,  3  ss.  M.  Ft. 
pil.  no.  xxx.  Sig.  :  Two  pills  three  times  a  day.  Alum  is  a  service- 
able haemostatic  in  hoematemesis.  It  is,  of  course,  adapted  only  to- 
cases  of  passive  hemorrhage,  when  there  is  a  relaxed  condition  of 
the  mucous  membrane.  Other  astringents — as,  for  example,  Monsel's 
salt — are  more  effective.  When  intestinal  haemorrhage  is  dependent 
on  mechanical  causes  (cirrhosis,  for  example),  and  the  mucous  mem- 
brane is  free  from  acute  inflammation,  alum  is  a  serviceable  astringent. 
It  was  formerly  much  used  in  chronic  diarrhoea  and  chronic  dysentery, 
but  more  effective  agents  are  now  employed  in  these  diseases.  The 
following  formulae  are  applicable  to  the  above-mentioned  diseases,  in 
the  absence  of  more  suitable  agents  :  ty  Aluminis,  3  ij  ;  pulv.  aromat., 
3  j  ;  pulv.  opii,  grs.  vj — grs.  xij.  M.  Ft.  pulv.  no.  vj.  Sig.  :  One  pow- 
der in  honey  or  sirup  three  times  a  day  or  oftener.  $  Aluminis,  3  j  ; 
extract,  opii,  grs.  x  ;  catechu,  3  j.  M.  Ft.  pil.  no.  xx.  Sig.:  Two  pills 
every  two,  three,  or  four  hours.  1$,  Aluminis,  3  ij  ;  pulv.  opii,  grs.  iij 
— grs.  vj  ;  pulv.  kino, 3 j  ;  sacch.  lactis,  3  j.  M.  Ft.  pulv.  no.  vj.  Sig.: 
One  powder  every  three  hours. 

It  is  a  singular  fact  that  the  most  effective  agent  for  the  cure  of 
colica  pictonum  is  alum.  It  relieves  the  pain  and  nausea,  and  over- 


336  AGENTS   INCREASING   WASTE. 

comes  the  constipation,  more  certainly  than  any  other  agent.  The 
chemical  theory  of  its  action  is  entirely  unequal  to  the  explanation  of 
its  remarkable  effects  ;  the  conversion  of  any  portion  of  the  lead  pres- 
ent in  the  intestinal  canal  into  the  insoluble  sulphate  would  not  suffice 
to  quiet  pain,  relieve  flatulence,  and  relax  the  obstinately  constipated 
bowels.  Its  action  is  doubtless  dynamical :  it  overcomes  the  relaxa- 
tion and  paresis  of  the  muscular  layer,  on  which  the  phenomena  of 
lead-colic  depend.  The  following  are  convenient  formulae  for  the  ad- 
ministration of  alum  in  this  disease  :  IJ  Aluminis,  3  ij  ;  acid,  sulphuric, 
dil,  3  j  ;  syrup,  limonis,  §  j  ;  aquae,  §  iij.  M.  Sig.  :  A  tablespoonful 
every  hour  or  two.  IJ  Aluminis,  3  ij  ;  vini,  3  iv  ;  catechu,  3  j  ;  traga- 
cantha;,  3  j  ;  aquas,  f  viij.  M.  Sig. :  A  tablespoonful  every  hour. 
Alum-whey,  prepared  as  follows,  may  be  used  in  lead-colic  :  To  a  pint 
of  boiling  milk,  add  ninety  grains  of  alum-powder  ;  separate  the  curd, 
and  sweeten  the  whey  if  desired  with  an  ounce  of  white  sugar.  A 
wineglassful  may  be  taken  every  hour  or  two. 

Alum  not  unfrequently  affords  relief  in  gastralgia,  enteralgia,  and 
catarrh  of  the  intestines.  It  is  a  serviceable  laxative  in  females  of  lax 
fiber,  in  whom  constipation  depends  upon  a  paretic  state  of  the  muscu- 
lar layer  of  the  bowel.  It  is  true  that  we  possess  many  other  agents 
more  agreeable  for  administration,  and  also  more  effective  ;  but  alum 
is  cheap,  and  always  to  be  obtained. 

Alum,  dissolved  in  infusion  or  solution  of  the  extract  of  logwood, 
is  a  useful  injection  in  haemorrhage  from  the  rectum,  or  as  an  applica- 
tion to  bleeding  piles,  or  as  an  astringent  wash  in  prolapsus  of  the  rec- 
tum in  children.  A  crystal  of  alum,  cut  into  a  globular  shape,  may 
be  passed  into  the  rectum  in  such  cases.  The  following  ointment  may 
be  applied  to  haemorrhoids  when  they  protrude,  bleed,  and  are  painful : 
IJ  Pulv.  aluminis,  3  ij  ;  pulv.  camphorse,  pulv.  opii,  aa  3  j  ;  unguent., 
§  j.  M.  Sig. :  Ointment. 

Notwithstanding  the  theoretical  objections  which  have  been  made 
as  to  its  utility,  the  use  of  alum  is  sanctioned  by  high  authority  in 
haemorrhages  from  distant  organs  of  the  body.  Oppolzer  recom- 
mends the  following  formula  :  IJ,  Aluminis,  amyli,  aa  3  j  ;  sacchari, 
3  ij.  M.  Ft.  pulv.  no.  vj.  Sig.  :  One  powder  every  two  hours.  Skoda 
advises  the  following  formula  in  haemoptysis :  IJ  Aluminis,  3  j  ;  sacch. 
alb.,  3  ss  ;  pulv.  ipecac,  comp.,  3j.  M.  Ft.  pulv.  no.  vj.  Sig.:  One 
powder  every  two  hours. 

Alum  was  formerly  used  in  diabetes  mellitus,  but  more  effective 
methods  of  treatment  have  taken  its  place.  Good  results  have  cer- 
tainly been  produced  by  the  use  of  alum  in  diabetes  insipidus.  Cotti- 
quative  sweats  are  moderated  by  the  internal  use  of  alum,  and  by 
sponging  the  surface  with  a  solution. 

Alum  has  been  used  with  a  certain  measure  of  success  in  whoop- 
ing-cough,  during  the  spasmodic  stage,  but  the  more  certain  and  pal- 


ALUM.  337 

atable  remedies  now  in  our  possession  have  quite  displaced  it.  As  an 
emetic  in  croup,  there  is  no  doubt  of  the  utility  of  alum.  It  is  used 
to  cause  the  dislodgment  of  the  false  membrane,  and  to  prevent  its 
re-formation.  It  acts  without  depressing  the  bodily  functions,  is 
prompt  and  thorough.  A  teaspoonful  of  the  powder,  mixed  with 
honey  or  sirup,  may  be  given,  and  repeated  every  half -hour  until  free 
tmesis  occurs. 

EXTERNAL  USES  OF  ALUM. — A  solution  of  alum  in  nitric  ether  is 
said  to  be  an  effective  application  in  toothache  (  3  ij —  3  vij).  When 
the  gums  are  spongy  and  ill-conditioned,  and  manifest  a  tendency  to 
recede  from  the  teeth,  the  following  local  application  is  very  service- 
able :  IJ  Aluminis,  3  j  ;  vini,  Oj  ;  tinct.  cinchonas,  f  ss  ;  tinct.  myrrhae, 
3  ij  ;  mel.  rosae,  3  ij.  M.  Sig.  :  As  a  mouth-wash.  When  there 
is  much  relaxation  of  the  faucial  mucous  membrane,  alum  and  sugar, 
in  equal  proportions,  may  be  applied  by  an  insufflation-tube.  Pow- 
dered alum,  dusted  over  the  affected  surface,  is  a  useful  application 
in  chronic  pharyngitis,  chronic  tonsillitis,  chronic  nasal  catarrh.  Ul- 
cers  of  the  mouth,  whether  syphilitic,  or  due  to  nursing,  or  arising 
from  gastric  disorder,  are  improved  in  character  by  application  of  a 
crystal  of  alum.  A  useful  gargle  in  various  affections  of  the  mouth 
and  throat  is  the  following :  IJ  Infus.  lini,  f  xv ;  tinct.  kino,  3"  j  ; 
aluminis,  3  ij.  M.  Sig.  :  As  a  gargle. 

In  catarrhal  ophthalmia,  after  the  acute  symptoms  have  subsided, 
an  alum-lotion  is  useful :  IJ  Aluminis,  3  j  ;  aquae  rosae,  §  iv.  M. 
Sig.  :  Lotion.  Alum-curd  is  a  domestic  application  which  is  often  ser- 
viceable :  3  ss  of  alum  to  the  white  of  an  egg. 

The  following  is  a  useful  injection  in  chronic  gonorrhoea :  IJ  Alu- 
minis, 3  j  ;  zinci  sulphatis,  3  ss  ;  sodii  biborat.,  grs.  iv  ;  aquae  rosae, 
3*  viij.  M.  Sig.  :  An  injection.  This  prescription  is  equally  applica- 
ble to  leucorrhcea. 

Alum  is  a  useful  haemostatic,  but  there  are  others  more  powerful. 
Alum  is  a  constituent  of  the  once  famous  Pagliari's  mixture  (Men- 
tel's)  :  IJ  Benzoini,  gr.  c  ;  alcohol,  fort.,  §  ss.  Dissolve  and  add 
water,  3  x  ;  alum,  3  j.  The  mixture  is  to  be  boiled  until  clear,  and, 
when  cool,  filtered.  This  is  also  a  good  preservative  solution  for 
anatomical  preparations,  and  is  an  effective  application  in  leucorrhcea, 
pruritus  of  the  vulva,  etc. 

Alum  3  ss,  the  whites  of  four  eggs,  and  tincture  of  camphor  f  ij,  is 
an  excellent  application  to  bed-sores.  Burned  alum  is  a  mild  escha- 
rotic,  which  is  sometimes  used  to  destroy  exuberant  granulations. 

Authorities  referred  to  : 

GUBLER,  DR.  A.     Commentaires  de  TTierapeutique,  etc.,  p.  433. 
NOTHNAGEL,  DR.  HERMANN.     Handbuch  der  Arzneimittellehre,  p.  311. 
TROUSSEAU  KT  PIDOUX.     Traite  de  Therap.,  etc.,  vol.  i,  p.  188. 
WALDENBURG  UND  SIMON.      Handbuch  der  Arzneiverordnungs-Lehre,  p.  154. 
24 


338  AGENTS  INCREASING   WASTE. 

Alunmol. — Under  this  name  is  known  a  naphthol-sulphonic-acid 
salt  of  aluminum.  It  is  supposed  to  contain  5  per  cent  of  aluminum 
and  15  per  cent  of  sulphur,  and  is  a  white  powder  soluble  in  water,, 
slightly  soluble  in  alcohol,  and  insoluble  in  ether.  It  may  be  applied 
as  a  powder  undiluted,  or  mixed  with  talc  or  starch,  or  in  solution  in 
water.  So  active  is  it  as  a  germicide  that  a  one-per-cent  solution  will 
inhibit  pathogenic  bacteria.  It  is  a  decided  astringent,  and  this  action 
is  not  limited  to  the  surface  on  which  it  is  applied,  but  penetrates 
to  the  tissues  beneath.  It  also  causes  contraction  of  the  vessels  when 
applied  to  the  frog's  mesentery  even  in  a  very  dilute  solution. 

Therapeutically,  alumnol  is  applied  to  the  treatment  of  wounds, 
injuries,  abscesses,  ulcers,  and  affections  of  the  skin.  For  chancroids, 
erosions,  and  abscesses,  alumnol  powder  undiluted  may  be  applied. 
In  acute  troubles  of  the  skin  and  mucous  membrane  it  should  be  di- 
luted with  starch  to  10  or  20  per  cent.  JBalanitis,  freely  discharging 
eczema,  and  burns  of  the  first  degree  are  conditions  in  which  the 
diluted  powders  are  made  use  of.  The  solution  in  water  of  1  to  5  per 
cent  is  of  suitable  strength  in  gonorrhoea.  An  ointment  prepared  with 
lanolin  or  lard  is  also  employed  in  skin  diseases.  In  most  of  the  dis- 
eases in  which  it  has  been  used  alumnol  has  had  satisfactory  results. 

Authorities  referred  to  : 

CHOTZEN,  DR.     Alumnol  ein  ncues  Mittelgegen  Hautkrankheiten  und  Gonorrhoe.    Ibid. 
GOTTHEIL,  DR.  W.  S.     The  New  York  Medical  Journal,  November  4,  1893. 
HEIXTZ  u.  LIEBRECHT.     Berliner  kliniscJie  Wochenschrift.     Quoted  by  Virchow  und 
HirscKs  Jahresbcricht  for  1892. 

Boral,  Cutol,  and  Cutolum  Solllbile  are  names  given  to  preparations 
of  aluminum  recently  prepared  by  Leuchter,  an  apothecary  of  Berlin, 
and  subsequently  submitted  to  clinical  investigation  by  Dr.  Koppel, 
whose  paper  appeared  in  the  Therapentische  Monatshefte  for  Novem- 
ber, 1895. 

Boral  is  obtained  by  the  reaction  of  boric  and  tartaric  acids  on 
aluminum  ;  cutol,  of  boric  and  tannic  acids.  Cutolum  solubile  is. 
cutol  rendered  soluble  by  the  action  of  tartaric  acid.  Boral  and  cutol 
are  powders  employed  in  that  form,  or  mixed  with  chalk  and  talc  or 
made  into  ointment. 

These  preparations  are  indicated  in  forms  of  cutaneous  disease,  as 
eczema,  catarrh  of  the  mucous  membrane,  hyperidrosis,  etc.  Accord- 
ing to  Koppel,  the  following  recipe  is  an  excellent  application  to  haem- 
orrhoids :  ft  Cutol,  5-0  =  75  gr. ;  olei  olivarum,  2'0  =  3  ss. ;  lanolini, 
40-0=  §j  and  3  ij  ;  adde  liq.  plumbi  subacetat.,  I'O  =  15  gr.  M. 
Ft.  ung.  Or  the  following  :  ft  Cutol,  3'0  =  45  gr. ;  olei  olivarum, 
2-0  =  3  ss. ;  acid,  carbol.  liq.,  gtts.  vj  ;  lanolini  ad.,  30-0  =  1  iv.  M. 
Ft.  ung. 

It  may  be  said  of  these  combinations  that  they  are  indicated  and 
will  probably  be  found  useful  in  the  same  kind  of  cases  as  alumnol. 


TANNIC  ACID   AND   VEGETABLE   ASTRINGENTS.  339 

Acidum  Tannicum. — Tannic  acid.     Tanin,  Fr.  ;   Tanninum,  Ger. 

Tannic  acid  has  a  yellowish-white  color  and  strongly  astringent 
taste.  It  is  soluble  in  about  1  part  of  water,  in  0'6  part  of  alcohol,  and 
in  1  part  of  glycerin  with  a  moderate  heat.  Its  solution  reddens  lit- 
mus, and  produces,  with  solution  of  gelatin,  a  white,  flocculent  pre- 
cipitate ;  with  the  salts  of  the  sesquioxide  of  iron  a  bluish-black  pre- 
cipitate ;  and  with  solutions  of  the  alkaloids  white  precipitates,  very 
soluble  in  acetic  acid.  Dose,  gr.  j — 3  j. 

Collodium  Stypticum. — Styptic  collodion.  (Tannic  acid,  20  grm.; 
alcohol,  5  c.  c.;  stronger  ether,  25  c.  c.;  collodion,  q.  s.  to  make  100  c.  c.) 

Trochisci  Acidi  Tannici. — Troches  of  tannic  acid.  (Each  troche 
contains  one  grain  of  tannic  acid.) 

Unguentum  Acidi  Tannici. — Ointment  of  tannic  acid.  (Tannin,  20 
grm.  ;  benzoinated  lard,  80  grm.) 

Glyceritum  Acidi  Tannici.  —  Glycerite  of  tannic  acid.  (Tannic 
acid,  20  grm.  ;  glycerin,  80  grm.) 

Acidum  Gallicum. — Gallic  acid.  Acide  gallique,  Fr. ;  Gallapfel- 
saure,  Ger. 

Gallic  acid  is  in  small,  silky,  nearly  colorless  crystals,  having  a 
slightly  acid  and  astringent  taste.  It  is  soluble  in  one  hundred  parts 
of  cold  and  in  three  of  boiling  water.  The  solution  reddens  litmus, 
and  does  not  produce  a  precipitate  with  a  solution  of  gelatin,  or  of 
sulphate  of  protoxide  of  iron.  With  solutions  of  salts  of  sesquioxide 
of  iron  it  produces  a  bluish-black  precipitate,  the  color  of  which  disap- 
pears when  the  liquid  is  heated.  It  is  decomposed  by  a  strong  heat,  and 
entirely  dissipated  when  thrown  on  red-hot  iron.  Dose,  gr.  j — gr.  x. 

Unguentum  Acidi  Gallici. — Ointment  of  gallic  acid.  (Gallic  acid, 
10  grm.  ;  benzoinated  lard,  90  grm.) 


The  following  remedies  contain  a  tannic  acid,  and  have  physiologi- 
cal and  therapeutical  actions  due  to  the  presence  of  this  substance  : 

Galla. — Xutgall.     JVoix  de  galle,  Fr.  ;   Gallapfel,  Ger. 

Tinctura  Gallce. — Tincture  of  galls.     Dose,   3  ss —  3  ij. 

Unguentum  Gallce. — Ointment  of  galls.  (Galls  in  fine  powder,  20 
grm.  ;  benzoinated  lard,  80  grm.) 

COMPOSITION. — Tannic  acid  (gallo-tannic),  60  to  70  per  cent ;  gallic 
acid,  3  per  cent ;  sugar,  resin,  etc. 

Catechu.  —  Catechu.  An  extract  prepared  principally  from  the 
wood  of  Acacia  catechu.  Cachou,  Fr.  ;  IZatechusafe,  Ger. 

Tinctura  Catechu  Composita. — Tincture  of  catechu.  (Catechu,  100 
grm.  ;  cinnamom,  50  grm.  ;  diluted  alcohol,  a  sufficient  quantity  to 
make  1,000  c.  c.)  Dose,  TTI  x —  3  j. 


340  AGENTS   INCREASING   WASTE. 

Infusum  Catechu  Compositum. — Compound  infusion  of  catechu. 
(Not  official.)  (Catechu,  3  ss  ;  cinnamon,  3  j  ;  boiling  water,  Oj.) 
Dose,  3  j —  3  ss. 

Trochisci  Catechu. — Troches  of  catechu.  Each  troche  contains 
one  grain  of  catechu. 

COMPOSITION. — Catechin,  or  catechuic  acid. 

Kino. — Kino.  The  inspissated  juice  of  Pterocarpus  marsupium, 
and  of  other  plants  (Nat.  Ord.  Leguminosece).  Kino  de  Vlnde,  Fr.  ; 
Kino  Gtimmi,  Ger0 

Tinctura  Kino. — Tincture  of  kino  (100  grm.  to  1,000  c.  c.).  Dose, 
ni  x—  3  ijo 

COMPOSITION. — Kino-tannic  acid. 

Krameria. — Rhatany.  The  root  of  Krameria  trianda  and  of  K. 
ixina  Linne  (Nat.  Ord.  Polygalae).  Ratanhia,  Fr.;  Ratanhiawur- 
zel,  Ger. 

Extractum  Krameriw. — Extract  of  rhatany.     Dose,  gr.  v — gr.  x. 

Tinctura  Kramerice. — Tincture  of  rhatany  (200  grm.  to  1,000  c.  c.). 
Dose,  TTI  v —  3  j. 

Extractum  Kramerioe  Fluidum. — Fluid  extract  of  rhatany.  Dose, 
Tf[  v —  3  ss. 

COMPOSITION.  —  Ratanhia-tannic  acid;  odorous  principle;  wax, 
gum,  etc. 

Hsematoxylon. — Logwood.  The  heart-wood  of  Hcematoxylon  cam- 
pechianam  Linne  (Nat.  Ord.  Leguminoseae).  Bois  de  Campeche,  Fr.  ; 
Campecheholz,  Ger. 

Decoctum  Hcematoxyli. — Decoction  of  logwood.  (Not  official.) 
(Logwood,  |  j  ;  water,  Oij,  boiled  down  to  Oj.)  Dose,  §  ss —  1  j. 

Extractum  Hcematoxyli. — Extract  of  logwood.     Dose,  gr.  v  —  3j. 

COMPOSITION. — Hsematoxylin,  tannic  acid,  etc. 

Geranium. — Cranesbill.  The  rhizona  of  Geranium  maculatum 
Linne  (Nat.  Ord.  GeraniacecB). 

Extractum  Geranii  Fluidum. — Fluid  extract  of  geranium.     Dose, 

m  v—  3  j. 

COMPOSITION. — Tannic  and  gallic  acids,  resin,  gum,  starch,  chloro- 
phyll, etc. 

Quercus  Alba.  —  White-oak  bark.  The  bark  of  Quercus  alba 
Linne  (Nat.  Ord.  Cupuliferce). 

Quercus  Tinctoria. — Black-oak  bark.  (Not  official.)  Hcorce  de 
ch$ne,  Fr.  ;  Eichenrinde,  Ger. 

Decoctum  Quercus  Albce. — Decoction  of  white  oak.    (Not  official.) 

(  §  J— °j-)     D086*  I  6S~  1  J- 

COMPOSITION. — Quercitrin  or  quercitric  acid,  tannic  acid,  etc. 


TANNIC   ACID   AND   VEGETABLE   ASTRINGENTS.  341 

Rosa  Gallica. — Red  rose.  The  petals  of  Rosa  gallica  Linne  (Nat. 
Ord.  Rosaceoe).  Roses  rouges,  Fr.  ;  JEssigrosen,  Ger. 

Confectio  Rosce. — Confection  of  rose. 

Extractum  Rosce  Fluidum. — Fluid  extract  of  rose.    Dose,  TTJ,  v —  3  ij. 

Mel  Rosce. — Honey  of  rose. 

COMPOSITION. — Tannic  and  gallic  acids,  quercitrin,  coloring  matter, 
volatile  oil,  etc. 

Rubus. — Blackberry-root.  Bark  of  the  root  of  Rubus  Canadensis 
and  Rubus  viUosus. 

Extractum  Rubi  Fluidum. — Fluid  extract  of  rubus.     Dose,  Tf\,  x 

— 3ij. 

COMPOSITION. — Tannic  acid,  etc. 

Myrica  Cerifera. — Bayberry,  wax-myrtle.  (Not  official.)  Bark  of 
the  stem  and  root. 

Decoction  is  made  by  boiling  an  ounce  in  a  pint  of  water — dose, 
3  ss —  §  j.  An  alcoholic  extract  (myricine  of  the  eclectics) — dose, 
grs.  v  ;  and  a  fluid  extract — dose,  3  ss —  3  ij — are  to  be  obtained  in  the 
shops. 

COMPOSITION. — Tannic  and  gallic  acids,  myricinic  acid,  resin,  red 
coloring  matter,  etc. 

The  most  important  property  is  the  astringency  due  to  the  large 
quantity  of  tannic  and  gallic  acids.  In  large  doses  it  is  emetic. 

Statice  Limonium. — Marsh  rosemary.  (Not  official.)  The  root.  A 
docoction  (  §  j — Oj)  may  be  used — dose,  |  ss —  §  j.  A  fluid  extract  is 
prepared — dose,  m  xx —  3  j. 

COMPOSITION. — Tannic  acid  (twelve  per  cent),  gum,  extract,  etc. 

AlnuS  Serrulata. — Common  alder.  (Not  official.)  The  bark  in  de- 
coction (  §  j — Oj) — dose,  |  ss  —  §  j.  Fluid  extract — dose,  m  x  —  3  j. 
Alcoholic  extract  (alnuin  of  the  eclectics) — dose,  gr.  j— grs.  v. 

COMPOSITION. — Tannic  acid,  oil,  resin,  etc. 

Heuchera. — Alum-root.     Root  of  Heuchera  Americana.    (Not  offi- 
cial.)    Decoction — dose,  f  ss —  3  j  ;  fluid  extract — dose,  TTJ,  x —  3  j. 
COMPOSITION. — Tannic  acid,  etc. 

Hamamelis.  —  The  leaves  of  Hamamelis  mrginiana  (Nat.  Ord. 
Uamamelacece).  Witch-hazel. 

Extractum  Hamamelidis  Fluidum. — Fluid  extract  of  hamameli*. 
Dose,  nt  x —  3  ij. 

COMPOSITION. — Tannic  acid,  volatile  oil,  etc. 

The  extraordinary  claims  put  forth  of  late  years  as  to  the  powers 
of  hamamelis  are  hardly  tenable.  It  has  no  physiological  effect,  ex- 
cept that  which  belongs  to  an  agent  rich  in  tannin. 


342  AGENTS   INCREASING   WASTE. 

Nymphaea  Odorata. — Sweet-scented  water-lily.  Root.  Decoction 
(§j — Oj) — dose,  §  ss — §  j.  Fluid  extract — dose,  3  88 — 3  j.  (Not 
official.) 

COMPOSITION. — Tannic  acid,  gallic  acid,  etc. 

Castanea. — Leaves  of  Castanea  vesca  Linne  (Xat.  Ord.  Cupuliferce), 
collected  in  September  or  October,  while  still  green.     (TJ.  S.  P.) 
COMPOSITION. — Tannic  acid,  etc. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  mineral  acids,  the  salts 
of  antimony,  lead,  and  silver,  and  the  persalts  of  iron,  and  alkalies, 
are  chemically  incompatible.  The  vegetable  alkaloids  and  gelatin 
form  insoluble  precipitates. 

SYNERGISTS. — Tonics  and  bitters,  as  a  rule,  favor  the  action  of 
tannic  and  gallic  acids,  and  of  the  substances  containing  them.  The 
agents  comprehended  in  this  group — or  remedies  whose  chief  result  is 
to  increase  waste — are  synergistic. 

PHYSIOLOGICAL  ACTIONS. — Tannin  has  a  bitter  astringent  taste,  and 
constringes  the  mucous  membrane.  In  the  stomach  it  enters  into  com- 
bination with  albumen,  and  with  the  pepsin  of  the  gastric  juice,  which 
it  precipitates  from  its  solution.  Tannin,  therefore,  impairs  digestive 
power  by  rendering  the  pepsin  inoperative.  It  diminishes  secretion  of 
the  mucous  membrane  by  virtue  of  its  power  to  contract  the  caliber  of 
the  vessels,  and  it  restrains  peristalsis  by  its  action  on  the  muscular 
layer  ;  hence  the  constipating  effects  which  follow  its  use.  If  long 
continued  in  considerable  quantity,  tannin  disorders  digestion,  sets  up 
irritation  of  the  mucous  membrane,  and  gives  rise  to  a  febrile  state 
and  to  wasting  of  the  tissues. 

Having  such  affinity  for  and  coagulating  action  on  albumen,  it  is 
obvious  that  tannin  must  diffuse  into  the  blood  with  difficulty.  A 
part  undergoes  conversion  into  gallic  and  pyrogallic  acids  in  the 
stomach,  and  in  this  form  is  absorbed.  Injected  into  the  veins,  tannic 
acid  coagulates  albumen,  and  the  results  which  follow  are  due  to  mul- 
tiple embolisms.  Elimination  of  tannin  takes  place  by  the  intesti- 
nal canal  and  by  the  kidneys,  in  the  form  of  gallic  and  pyrogallic 
acids. 

THERAPY. —  Catarrh  of  the  stomach,  a  relaxed  state  of  the  mucous 
membrane,  acidity,  and  flatulence,  are  conditions  in  which  tannic  acid 
is  useful.  It  may  be  given  in  pill-form  with  sufficient  glycerin  to 
make  a  mass  of  proper  consistence — one  drop  to  four  grains.  Hoema- 
temesis  dependent  on  ulcer  of  the  stomach,  or  obstructive  disease  of 
the  liver,  and  not  inflammatory  in  origin,  is  an  indication  for  tannin. 
It  should  be  given  in  solution  and  in  a  large  dose — grs.  x — ^j.  Tan- 
nic acid  is  an  efficacious  remedy  in  diarrhoea,  after  acute  symptoms 
have  subsided,  in  chronic  diarrhoea,  colliquative  diarrhoea,  the  diarrhoea 


TANNIC  ACID  AND  VEGETABLE  ASTRINGENTS.  343 

of  phthisis,  etc.  Notwithstanding  the  chemical  incompatibility,  com- 
bination with  opium  or  morphine  increases  the  efficacy  of  the  tannin. 
As  tannic  acid,  in  large  part,  at  least,  escapes  conversion  into  gallic,  and 
passes  unchanged  into  the  intestine,  its  action  is  doubtless  chiefly  local. 
Oppolzer  advises  the  following  formula  in  profuse  diarrhoea :  I£  Acidi 
tannici,  3  ij  ;  pulv.  opii,  grs.  vj  ;  sacchari,  q.  s.  M.  Ft.  pulv.  no. 
vj.  Sig.  :  One  every  two  hours.  In  cholera  diarrhoea,  A.  von  Graefe 
prescribed  a  solution  of  tannic  acid  in  cinnamon-water  and  mucilage 
every  half -hour.  For  the  diarrhoea  and  intestinal  haemorrhage  of  ty- 
phoid fever,  tannin  is  one  of  the  most  serviceable  remedies.  Accord- 
ing to  Stille,  whose  faith  appears  rather  extravagant,  there  is  no  more 
effective  remedy  for  chronic  diarrhoea  and  chronic  dysentery  than  tan- 
nic acid  conjoined  with  a  milk-diet. 

Various  members  of  this  group  are  used  in  the  above-mentioned 
diseases.  Kino  has  been  a  favorite  remedy  in  pyrosis,  and  is  also 
given  in  diarrhceal  diseases.  Catechu,  in  the  form  of  the  tincture 
chiefly,  is  frequently  added  to  prescriptions  for  diarrhoea,  notably  to 
chalk-mixture  in  the  diarrhoea  of  children.  Kino  is  a  favorite  remedy 
for  the  diarrhoea  of  phthisis,  but  it  is  not  more  efficacious,  and  is  more 
disagreeable  in  administration,  than  tannic  acid.  Several  of  the  in- 
digenous remedies  mentioned  above  possess  undoubted  value  in  the 
treatment  of  diarrhoeal  diseases.  A  decoction  of  rubus  or  geranium, 
obtained  by  boiling  the  root  in  milk  (  f  j — Oj),  is  an  excellent  remedy 
in  cholera  infantum  and  the  summer  diarrhoea  of  children.  When  a 
nursing  child  passes  rather  frequent,  greenish,  and  watery  stools,  and 
suffers  with  pain  and  colic  at  each  motion,  great  relief  will  be  afforded 
by  the  use  of  syrupus  rubi,  or  better  by  the  unofficial  compound  sirup 
of  rubus.  In  the  chronic  diarrhoea  of  adults,  and  in  acute  diarrhoea 
after  the  subsidence  of  inflammatory  symptoms,  the  fluid  extracts  of 
hamamelis,  of  heuchera,  and  of  statice,  may  be  used  with  advantage. 
In  hcematemesis  and  intestinal  haemorrhage  the  hamamelis  is  very  ef- 
fective, owing,  doubtless,  to  the  very  large  percentage  of  tannin  which 
it  contains. 

The  comparative  merits  of  tannic  and  gallic  acids  may  be  formu- 
larized  as  follows  :  for  local  effects  tannic  acid,  for  systemic  effects 
gallic  acid  is  to  be  preferred.  It  is  true  that  tannic  acid  affects  re- 
mote parts,  but  in  order  to  diffuse  into  the  blood  it  must  first  be  con- 
verted into  gallic,  and  hence  the  systemic  actions  are  really  due  to  the 
latter.  It  follows  that  gallic  acid  should  be  prescribed  when  the  as- 
tringent effects  on  the  tissues  elsewhere  than  the  intestinal  canal  are 
to  be  produced.  Gallic  acid  is  an  effective  remedy  for  pulmonary  and 
renal  haemorrhage.  For  the  former  we  possess  other  agents  more  ef- 
ficient, but  for  the  latter  it  is  more  uniformly  successful  than  any  other 
remedy.  The  success  of  rhatany,  which  was  formerly  much  used  in 
hcematuria,  was  doubtless  due  to  its  tannic  and  gallic  acids.  In  the 


344  AGEXTS   INCREASING   WASTE. 

htemorrhagic  diathesis,  gallic  acid  is  one  of  the  remedies  which  may 
be  used  with  advantage.  Although  it  can  not  be  combined  with  chalyb- 
eates,  it  may  be  given  alternately  with  them.  Whenever  haemorrhage 
occurs  in  relaxed  and  debilitated  constitutions — is  passive  in  character 
— gallic  acid  may  be  combined  with  ergotine  and  digitalis  :  $  Acid, 
gallici,  3  i ;  ergotine  (aq.  ex.),  digitalis,  aa  3j.  M.  Ft.  pil.  no.  xx. 
Sig.  :  One  every  four  hours. 

As  gallic  acid  has  the  power  to  restrain  secretion  of  mucous  sur- 
faces, it  may  be  prescribed,  experience  has  shown  with  good  effect,  in 
chronic  bronchial  catarrh.  When  bronchiectasis  exists,  the  good  effects 
of  the  remedy  are  by  no  means  conspicuous,  but  it  is  very  serviceable 
when  the  bronchial  catarrh  is  the  result  of  the  irritation  extending 
from  disease  of  the  parenchyma  of  the  lungs,  or  is  produced  by  mitral 
or  tricuspid  regurgitation,  or  is  the  sequel  of  acute  catarrh.  In  pyelitis 
and  pyelo-nephritis,  gallic  acid  and  the  remedies  containing  it  diminish 
the  purulent  discharge,  and  retard  changes  in  the  mucous  membrane. 
It  is  also  a  serviceable  remedy  in  catarrh  of  the  bladder.  In  these 
states,  to  insure  as  far  as  possible  its  rapid  and  complete  diffusion  into 
the  blood,  it  should  be  given  frequently  and  well  diluted.  As  it  is- 
soluble  in  eight  parts  of  rectified  spirit,  and  as  this  solution  mixes  in 
all  proportions  with  water  without  precipitation,  a  spirituous  solution 
should  be  prescribed  :  IJ  Acidi  gallici,  3  j  ;  spirit,  vini  rectif.,  §  j.  M, 
Sig. :  A  teaspoonful  in  sufficient  water  every  four  hours. 

Gallic  acid  has  the  power  to  restrain  the  waste  of  albumen  in  cases 
of  albuminuria.  It  is  adapted  to  the  acute  forms — desquamative  ne- 
phritis, the  albuminuria  following  scarlatina,  etc.,  and  does  not  seem, 
according  to  the  author's  observation,  to  check  in  the  least  the  loss  of 
albumen  in  the  chronic  forms  of  albuminuria.  Dr.  Aitken  recommends 
the  following  formula  :  I£  Acidi  gallici,  3  j —  3  ij  ;  acid,  sulphuric,  dil., 
3  ss  ;  tinct.  lupuli,  3  j ;  infus.  lupuli,  §  vj.  M.  Sig. :  A  tablespoonful 
three  times  a  day. 

The  following  mixture  is  very  effective  in  menorrhagia,  hcematu- 
ria,  purpura  hcemorrhagica,  and  the  hcemorrhagic  diathesis .°  I£  Acidi 
gallici,  3  ss ;  acid,  sulphur,  dil.,  3  j  ;  tinct.  opii  deod.,  3  j ;  inf.  rosae 
comp.,  §  iv.  M.  Sig. :  A  tablespoonful  every  four  hours  or  oftener. 

Hillier  advises  the  following  prescription  for  chronic  diarrhoea  in  a 
child  of  two  years  :  §,  Acidi  gallici,  gr.  xij  ;  tiuct.  cinnamomi  comp.r 
3  jss  ;  tincturae  opii,  TTJ,  viij  ;  aquae  carui  ad  §  ij.  M.  Sig. :  Two  tea- 
spoonfuls  a  dose. 

For  the  sweating  of  phthisis  the  following  formula  is  useful :  $ 
Acid,  gallici,  3  ss  ;  ext.  belladonnae,  gr.  ij.  M.  Ft.  pil.  no.  x,  Sig.  i 
Two  pills  at  bed-hour. 

In  addition  to  the  foregoing  internal  applications  of  the  vegetable 
astringents,  it  may  be  mentioned  that  a  decoction  of  chestnut-leaves 
(castanea)  has  been  used  with  much  success  in  whooping-cough.  As 


TANNIC   ACID   AND   VEGETABLE   ASTRINGENTS.  345 

both  tannic  and  gallic  acids  have  been  employed  with  more  or  less 
service  in  this  disorder,  it  is  probable  that  the  good  effects  of  castanea 
are  really  due  to  the  presence  in  it  of  these  acids.  The  decoction  of 
castanea  may  be  drunk  ad  libitum,  or  the  fluid  extract  may  be  admin- 
istered in  drachm-doses. 

EXTERNAL  USES  OF  TANNIC  ACID  AND  SUBSTANCES  CONTAINING  IT., 
— Dr.  B.  W.  Richardson  has  proposed  a  tannin  solution,  to  which  he 
has  applied  the  term  styptic  colloid.  It  consists  of  a  saturated  solution 
of  tannin  in  alcohol  (one  part  to  eight)  mixed  with  collodion.  This  is 
an  elegant  application  to  restrain  oozing  of  blood  from  a  large  surface, 
to  unite  incised  wounds,  to  protect  lacerated  wounds,  to  remove  fetor 
from  decomposing  animal  matter,  to  change  the  character  of  foul 
ulcers,  etc.  The  following  formula  was  proposed  by  Monsel  as  a 
haemostatic  :  $  Acidi  tannici,  3  j  ;  aluminis,  3  ij  ;  aquae  rosae,  f  iij. 
M.  Sig. :  For  external  use  as  a  haemostatic.  The  glycerite  of  tannin 
is  a  neat  formula  for  external  application. 

Tannic  acid  is  much  employed  as  an  application  to  the  mouth  and 
throat  in  various  diseases  of  these  parts.  In  mercurial  salivation  an 
excellent  application  is  a  solution  of  tannin,  with  honey  of  roses  :  $ 
Acidi  tannici,  3  j  ;  mel  rosae,  3  ij  ;  aquae,  §  vj.  M.  Sig. :  As  a  gargle. 
Elongated  uvula,  relaxed  palate,  and  follicular  pharyngitis,  are  effec- 
tively treated  by  insufflation  of  tannin,  i.  e.,  some  finely-powdered  tan- 
nin blown  over  the  affected  surface  with  a  hand-ball  insufflator.  Epis- 
taxis  may  often  be  promptly  arrested  by  passing  through  the  nares  a 
strong  solution  of  tannin  (  3  ij —  3  iv)  by  means  of  a  post-nasal  syringe 
or  nasal  douche,  or  powdered  tannin  may  be  blown  on  the  bleeding 
surface  by  an  insufflator.  The  following  is  an  excellent  gargle  for  the 
more  chronic  throat-affections  :  r>  Acidi  tannici,  3  ij  ;  spts.  vini  rect., 
3j;  mist,  camphor,  ad  3  x.  M.  Sig.:  An  astringent  gargle.  In 
chronic  affections  of  the  larynx  mucous  membrane,  and  of  the  vocal 
cords,  no  inhalation  is  more  frequently  serviceable  than  a  solution  of 
tannin  (grs.  x — 3j — f  iv)  applied  by  means  of  the  hand-ball  or 
steam  atomizer.  This  treatment  is  useful  in  chronic  catarrh  of  the 
fauces,  of  the  larynx,  trachea,  and  bronchi,  in  ulcerations  of  the 
pharynx,  larynx,  and  trachea,  in  bronchiectasis,  in  pulmonary  haemor- 
rhage, gangrene  of  the  lung,  cedema  of  the  glottis,  croup,  and  diph- 
theria. 

The  following  is  Druitt's  prescription  for  toothache  :  IJ  Acidi  tan- 
nici, 3  j  ;  mastich,  grs.  x  ;  etheris,  §  ss.  M.  Sig.  :  To  be  applied  on 
cotton  to  a  carious  tooth. 

Tannin  solutions  of  various  strengths  (gr.  j — grs.  x —  3  j)  are  used 
in  inflammation  of  the  conjunctiva.  Hairion  advises  a  strong  solution 
(  3  j —  3  iij)  in  acute  and  chronic  conjunctivitis,  granulations,  corneitis, 
chemosis,  and  pannus.  Very  remarkable  results  have  been  obtained 
by  Dr0  Hamilton,  of  Liverpool,  in  certain  diseases  of  the  eye  by  the 


* 

346  AGENTS   INCREASING   WASTE. 

application  of  powdered  tannin  to  the  conjunctiva.  This  method  con- 
sists in  dusting  over  the  everted  lid  finely-powdered  tannic  acid,  using 
for  this  purpose  a  small  rubber-bag  insufflator.  He  employs  this  method 
with  signal  success  in  "granular  ophthalmia, pannus, phlyctenular  or 
pustular  ophthalmia,  chronic  granulations,  herpes  cornece,  fascicular 
corneitis,  and  some  ulcers  of  the  cornea"  This  application  produces 
very  little  pain  at  the  moment,  and  is  not  followed  by  any  inflamma- 
tory reaction. 

Tannic  acid  has  limited  uses  in  diseases  of  the  skin.  It  is  an  excel- 
lent application,  especially  in  the  form  of  the  glycerite,  in  eczema,  im- 
petigo, and  intertrigo.  The  powder  dusted  on  the  affected  surface  is 
serviceable  in  cases  of  ulceration  of  the  skin,  and  promotes  the  healing 
process  in  cases  of  old  ulcers.  One  of  the  best  applications  to  irritable 
and  fissured  nipples  is  glycerite  of  tannin. 

Chronic  otorrhoea  and  the  vulvitis  of  children  are  successfully 
treated  by  application  of  the  glycerite  of  tannin.  The  same  remedy 
is  one  of  the  best  injections  in  gonorrhcea.  Solutions  of  tannic  acid  of 
various  degrees  are  used  in  gonorrhoaa.  Ricord  recommends,  in  obsti- 
nate cases,  after  the  subsidence  of  acute  symptoms,  3  ss  of  tannic  acid 
in  |  viij  of  claret  wine.  This  constitutes  a  serviceable  injection  in  leu- 
corrhcea.  Sigmund  advises  the  following  in  gonorrhoea  :  IJ  Acidi  tan- 
nici,  grs.  ij — grs.  x  ;  tinct.  iodinii,  fli  v  ;  aquae,  §  j.  M.  Sig.  :  As 
an  injection.  An  infusion  or  decoction  of  galls,  of  oak-bark,  of  witch- 
hazel  (hamamelis),  of  geranium,  of  alum-root,  or  other  remedies  of  the 
list  at  the  head  of  this  article,  may  be  advantageously  used  in  cervicitis, 
vaginitis,  purulent  discharges  from  the  vagina.  In  these  affections 
the  glycerite  of  tannin,  and,  much  better,  the  powdered  tannin,  may 
be  freely  applied  to  the  vaginal  canal.  The  author  knows  of  no  more 
effective  application  in  these  maladies  than  tannin  and  iodof onn,  or  iodo- 
tannin,  applied  in  the  dry  way,  well  packed  around  the  cervix  uteri. 

A  serviceable  ointment  for  haemorrhoids  is  the  following  prescrip- 
tion of  Oesterlen  :  $  Pulv.  gallae,  3  j  ;  pulv.  opii,  grs.  x  ;  ung.  plumbi 
subacetat.,  3ij  ;  ung.  simplicis,  3  j.  M.  Sig.  :  Ointment  for  haemor- 
rhoids. For  prolapsus  ani  in  children  the  glycerite  of  tannin,  pow- 
dered tannin,  or  a  decoction  of  the  vegetable  astringents  considered  in 
this  article,  may  be  used,  the  mucous  membrane  being  first  carefully 
cleansed  and  then  brushed  over  with  the  medicament.  Ulcers  of  the 
rectum  and  anus,  fissures  of  the  anus,  are  very  effectively  treated  by 
the  direct  application  of  the  powder  of  tannin,  tannin  and  iodoform, 
or  iodo-tannin.  The  ulcer  must  be  exposed,  if  necessary,  by  the  use 
of  the  speculum,  and  then  the  powder  be  thoroughly  applied  to  the 
affected  surface.  Trousseau  strongly  recommends  a  mixture  of  the 
decoction  and  the  tincture  of  rhatany  as  an  injection  for  the  cure  of 
fissure  of  the  anus,  but  the  applications  above  advised  are  neater  and 
more  effective. 


PYROGALLOL.  347 

Pyrogallol. — Pyrogallic  acid,     A  triatomic  phenol. 

PROPERTIES. — Gallic  acid,  subjected  to  a  high  temperature,  loses 
its  water  of  crystallization  and  becomes  pyrogalllc  acid.  This  is  a 
white,  shining  powder,  crystalline  in  structure,  without  odor,  and  hav- 
ing a  persistent  bitter  taste.  It  is  soluble  in  two  and  a  half  parts  of 
water,  and  to  some  extent  in  alcohol  and  ether.  For  exhibition  by  the 
stomach,  the  pill-form  is  best,  the  excipient  being  some  unoxidizable 
substance,  and  the  coating  complete.  The  dose  for  internal  adminis- 
tration will  range  from  one  sixth  of  a  grain  to  two  grains.  For  topi- 
cal application,  solutions  are  preferred,  and  they  vary  in  strength  from 
one  to  ten  per  cent.  Solutions  can  not  be  kept  long,  because  of  chemi- 
cal changes  ;  exposed  to  light,  the  color  becomes  brownish,  and  the 
power  declines  with  the  loss  of  oxygen. 

Pyrogallic  acid  is  an  active  poison,  and  this  property  is  exhib- 
ited as  well  when  administered  by  the  stomach  as  when  applied  to 
an  abraded  surface  on  the  skin.  Caution  in  its  use  becomes  neces- 
sary, therefore,  for  several  instances  of  fatal  poisoning,  and  numer- 
ous cases  in  which  the  toxic  action  was  stopped  by  treatment,  have 
been  reported.. 

Pyrogallic  acid  is  an  irritant  poison,  and  all  the  characteristic  ac- 
tions of  that  group  of  remedies  follow  its  administration  in  sufficient 
quantity — nausea,  vomiting,  purging,  accompanied  by  intense  gastro- 
enteric  inflammation  (Besnier).  The  changes  wrought  in  the  blood 
are  significant  in  a  high  degree.  It  impairs  or  destroys  the  respiratory 
function  of  the  blood  by  the  damage  it  inflicts  on  the  red  corpuscles, 
which  are  disorganized,  the  haemoglobin  separated.  Changes  in  the 
intima  of  the  blood-vessels,  fatty  and  fibroid  degeneration  of  organs, 
especially  of  the  liver  and  kidneys,  are  constant  results  of  its  toxic 
activity  (Neisser)  ;  and  of  these  lesions,  we  find  the  clearest  evidence 
in  the  changes  which  take  place  in  the  urine,  which  becomes  brown, 
almost  black,  and  by  the  presence  in  it  of  haemoglobin,  or  the  products 
of  its  decomposition.  Decline  in  temperature,  profound  anemia, 
haemorrhages,  especially  haematuria,  are  also  most  clearly  significant 
of  the  toxic  action.  It  need  hardly  be  observed  that  such  dire  results 
are  toxic,  and  the  quantity  of  the  agent  necessary  to  produce  them  is 
much  beyond  ordinary  medicinal  doses. 

The  elimination  of  pyrogallic  acid  takes  place  by  the  ordinary 
channels,  but  especially  by  the  kidneys  and  liver.  It  is  probable  that 
the  structural  changes  in  the  eliminating  organs  are  due  to  the  imme- 
diate contact  of  the  acid  as  it  passes  out  of  the  system. 

THERAPY. — The  use  to  which  pyrogallic  acid  was  first  applied,  was 
suggested  by  its  therapeutical  relationship  to  chrysarobin.  As  is  now 
well  known,  chrysarobin,  under  the  designation  "  Goa-powder,"  has 
proved  to  be  an  efficient  remedy  for  psoriasis  and  parasitic  affections 
of  the  skin.  If  pyrogallic  acid  is  not  so  certain,  which  may  well  be 


348  AGENTS  INCREASING   WASTE. 

doubted,  it  has  great  advantages.  Both  color  and  irritate  or  inflame 
the  skin,  but  pyrogallic  acid  is  far  less  injurious  in  its  local  action 
(Jarisch). 

Having  very  powerful  germicide  action,  pyrogallic  acid  is  an  effi- 
cient remedy  in  pity ria sis  versicolor,  herpes  tonsurans,  favus,  etc.,  and 
it  has  also  exhibited  some  curative  action  in  more  serious  affections,  as 
lupus  and  epithelioma. 

The  strength  of  the  solutions  used  has  ranged  from  one  hundredth 
to  one  tenth  per  cent.  The  ointment  made  in  these  proportions  with 
vaseline  or  lard — more  frequently  vaseline — is  held  to  be  less  effective 
than  solutions  of  the  same,  which  are  also  more  readily  applied  (Arra- 
gon,  Kaposi). 

If  the  solutions  or  unguents  are  too  strong,  or  frictions  too  forci- 
bly made,  violent  inflammation  may  be  set  up,  and  permanent  injury 
done  to  the  skin.  More  or  less  brownish  discoloration  of  the  skin  is 
an  effect  of  the  application,  but  it  is  not  permanent.  The  aqueous  or 
alcoholic  solution  of  pyrogallic  acid  can  be  applied  to  the  affected  sur- 
face by  means  of  absorbent  cotton,  the  strength  of  the  solution  and 
the  duration  of  the  application  being  regulated  by  the  effect  it  has  on 
the  diseased  surface.  As,  however,  toxic  effects  follow  if  the  applica- 
tion is  made  over  too  extensive  surface,  a  part  of  the  diseased  area 
only  should  be  treated  at  one  time. 

M.  Vidal  has  made  the  important  announcement  that  the  ointment 
of  pyrogallic  acid  is  an  excellent  application  to  chancroid,  especially  if 
it  tends  to  slough.  A  few  applications  change  the  character  of  the 
sore,  and  soon  effect  cicatrization. 

In  the  treatment  of  ulcers,  sloughing  phagedena,  epithelioma, 
and  similar  conditions,  pyrogallic  acid  may  be  mixed  with  a  pow- 
der— kaolin  or  starch,  for  example — and  then  well  dusted  over  the  dis- 
eased part. 

Authorities  referred  to  : 

BESNIER,  DR.  E.     Bui.  Gen.  de  Therap.  for  1884. 

HAMILTON,  ROBERT,  F.  R.  C.  S.  On  the  Employment  of  Tannic  Acid  in  some  Disease* 
of  the  Eye  and  Eyelids.  The  Practitioner,  vol.  ii,  p.  347. 

HANBURY  AND  FLUCKIGER.     Pharmacographia,  pp.  170,  213,  536,  el  seq. 

HCSEMANN,  DRS.  AUGUST  UND  THEODOR.  Die  Pflanzenstoffe,p.  996,  and  pp.  1002, 1006, 
1008,  el  seq. 

JARISCH,  DR.  A.     Centralblatt  fur  die  gesammte  Therapie,  vol.  i,  p.  17,  et  seq. 

KAPOSI,  PROF.  DR.     Ibid. 

NEISSEB,  DR.     Annuaire  de  Therap.,  1883. 

PORCHER,  DR.  FRANCIS  PEYRE.  Resources  of  the  Southern  fields  and  Forests  :  Various 
articles  on  the  indigenous  remedies  mentioned  at  the  head  of  this  article. 

RINGER,  DR.  SIDNEY.  On  the  Glycerine  of  Tannin.  The  Practitioner,  vol.  i,  p.  27. 
Ibid.,  Handbook  of  Therapeutics. 

WALDENBURG,  PROF.  DR.  L.  Die  locale  Behandlung  der  Krankheiten  der  Athmung* 
organe,  Berlin,  1872,  p.  237,  et  seq. 

WALDENBURG  UND  SIMON.     Handbuch  der  Arzneiverordnungslehrt. 


TANNIGEN— THIOL.  349 

Tannigen. — As  the  name  implies,  this  is  a  derivative  of  tannin, 
and  has  for  its  formula  (C14H8[CHSCO].,O9).  It  was  originally  pro- 
duced by  Meyer,  of  Marburg,  and  the  first  investigation  of  its  proper- 
ties was  made  by  Fr.  Milller,  of  Bonn  ;  afterward  was  employed  in 
the  medical  clinic  by  Kunkler,  and  by  Drews,  of  Hamburg. 

Tannigen  is  an  odorless,  tasteless,  grayish-yellow  powder,  soluble 
to  a  slight  extent  in  water,  but  dissolves  freely  in  alcohol  and  in  solu- 
tions of  the  alkaline  salts.  The  dose  for  internal  administration  ranges 
from  1  to  10  or  even  15  grains.  It  is  preferably  given  in  powder. 
Locally,  the  powder  can  be  applied  undiluted.  It  is  not  poisonous. 
Apparently  it  does  not  alter  in  any  way  the  condition  of  the  stomach, 
except  as  an  astringent.  In  the  presence  of  alkaline  salts  it  preserves 
its  astringent  property,  and  hence  its  powers  are  not  impaired  by  the 
intestinal  juices.  It  undergoes  saponification  in  its  passage  through 
the  intestinal  canal,  but  some  part  of  that  administered  escapes  un- 
changed in  the  faeces.  Of  that  absorbed  by  oxidation,  it  is  converted 
into  gallic  acid  and  in  this  form  appears  in  the  urine. 

Tannigen  has  thus  far  been  chiefly  used  as  a  remedy  for  the  diar- 
rhoea of  children.  It  has  been  found  especially  useful  in  the  ileocolUis 
of  early  life.  In  chronic  cases  it  has  seemed  far  less  efficient.  It  pos- 
sesses great  advantage  as  a  remedy  for  children,  in  that  the  powder  is 
odorless  and  tasteless. 

By  Mtiller,  tannigen  has  been  used  successfully  in  the  treatment  of 
gastric  catarrh,  pyrosis,  and  other  affections  in  which  tannin  has  been 
heretofore  used.  Local  application  of  the  powder  has  been  made  in 
catarrhal  affections  of  the  nasal  and  faucial  mucous  membrane.  It 
will  probably  prove  a  useful  substitute  for  tannin. 

Ichthyol. — The  source  of  ichthyol  is  a  bituminous  mineral  rich  in  the 
remains  of  fossilized  fish  and  other  marine  animals.  From  this  mineral 
it  is  derived  by  distillation,  and  is  subsequently  treated  with  sulphuric 
acid,  yielding  a  sulphonate.  Neutralized  by  ammonium  and  sodium, 
corresponding  ammonium  and  sodium  ichthyol  salts  are  obtained. 

Ichthyol  is  rich  in  sulphur — containing  about  10  per  cent — and  this 
is  chemically  combined  with  the  other  ingredients,  and  partly  with 
oxygen  and  partly  with  carbon.  It  is  an  oily  substance,  with  a  bitu- 
minous odor  and  taste,  a  reddish-brown  color,  and  is  freely  soluble  in 
water  and  in  a  mixture  of  equal  parts  of  alcohol  and  ether,  and  also 
mixes  well  with  lonolin,  vaselin,  and  fats  and  oils  generally.  It  is  the 
ammonium  salt  of  ichthyol  that  answers  to  the  foregoing  description. 
Thiol  is  for  the  most  part  preferred  to  ichthyol.  They  are  iso- 
meric,  but  thiol  is  purer  in  form,  less  irritating,  and  has  no  toxic 
properties.  The  facts  stated  of  ichthyol  are  equally  true  of  thiol, 
with  the  important  exception  that  thiol  is  much  more  pleasant  for 
administration,  and  may  be  given  more  freely  without  risk. 


350  AGENTS  INCREASING   WASTE. 

ACTIOXS  A:NT>  USES. — Notwithstanding  its  odor  and  taste,  ichthyol 
is  well  borne  by  the  stomach,  and  promotes  appetite  and  digestion. 
It  increases  assimilation  and  hinders  retrograde  metamorphosis,  where- 
by the  nutrition  is  improved  and  the  body-weight  brought  up  to  the 
normal  level.  According  to  Dr.  Cranstoun  Charles,  massive  doses  of 
ichthyol  caused  in  animals  only  diarrhcea.  The  same  results  were  ar- 
rived at  by  Prof.  Baumann  and  Dr.  Schotten.  Dr.  Helmers,  in  Zuntz's 
laboratory,  found  that  in  experiments  on  himself  it  was  without  any 
injurious  effect,  but  promoted  the  metabolism  in  which  sulphur  is  con- 
cerned, and  the  amount  of  this  substance  which  had  accumulated  re- 
quired seven  days  in  which  to  become  eliminated.  It  has  a  decided 
antiseptic  action,  and  is  fatal  to  pathogenic  organisms.  It  increases 
the  volume  and  force  of  the  circulation  after  stimulating  the  primary 
assimilation. 

As  a  compound  rich  in  sulphur,  it  is  adapted  to  the  treatment  of 
those  morbid  states  in  which  this  substance  has  proved  efficacious. 
According  to  Unna,  of  Hamburg,  it  is  serviceable  in  cases  of  acne, 
furuncle,  lepra,  sycosis,  and  other  cutaneous  diseases.  Similarly,  it  is 
effective  in  erysipelas,  erythema,  eczema,  and  analogous  affections. 
Unna  finds  that  it  diminishes  heat,  reduces  swelling,  and  relieves  pain. 
In  the  treatment  of  skin  diseases  he  employs  the  remedy  internally  as 
well  as  topically.  The  dose  for  internal  administration  in  such  cases 
ranges  from  5  to  10  grains  two  or  three  times  a  day.  It  is  usually  dis- 
solved in  water  for  this  purpose.  Of  equal  parts  of  ichthyol  and 
water,  5  to  20  drops  three  times  a  day  are  usually  given.  For  appli- 
cation to  eruptions,  the  proportion  of  ichthyol  ranges  from  1  to  10 
parts.  It  is  mixed  with  water,  glycerin,  vaselin,  and  lanolin,  in  vary- 
ing proportions,  according  to  the  effects  desired,  or  it  is  combined 
with  zinc-ointment,  soft  soap,  and  other  unguents.  The  following  are 
among  the  more  useful  combinations  :  IJ  Ichthyol,  lanolin,  vaselin, 
equal  parts.  M.  $  Ichthyol,  4  parts ;  sulphur,  precipitated,  4 
parts  ;  wheat  starch,  20  parts  ;  zinc  oxide,  20  parts  ;  vaselin,  40  parts. 
M.  A  paste  for  the  face.  In  the  treatment  of  gastro-intestinal  ca- 
tarrh it  may  be  given  as  follows  :  1$,  Ichthyol,  30  to  60  parts  ;  oil  of 
peppermint,  1  part ;  absolute  alcohol,  10  parts  ;  distilled  water,  1,000 
parts. 

Good  results  are  claimed  for  ichthyol  in  the  treatment  of  phthisis, 
chronic  rheumatism,  chronic  alcoholism,  and  chronic  wasting  diseases. 
Cohn  maintains  its  superiority  over  guaiacol  as  a  remedy  for  phthisis. 
The  explanation  of  its  utility  in  wasting  diseases  is  afforded  by  the 
remarkable  influence  over  the  retrograde  metamorphosis  of  certain 
constituents  of  the  body,  and  in  its  effects  in  retarding  the  disintegra- 
tion of  the  albumins  and  in  favoring  their  accumulation  and  forma- 
tion. As  Zuelzer  and  others  have  shown,  it  has  a  remarkable  power 
to  check  waste,  the  urinary  solids  and  the  nitrogenous  excreta  being 


COLCHICUM.  351 

greatly  diminished.  Hence  it  is  under  its  administration  the  body 
weight  increases,  the  income  is  promoted  and  the  outgo  lessened,  and 
these  important  results  are  accomplished  without  in  any  way  impair- 
ing digestion  or  irritating  the  gastro-intestinal  mucous  membrane. 
In  rheumatic  affections,  applications  to  the  affected  joints  are  com- 
bined with  the  internal  administration  of  the  same.  Remarkable 
results  are  claimed  for  this  agent  in  the  treatment  of  gonorrhoea. 
A  warm  solution  of  one  half  to  one  per  cent  of  ichthyol  has  been 
used  quite  successfully ;  with  this  the  canal  may  be  thoroughly  irri- 
gated. 

ColcMcum.—  Meadow  saffron.      Colchique,  Fr. ;  Zeitlose,  Ger. 

Colchici  Radix. — Colchicum-root.  The  corm  of  Colchicum  au- 
tumnale  Linne  (Nat.  Ord.  Liliacece). 

Colchici  Semen. — Colchicum-seed.  The  seed  of  Colchicum  au- 
tumnale. 

PKEPAEATIONS. — 1.  Of  the  root. 

Extractum  Colchici  Radicis  Fluidum. — Fluid  extract  of  colchi- 
cum-root.  Dose,  t[\,  ij — in,  v. 

Vinum  Colchici  Radicis. — Wine  of  colchicum-root.  (Four  hun- 
dred grm.  of  colchicum-root  ;  alcohol,  150  c.  c.;  white  wine  to  make 
1,000  c.  c.  Dose,  m,  v — Til  xxx.) 

Extractum  Colchici  Radicis. — Acetous  extract  of  colchicum-root. 
Dose,  gr.  ss — gr.  ij. 

2.  Of  the  seed. 

Extractum  Colchici  Seminis  Fluidum. — Fluid  extract  of  colchi- 
cum-seed.  Dose,  TII  ij — tn,  x. 

Tinctura  Colchici  Seminis. — Tincture  of  colchicum-seeds.  (Col- 
chicum-seeds,  150  grm.,  to  1,000  c.  c.  of  diluted  alcohol.)  Dose,  ui  x 

-3j. 

Vinum  Colchici  Seminis. — Wine  of  colchicum-seed.  (One  hundred 
and  fifty  grm.  of  the  seed  ;  alcohol,  150  c.  c.;  a  sufficient  quantity  of 
white  wine  to  make  1,000  c.  c.)  Dose,  T\[  x —  3  j. 

COMPOSITION. — Tannic  and  gallic  acids,  starch,  sugar,  gum,  a  pe- 
culiar alkaloid,  colchicina  or  colchicine.  Colchicine  is  easily  con- 
verted (by  acids,  in  long-kept  alcoholic  preparations)  into  an  iso- 
meric,  cystallizable  body,  colchice'in.  The  amount  of  the  alkaloid 
contained  in  the  root  and  the  seed  is  said  to  be  not  greater  than  the 
half  of  one  per  cent.  Colchicine  is  not  crystallizable,  but  combines 
with  acids  to  form  crystallizable  salts.  The  conversion,  in  any  of 
the  pharmaceutical  preparations,  of  colchicine  into  colchice'in,  does 
not  appear  to  impair  the  therapeutical  activity.  That  colchicine  is 
the  active  principle,  is  proved  by  the  fact  that  the  physiological 
effects  of  this  alkaloid  are  the  same  as  those  of  the  crude  drug 
(Husemann). 


352  AGENTS  INCREASING  WASTE. 

ANTAGONISTS  AND  INCOMPATIBLES. — Tannic  acid,  by  forming  an 
insoluble  tannate  with  the  alkaloid,  retards  but  does  not  prevent  its 
absorption.  When  a  lethal  quantity  has  been  taken,  emetics  and  pur- 
gatives are  required,  and  demulcents  may  be  freely  administered. 
Opium  and  the  alcoholic  substances  antagonize  the  depression  of  the 
heart's  action. 

SYNEBGISTS. — Such  alkaloids  as  produce  gastro-intestinal  irritation 
and  depress  the  action  of  the  heart,  e.  g.,  veratrine,  aconitine,  etc.,  are 
synergistic.  Therapeutically  considered,  emetics,  purgatives,  alkalies, 
promote  the  activity  of  colchicum. 

PHYSIOLOGICAL  ACTIONS. — Colchicum  imparts  its  virtues  to  water, 
alcohol,  and  ether.  It  has  a  bitter  taste,  and  excites  the  flow  of  saliva. 
In  small  doses  it  increases  the  mucous  and  glandular  secretion  of  the 
stomach  and  intestines,  and  probably  also  of  the  liver,  kidneys,  and 
skin.  If  the  dose  be  large  but  still  medicinal,  colchicum  produces  a 
feeling  of  epigastric  heat,  nausea,  and  vomiting,  depression  of  the  cir- 
culation, muscular  feebleness,  headache.  It  frequently  purges,  pro- 
ducing copious  watery  stools,  and  is  generally  held  to  increase  the 
discharge  of  biliary  matters.  It  increases  the  flow  of  urine,  of  the 
solid  constituents  (urea,  uric  acid,  etc.),  as  well  as  of  the  water,  and 
promotes  the  cutaneous  transpiration.  In  toxic  doses  colchicum  pro- 
duces all  of  the  local  as  well  as  the  systemic  effects  of  an  irritant 
poison,  viz.  :  acute  abdominal  pain,  profuse  watery  and  choleriform 
discharges,  suppression  of  urine,  feeble  pulse,  cold  sweat,  coldness  of 
the  extremities.  The  intellect  remains  unaffected  until  carbonic-acid 
poisoning  supervenes.  The  muscular  cramps  which  have  been  occa- 
sionally observed  are  probably  due  to  the  great  loss  of  fluid  from 
the  system.  When  colchicine  is  injected  subcutaneously,  gastro-intes- 
tinal inflammation  is  produced,  showing  that  it  has  a  selective  action 
on  this  tissue. 

This  view  of  the  action  of  colchicum  has  been  fully  confii'med  by 
Dr.  Roy.  The  strongly  accentuated  impression  on  the  mucosa  of  the 
intestine  is  due,  he  affirms,  to  its  elimination  by  this  membrane  and 
the  profuse  watery  discharge  as  a  transudation. 

THERAPY. — Colchicum  is  indicated  when  rapid  wasting  of  tissue 
and  prompt  elimination  of  the  products  of  waste  are  required.  Its  use 
at  the  present  time  is  almost  entirely  restricted  to  the  treatment  of 
gout  in  its  various  manifestations.  It  relieves  the  pain,  diminishes  the 
swelling,  and  shortens  the  duration  of  an  attack  of  acute  gout.  In 
order  to  accomplish  these  results,  it  is  not  necessary  that  the  more 
harsh  and  violent  physiological  effects  of  the  drug  be  produced.  Suf- 
ficient quantity  of  colchicum  should  be  given  to  icsrease  secretion  from 
the  skin,  the  intestinal  mucous  membrane,  and  the  kidneys,  but  nausea 
and  vomiting  should  be  avoided.  Combination  with  an  alkali  increases 
the  therapeutical  effect  of  colchicum :  $  Spts.  ammoniae  aromat.,  3  xiij; 


COLCHICUM.  353 

vini  seminis  colchici,  3  iij.  M.  Sig. :  A  teaspoonful  every  three  hours, 
until  some  physiological  effect  is  produced.  The  following  is  a  formula 
used  at  the  London  Hospital  for  gout :  I£  Tinct.  colchici  seminis,  TTI  xx  ; 
potassii  bicarbonat.,  grs.  x  ;  aquae  pimentae,  f  j.  M.  Sig.  :  A  draught. 
The  following  modification  of  Scudamore's  prescription  is  in  use  at 
University  College  Hospital :  I£  Tinct.  colchici  seminis,  TTI  xv ;  mag- 
nesii  carb.,  gr.  vj  ;  magnesii  sulph.,  grs.  xxx  ;  aquae  menth.  pip.  ad 
3  j.  M.  Sig.  :  A  draught.  After  the  more  acute  symptoms  of  the 
gouty  attack  have  subsided,  the  following  was  recommended  by  Sir 
Henry  Half  ord  :  $  Ext.  colchici  acet.,  gr.  vj  ;  pulv.  opii  et  ipecac,  comp., 
ext.  colocynth.  comp.,  aa  gr.  xij.  M.  Ft.  pil.  no.  xij.  Sig.  :  One  pill 
night  and  morning.  The  efficiency  of  colchicum  is  increased  by  com- 
bination with  digitalis  :  IJ  Ext.  colchici  acet.,  gr.  x  ;  pulv.  digitalis, 
ext.  colocynth.  comp.,  aa  3  j.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill 
twice  or  thrice  a  day. 

The  active  principle,  colchicine,  is,  there  is  reason  to  believe,  more 
successful  in  gout  than  any  of  the  preparations  of  the  crude  drug.  IJ 
Colchicinae,  gr.  j  ;  ext.  colocynth.  comp.,  3  ss  ;  quininae  sulph.,  3  iij. 
M.  Ft.  pil.  no.  Ix.  Sig.  :  One  every  four  hours. 

In  the  so-called  rheumatic  gout,  colchicum  with  alkalies  is  extreme- 
ly serviceable.  Attacks,  without  decided  pain  and  inflammation,  of 
soreness  of  joints,  which  have  been  the  seat  of  gouty  attacks,  or  about 
which  nodosities  have  been  deposited,  are  relieved  by  colchicum. 

Constipation,  hepatic  congestion,  and  headache,  due  to  torpor  of 
the  portal  circulation,  occurring  in  gouty  subjects,  are  quickly  relieved 
by  a  combination  of  colchicum  and  saline  purgatives.  The  plethoric 
and  overfed  without  being  gouty,  suffering  from  the  same  group  of 
symptoms,  are  relieved  by  the  same  means.  Inflammations  of  internal 
organs  occurring  in  gouty  subjects,  for  example,  gouty  bronchitis  and 
rheumatic  pneumonia,  are  best  treated  with  prescriptions  containing 
a  preparation  of  colchicum.  The  following  prescription  is  recom- 
mended by  Greenhow  in  gouty  bronchitis  :  5,  Potassii  iodidi,  ammonii 
carbonat.,  aa  3j  ;  vin.  colchici  seminis,  3  j  ;  tinct.  scillae,  tinct.  hyos- 
cyami,  aa  3  i j  ;  aquae  c amphorae  q.  s.  ad  §  iij.  M.  Sig.  :  A  table- 
spoonful  three  times  a  day. 

Although  colchicum  is  still  advocated  by  some  authorities  in  acute 
rheumatism,  the  general  professional  experience  is  against  its  use.  In 
chronic  rheumatism,  when  the  joint  changes  are  allied  in  nature  to 
those  which  take  place  in  gout,  it  is  unquestionably  serviceable.  Neu- 
ralgia occurring  in  gouty  and  rheumatic  constitutions  is  often  relieved 
by  colchicum.  The  indications  for  its  use  are  plethora,  constipation, 
and  deficient  excretion  of  the  liver,  kidneys,  and  skin.  Colchicum  re- 
lieves in  such  cases,  by  setting  up  an  eliminative  process.  In  hepatic 
dropsy  and  cardiac  dropsy,  when  the  patient  is  vigorous,  the  gastro- 
intestinal tract  free  from  inflammatory  mischief,  colchicum  may  be 
25 


354  AGENTS  INCREASING  WASTE. 

used  with  advantage  as  a  hydragogue  :  IJ  Elaterii,  gr.  j  ;  spts.  etheris 
nitrosi,  §  ij  ;  tinct.  scillae,  tinct.  colchici,  aa  §  ss  ;  syrup,  simplicis,  §  j. 
M.  Sig.  :  A  teaspoonful  three  or  four  times  a  day.  The  following 
combination  is  an  excellent  diuretic  in  dropsy  :  IjJ,  Vini  seminis  col- 
chici, §  ss  ;  sol.  ammonii  acetat.,  §  ijss  ;  inf.  petroselin,  §  v.  M.  Sig.  : 
A  tablespoonful  every  four  hours.  This  prescription  is  well  adapted 
to  dropsy  following  scarlatina. 

Colchicum  is  a  serviceable  remedy  in  certain  cerebral  disorders. 
Thus,  it  may  be  used  in  acute  cerebral  congestion  in  plethoric  subjects, 
in  uroemic  intoxication,  in  hypochondriasis,  especially  when  due  to 
deficient  elimination  (uric  acid,  oxalate  of  lime,  etc.). 

The  wine  of  colchicum-seed  has  frequently  succeeded  in  curing 
gonorrhoea,  and  by  Brodie  a  nightly  dose  of  thirty  minims  was  given 
for  the  relief  of  chordee.  In  the  treatment  of  gonorrhoea,  the  follow- 
ing may  be  used  :  1^  Vini  colchici  seminis,  §  ss  ;  sol.  potassii  citratis, 
§  vjss  ;  tinct.  opii  deod.,  3  ij.  M.  Sig.  :  A  tablespoonful  three  or 
four  times  a  day  in  gonorrhcea. 

Authorities  referred  to  : 

BRODIE,  SIR  BENJAMIN.  Works  by  Mr.  Hawkins,  Diseases  of  Urinary  Organs, 
vol.  ii. 

CASPAR,  JOHANN  LUDWIG.  Practisches  Handbuch  der  gerichtlichen  Medicin.  Neo 
bearbeitet  und  vennehrt  von  Dr.  Carl  Liman,  Berlin,  1871,  p.  570. 

FULLER,  DR.  WILLIAM  HENRY.     On  Rheumatism,  Rheumatic  Gout,  etc.,  1874. 

GREENHOW,  DR.  E.  HEADLAM.     Chronic  Bronchitis,  etc. 

GCBLER,  DR.  ADOLPHE.  Commentaires  du  Codex  Medicamentarius,  etc.,  article  CoU 
chique. 

HANBURY  AND  FLUCKIGER.     Pharmacographia,  p.  636. 

HAMMOND,  DR.  W.  A.  The  Amerian  Journal  of  the  Medical  Sciences,  January,  1859, 
p,  278. 

HUSEMANN,  DRS.  THEO.  AND  AUG.     Die  Pflanzenstoffe,  p.  493,  article  Colchicin. 

ROY,  DR.  CH.  Archives  de  Physiologie,  normale  et  pathologiqve.  New  series,  vol.  v, 
p.  656. 

Sarsaparilla. — Sarsaparilla.  Root  of  Smilax  officinalis  and  other 
species  of  smilax  (Nat.  Ord.  Liliacece).  Separeille,  Fr.;  Sarsaparill- 
wurzel,  Ger. 

Decoctum  Sarsaparillce  Compositum. — Compound  decoction  of  sar- 
saparilla.  (Sarsaparilla,  sassafras-root,  guaiacum-wood,  licorice-root, 
mezereum.)  Dose,  §  j  —  §  iv. 

Extractum  Sarsaparillce  Fluidum. — Fluid  extract  of  Sarsaparilla. 
Dose,  3  j  —  1  ss. 

Syrupus  Sarsaparittce  Compositus. — Sirup  of  Sarsaparilla.  (Sarsa- 
parilla, guaiacum-wood,  rose,  senna,  licorice-root,  essential  oils.)  Dose, 
3  j  —  f  ss. 

Extractum  Sarsaparillce  Compositum  Fluidum. — Compound  fluid 
extract  of  sarsaparilla.  (Sarsaparilla,  licorice-root,  sassafras,  meze- 
reum.) Dose,  3  ss  —  3  ij. 


SARSAPARILLA.  355 

COMPOSITION. — An  alkaloid,  parilline,  or  smilacine,  an  essential  oil, 
etarch,  resin,  oxalate  of  lime,  and  extractive  matters.  From  parilline, 
by  the  action  of  dilute  sulphuric  acid,  is  obtained  parigenine,  a  distinct 
alkaloid. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alkalies  favor  the  decomposi- 
tion of  the  decoction  and  fluid  extracts.  As  there  is  much  starch  pres- 
ent in  the  drug,  free  iodine  should  not  be  prescribed  with  the  official 
preparations. 

SYNEKGISTS. — Iodine,  mercury,  and  other  so-called  alteratives,  in- 
crease the  therapeutical  activity  of  sarsaparilla.  Warm  clothing  in- 
creases the  action  on  the  skin  ;  diluents  favor  increased  urinary  dis- 
charge. 

PHYSIOLOGICAL  ACTIONS. — Much  discrepancy  obtains  in  the  opin- 
ions which  have  been  emitted  in  respect  to  the  physiological  actions 
of  sarsaparilla.  Surgeons  generally  hold  to  its  therapeutical  powers  ; 
physicians  are  skeptical.  The  physiological  experiments  which  have 
been  made,  both  with  the  preparations  of  the  crude  drug  and  with  the 
alkaloid,  have  yielded  negative  results.  Palotta's  experiments,  made 
with  the  alkaloid  which  he  had  discovered  so  long  ago  as  1825,  indicate 
that  eight  grains  of  the  alkaloid  produce  gastric  disturbance,  vomiting, 
slowing  of  the  pulse,  depression,  faintness,  and  sweating.  These  re- 
sults have  since  been  in  part  confirmed  by  Cullerier.  Boecker,  how- 
ever, making  more  systematic  examination  in  accordance  with  modern 
methods,  finds  that  sarsaparilla  is  devoid  of  physiological  activity  and 
of  therapeutical  power  (Husemann). 

THERAPY. — From  the  point  of  view  of  the  physiological  experi- 
ments it  is  not  difficult  to  understand  the  modern  incredulity  in  regard 
to  the  curative  power  of  sarsaparilla.  The  difficulty  of  distinguishing 
between  the  post  hoc  and  the  propter  hoc  serves  to  account  for  the 
belief  still  held  in  some  quarters,  that  this  drug  is  an  alterative.  Pop- 
ularly, sarsaparilla  is  supposed  to  have  extraordinary  powers  as  a 
"  blood-purifier,"  and  its  large  use  at  the  present  time  arises  from  this 
belief. 

Almost  the  only  use  of  sarsaparilla  at  the  present  time  is  in  the 
treatment  of  syphilis.  It  is,  of  course,  not  adapted  to  the  primary  or 
to  the  secondary  forms.  The  experience  in  its  favor,  even  of  those 
most  confident  of  its  powers,  restricts  its  use  to  the  tertiary  form  in 
debilitated  subjects,  who  have  been  broken  down  by  the  combined  in- 
fluence of  syphilis,  mercurialism,  and  iodism.  It  has  been  further  dem- 
onstrated that  the  best  effects  have  been  obtained  by  the  use  of  large 
doses  of  the  compound  decoction  (Allbutt).  As  the  compound  decoc- 
tion contains  guaiac  and  mezereon,  it  is  difficult  to  assign  the  exact 
share  of  the  sarsaparilla  in  the  result.  Furthermore,  as  a  pint  or  more 
of  the  compound  decoction  must  be  taken  in  the  twenty-four  hours, 
these  large  draughts  of  a  warm  liquid  are  not  without  influence  on  the 


356  AGENTS   INCREASING  WASTE. 

functions  of  the  skin  and  kidneys.  It  is  extremely  questionable 
whether  sarsaparilla  has  any  therapeutic  power  ;  it  is  not  at  all  equal 
us  an  alterative  to  some  of  the  remedies  indigenous  in  the  United 
States,  to  be  considered  hereafter. 

The  compound  fluid  extract,  the  compound  decoction,  and  the 
compound  sirup  of  sarsaparilla,  are  frequently  used  as  vehicles  for 
iodide  of  potassium  and  for  the  bichloride  of  mercury  in  secondary 
and  tertiary  syphilis. 

Scrofula,  chronic  abscesses,  necrosis  of  bones,  old  ulcers,  and  stru- 
mous  cutaneous  affections,  are  diseases  in  which  sarsaparilla  is  sup- 
posed to  be  efficacious.  It  is  more  used  as  an  adjunct  to  more  active 
remedies  than  depended  on  alone. 

Authorities  referred  to : 

ALLBUTT,  DR.  CLIFFORD.     The  Practitioner,  1870,  vol.  i. 

GCBLER,  DR.  ADOLPHE.     Commentaires  Therap.  du  Codex  Medicamentariiis,  p.  304. 

HANBURY  AND  FLUCKIGKR.     Pharmacographia,  p.  636,  et  seq. 

HUSEMANN,  DRS.  AUG.  UND  THEODOR.     Die  Pflanzenstoff'e,  p.  1040. 

Guaiacum. — Guaiac.     Gayac,  Fr. ;  Franzosenholz,  Ger. 

Guaiaci  Lignum. — Guaiacum- wood.  The  heart- wood  of  Guaiacum 
officinale  Linne,  and  of  G.  sanctum  Linne  (Nat.  Ord.  Zygophyllece). 

Guiaci  Resina. — Guaiac.  A  peculiar  resin  obtained  from  Guaia- 
cum officinale. 

Tinctura  Guaiaci.  Tincture  of  guaiac.  (Guaiac,  200  grm. ;  alco- 
hol, to  1,000  c.  c.)  Dose,  3  ss  —  3  ij. 

Tinctura  Guaici  Ammoniata. — Ammoniated  tincture  of  guaiac. 
(Guaiac,  200  grm.;  aromat.  spirit  of  ammonia,  to  1,000  c.  c.)  Dose, 
3  ss  —  3  ij. 

COMPOSITION. — The  only  constituent  of  interest  in  the  wood  is  the 
resin.  Guaiac  has  a  complex  chemical  composition.  It  contains  gua- 
iaconic  acid  (seventy  per  cent),  guaiarec  acid,  guaiac  beta-resin,  guaia- 
cic  acid,  guaiac  yellow,  gum,  etc. 

ANTAGONISTS  AND  INCOMPATIBLES. — Spirits  of  nitrous  ether  and  the 
mineral  acids  are  incompatible. 

SYNEBGISTS. — Agents  which  promote  cutaneous  activity  are  syner- 
gistic.  The  action  of  guaiac  is  much  aided  by  external  warmth  and 
warm  diluent  drinks. 

PHYSIOLOGICAL  EFFECTS. — Guaiac  has  a  very  acid  and  pungent 
taste.  It  excites  an  abundant  flow  of  saliva.  In  the  stomach  it  cre- 
ates a  sensation  of  warmth  and  burning,  increases  the  secretions  of  the 
gastro-intestinal  canal,  accelerates  the  action  of  the  heart,  promotes 
diaphoresis,  and  favors  the  production  and  excretion  of  bronchial  mu- 
cus. In  large  doses  it  deranges  digestion  and  causes  gastric  catarrh, 
and  in  excessive  doses  the  series  of  symptoms  produced  by  the  irritant 
poisons,  vomiting,  purging,  cramps,  headache,  giddiness,  etc. 


STILLINGIA.  357 

THERAPY. — Formerly  guaiac  was  in  great  repute  as  a  remedy  for 
constitutional  syphilis.  The  decoction  was  drunk  in  large  quantity,  a 
very  spare  diet  was  enjoined,  and  the  diaphoretic  action  of  the  rem- 
edy was  aided  by  external  warmth.  Doubtless  many  cases  were  bene- 
fited by  this  mode  of  treatment,  but  the  result  was  probably  less  due 
to  guaiac  per  se  than  to  the  regimen. 

Its  present  use  as  an  anti-syphilitic  remedy  is  confined  to  the  prep- 
arations of  sarsaparilla,  in  which  it  enters  as  a  constituent. 

Recent  clinical  experience  has  shown  that  guaiac  is  a  capital  rem- 
edy in  tonsillitis.  Given  in  a  half -drachm  dose  (tincture)  every  four 
hours,  it  appears  to  abate  the  inflammation  and  to  cut  short  the  dis- 
ease in  a  remarkable  manner.  It  is  a  very  acrid  and  disagreeable  rem- 
edy, and  should  be  given  in  emulsion,  with  mucilage  or  yolk  of  egg. 

Guaiac  is  a  useful  remedy  in  dysmenorrhcea,  when  the  pain  is  due 
to  rheumatism  or  neuralgia,  and  is  of  course  not  adapted  to  those 
cases  in  which  there  is  narrowing  of  the  cervical  canal. 

Lastly,  guaiac  is  used  with  varying  degrees  of  success  in  chronic 
gout,  chronic  rheumatism,  lumbago,  sciatica,  gouty  bronchitis,  etc.  As 
we  have  so  many  more  efficient  and  pleasant  remedies  for  these  dis- 
eases, it  will  rarely  be  necessary  to  resort  to  guaiac. 

Authorities  referred  to  : 

CARTER,  MR.     The  Practitioner,  vol.  iv,  p.  190. 

FLUCKIGER  AND  HANBURY.     Pharmacographia,  p.  92,  et  seq. 

HUSKMANN,  DBS.  AUG.  UND  THEO.    Die  Pflanzenstoffe,  p.  712. 

STILLE,  DR.  A.     Therapeutics  and  Materia  Medica,  fourth  edition,  vol.  ii,  p.  594. 

Stillingla. — Root  of  StiUingia  sylvatica  Linne  (Nat.  Ord.  Euplior- 
biacece). 

JExtractum  Stillingice  Fluidum. — Fluid  extract  of  stillingia.  Dose, 
TTIX  — 3j. 

(A  tincture  may  be  made  of  two  ounces  of  the  bruised  root  to  a 
pint  of  diluted  alcohol,  of  which  the  dose  is  3  ss —  3  ij.  A  decoction 
may  be  made  as  follows  :  one  ounce  of  the  bruised  root  to  two  pints 
of  water,  boiled  down  to  one  pint,  of  which  the  dose  is  f  ss —  f  ij.  All 
the  preparations  should  be  made  of  the  fresh  root,  as  the  activity  of 
the  drug  is  diminished  by  drying.) 

COMPOSITION. — The  plant  yields  on  incision  a  milky  juice,  which 
appears  to  possess  the  medicinal  properties  of  the  drug.  The  so-called 
stillingin  of  the  eclectics  is  not  the  active  principle,  but  an  extract. 
The  active  principle  has  not  yet  been  isolated. 

PHYSIOLOGICAL  EFFECTS. — The  juice  of  the  plant  has  an  acrid,  pun- 
gent taste,  leaving  a  persistent  after-taste  of  great  activity.  It  excites 
an  abundant  flow  of  saliva.  In  the  stomach  a  feeling  of  warmth  fol- 
lows its  use,  and  the  secretions  of  the  organ  are  increased  in  amount. 
In  full  doses  it  excites  nausea  and  vomiting,  epigastric  pain,  and  an 


358  AGENTS   INCREASING   WASTE. 

acrid,  burning  sensation  in  the  fauces.  It  increases  the  secretions  of 
the  intestinal  canal,  notably  of  the  liver,  and,  in  full  doses,  purges,  the 
fseces  having  the  appearance  of  the  so-called  "bilious  stools."  In- 
creased action  of  the  heart  follows  the  introduction  of  the  active  prin- 
ciple into  the  circulation,  and  the  skin  becomes  warm  and  moist.  The 
bronchial  mucous  membrane  exhales  a  larger  quantity  of  mucus,  and 
the  kidneys  become  more  active,  excreting  an  increased  quantity  of  wa- 
ter and  solids.  It  may,  therefore,  with  propriety  be  grouped  with  the 
so-called  alteratives. 

THERAPY. — Stillingia  is  certainly  a  very  valuable  remedy.  It  has 
long  had  a  local  reputation  in  the  Southern  Atlantic  States  as  an  al- 
terative. 

In  habitual  constipation,  due  to  deficient  secretion  of  the  intestinal 
mucous  membrane,  it  may  be  used  with  advantage.  The  torpidity  of 
the  liver  and  jaundice,  which  follow  attacks  of  intermittent  fever,  are 
removed  by  stillingia.  This  agent  also  renders  important  service  in 
the  first  stage  of  cirrhosis,  and  in  ascites  due  to  the  hepatic  changes. 
Haemorrhoids,  when  produced  by  obstructive  difficulty  in  the  liver, 
may  be  removed  temporarily,  and,  if  due  to  constipation,  may  be  re- 
moved permanently,  by  stillingia. 

In  habitual  constipation  the  following  formula  is  useful  :  $  Ext. 
stillingiae  fl.,  3  v  ;  tinct.  belladonnae ;  tinct.  nucis  vom. ;  tinct.  physostig- 
matis,  aa  3  j-  M.  Sig. :  Twenty  drops,  in  water,  three  times  a  day  be- 
fore meals.  When  the  biliary  secretion  is  deficient,  the  following  :  $ 
Ext.  stillingiae  fl.,  3  v  ;  tinct.  aloes,  3  ij ;  tinct.  nucis  vom.,  3  j.  M. 
Sig. :  Twenty  drops,  in  water,  three  times  a  day. 

Stillingia  has  long  been  in  popular  repute  as  an  alterative,  and  em- 
ployed in  domestic  practice  as  a  remedy  for  scrofula  in  its  various 
forms.  The  success  which  has  attended  its  employment  in  some  de- 
gree justifies  the  high  encomiums  which  have  been  bestowed  on  it. 
It  is  very  serviceable  in  children  who  present  the  following  symptoms : 
enlarged  cervical  glands,  muco-purulent  discharge  from  the  nose,  with 
excoriations  of  the  surrounding  integument,  a  pasty  complexion,  ca- 
pricious and  unnatural  appetite,  tumid  abdomen,  whitish  and  pasty 
stools  /  dull-red,  soft,  and  tubercular  eruption  on  the  skin,  ulcerating 
and  furnishing  a  large  quantity  of  unhealthy  pus.  The  steady  use 
of  stillingia,  combined  with  suitable  hygienic  means,  will  accomplish 
important  relief  in  such  cases. 

The  most  satisfactory  results  have  been  obtained  from  the  use  of 
stillingia  in  syphilitic  affections.  It  is  applicable  to  the  same  condi- 
tions under  which  the  preparations  of  sarsaparilla  are  now  used,  viz., 
in  chronic  cases  of  the  secondary  and  tertiary  form,  the  patients  hav- 
ing been  broken  down  by  the  long-continued  use  of  mercurials  and 
iodides.  Repeated  observation  of  cases  in  which  it  was  used  as  the 
sole  agent  has  satisfied  me  of  its  curative  value.  It  differs  from  the 


SANGUINARIA.  359 

compound  decoction  of  sarsaparilla  in  this,  that  its  effect  is  distinctive, 
and  is  not  due  to  the  use  merely  of  a  large  quantity  of  fluid.  The 
eminent  Dr.  Porcher,  of  South  Carolina,  thus  expresses  himself  with 
regard  to  the  use  of  stillingia  in  syphilitic  affections  :  "  I  have  em- 
ployed the  decoction  of  the  root  of  this  plant  as  an  alterative  in  syphi- 
litic sores,  occurring  in  patients  in  the  City  Hospital,  Charleston,  the 
spread  of  which  nothing  else  could  arrest.  It  proved  completely  satis- 
factory. Phagedenic  chancres  were  rapidly  cured  under  its  use.  A 
strong  decoction  was  given  three  times  a  day,  with  four  drops  of  nitric 
acid  to  each  dose." 

A  strong  infusion  or  decoction  of  stillingia  is  said  to  be  effective 
in  preventing  the  development  of  a  paroxysm  of  ague,  if  taken  before  or 
just  as  the  chill  is  beginning.  It  is  reported  that  profuse  diaphoresis 
is  produced  and  the  impending  attack  is  averted.  The  fluid  extract 
of  stillingia  may  be  given  in  combination  with  quinine  or  arsenic  in 
intermittents. 

Authorities  referred  to  : 

PORCHER,  DR.  FRANCIS  PETRE.     Resources  of  the  Southern  Fields  and  Forests,  Charles- 
ton, 1869,  p.  146. 

Sanguinaria. — Blood-root.  The  rhizoma  of  Sanyuinaria  Cana- 
densis  Linn6  (Nat.  Ord.  Papaveracece),  collected  in  autumn.  (U.  S.  P.) 

Tinctura  Sanguinarice. — Tincture  of  sanguinaria.  Dose,  Til  v — 
3  ss. 

Acetum  Sanguinarice. — Vinegar  of  sanguinaria  (sanguinaria,  10 
parts  ;  diluted  acetic  acid,  sufficient  to  make  100  parts).  Dose,  TIJ,  v — 
3  ss.  (Not  official.) 

Extractum  Sanguinarice  Fluidum. — Fluid  extract  of  sanguinaria. 
Dose,  TTI  ij — TH  xx. 

COMPOSITION. — Sanguinaria  contains  an  alkaloid,  sanguinarine, 
which  appears  to  be  identical  with  the  chelerythrine  of  Probst.  San- 
guinarine is  a  white,  pearly  substance  of  an  acrid  taste,  very  sparingly 
soluble  in  water,  soluble  in  ether,  and  very  soluble  in  alcohol.  With 
the  acids  it  forms  salts  soluble  in  water,  all  of  which  have  some  shade 
of  red,  crimson,  or  scarlet,  and  form  beautiful  red  solutions.  Another 
alkaloid,  named  porphyroxine  (sanguinaria-porphyroxin — Husemann), 
has  been  found  by  Riegel.  Besides  these  alkaloids,  sanguinaria  con- 
tains a  peculiar  acid,  chelidonic,  and  another  has  been  announced,  for 
which  the  name  sanguinarinic  acid  has  been  proposed,  but  this  latter 
acid  has  been  shown  to  be  a  mixture  of  malic  and  citric  acids.  The 
alkaloids  exist  in  the  root  in  combination  with  these  acids — the  most 
important  compound  being  the  chelidonate  of  sanguinarine.  Besides 
the  foregoing,  blood-root  contains  the  following  unimportant  constitu- 
ents :  resin,  gum,  extractive,  albumen,  sugar,  etc. 


360  AGENTS   INCREASING   WASTE. 

ANTAGONISTS  A>T>  INCOMPATIBLES. — Alkalies,  tannic  and  gallic 
acids,  and  most  of  the  metallic  salts,  are  chemically  incompatible  with 
the  preparations  of  blood-root.  The  local  irritant  action  of  the  drug 
and  the  depression  of  the  circulation  which  it  causes  are  antagonized 
by  opium,  by  amyl  nitrite,  by  atropine,  etc. 

SYNEKGISTS. — The  mineral  and  vegetable  emetics,  the  so-called 
alteratives  of  the  vegetable  kingdom,  and  the  mineral  salts,  considered 
from  the  therapeutical  point  of  view,  promote  the  physiological  and 
therapeutical  effects  of  sanguinaria. 

PHYSIOLOGICAL  EFFECTS. — Sanguinaria  has  a  bitter,  acrid  taste, 
which  persists  for  a  long  time.  When  swallowed,  it  leaves  a  sense  of 
constriction  and  acridity  in  the  throat.  It  excites  a  feeling  of  heat  in 
the  stomach,  and  stimulates  secretion  of  the  mucous  membrane.  If  the 
quantity  taken  is  insufficient  to  produce  nausea,  the  action  of  the  heart 
is  increased,  and  a  subjective  sensation  of  warmth  is  experienced 
throughout  the  system.  In  considerable  doses  sanguinaria  is  an  active 
emetic,  producing  much  nausea  and  depression,  and  slowing  the  action 
of  the  heart.  It  is  very  irritating  to  the  mucous  membrane.  Snuffed 
up  the  nose,  it  produces  violent  sneezing.  In  large  doses  it  inflames 
the  stomach,  producing  intense  burning,  with  thirst,  great  prostration, 
dimness  of  vision,  vertigo,  and  collapse. 

The  alkaloid,  sanguinarine,  manifests  all  the  physiological  capa- 
bilities of  the  drug.  It  has  an  intensely  bitter,  acrid  taste.  In  small 
doses  (one  twelfth  to  one  eighth  of  a  grain)  it  simply  increases  secre- 
tion of  the  gastro-intestinal  mucous  membrane  ;  in  doses  of  one  sixth 
to  one  fourth  of  a  grain  it  causes  depressing  nausea  and  sometimes 
vomiting.  In  large  doses  it  produces,  in  addition  to  the  gastric  symp- 
toms mentioned  above,  slowing  and  irregularity  of  the  pulse,  cold 
sweats,  cold  extremities,  vertigo,  dilated  pupils,  anxiety,  etc. 

Applied  to  fungous  granulations,  sanguinaria  has  considerable  es- 
charotic  power. 

The  sketch  above  given  of  the  physiological  actions  of  sanguinaria, 
which  embodies  the  results  of  the  author's  investigations  and  clinical 
studies,  requires  no  special  modification.  The  recent  elaborate  and 
most  thorough  research  of  Dr.  Robert  Meade  Smith  confirms  the 
author's  account.  The  reader  who  wishes  to  exhaust  the  subject  will 
find  that  nothing  has  been  omitted  by  Dr.  Smith. 

THEBAPY. — In  atonic  dyspepsia  from  two  to  five  drops  of  the  tinc- 
ture, or  the  one  twelfth  of  a  grain  of  sanguinarine,  may  be  used  with 
advantage.  It  promotes  secretion,  and  increases  the  appetite.  There 
seems  no  doubt,  according  to  the  author's  observation,  that  sanguinaria 
promotes  the  hepatic  and  intestinal  secretions.  It  is,  therefore,  a  ser- 
viceable remedy  in  duodenal  catarrh,  and  secondary  catarrh,  of  the 
biliary  ducts  with  jaundice. 

Its  most  important  therapeutical  effects  are  witnessed  in  diseases  of 


SANGUDTARIA.  361 

the  respiratory  organs.  Chronic  nasal  catarrh  is  successfully  treated 
by  the  internal  use  of  the  tincture  (ten  drops  ter  die),  or  of  the  alkaloid 
(one  fifteenth  of  a  grain  ter  die),  and  the  local  application  of  the  pow- 
der, in  small  quantity,  applied  by  an  insufflator  to  the  Schneiderian 
mucous  membrane.  In  acute  bronchitis  (catarrh),  after  the  subsidence 
of  the  more  acute  symptoms,  it  is  a  serviceable  expectorant.  It  may 
be  combined  with  other  expectorants  and  alterants  :  $  Tinct.  sangui- 
narise,  3  j  ;  tinct.  lobeliae,  3  j  ;  vini  ipecac.,  3  ij  ;  syrup,  tolutan.,  f  ss. 
M.  Sig.  :  A  teaspoonful  every  three  hours  as  an  expectorant.  In 
humid  asthma  the  following  combination  is  extremely  serviceable  :  IJ 
Tinct.  sanguinariae,  3  j  ;  tinct.  lobelias,  3  j  ;  ammonii  iodidi,  3  j  ;  syrup, 
tolutan.,  3  vj.  M.  Sig.  :  A  teaspoonful  every  two,  three,  or  four  hours. 
In  spasmodic  asthma  the  same  prescription  is  occasionally  very  effect- 
ual, but  the  author  is  unable  to  indicate  the  precise  condition  under 
which  it  is  most  useful. 

Sanguinaria  has  been  proposed  as  an  emetic  in  croup.  It  is,  how- 
ever, too  uncertain  in  action,  and  too  harsh,  to  justify  its  use  when 
there  are  so  much  more  eligible  remedies  at  hand. 

The  emmenagogue  properties  of  sanguinaria  seem  well  established. 
It  is  indicated  when  amenorrhoea  is  functional  in  character,  when 
there  is  an  absence  of  plethora,  and  when  no  malformation  exists.  It 
may  be  advantageously  combined  with  aloes,  provided  there  is  no  con- 
traindication to  the  use  of  the  latter.  IJ  Tinct.  sanguinariae,  3  ij  ; 
tinct.  aloes,  f  ss  ;  tinct.  nucis  vom.,  3  ij.  M.  Sig.  :  Twenty  drops  two 
or  three  times  a  day,  in  amenorrhoea  of  anaemia,  or  chlorosis.  Or  the 
following  :  IJ  Sanguinarinse,  grs.  ij  ;  ext.  aloes,  grs.  x  ;  ferri  redacti, 
3j.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill  three  times  a  day. 

Sanguinaria  has  decided  aphrodisiac  properties.  When  there  are 
relaxation  of  the  genital  organs,  diurnal  losses,  inaptitude  (from  irrita- 
bility) for  coitus,  sanguinarine  may  be  given  as  follows  :  IJ  Ergotin 
(aq.  ex.),  3j  ;  sanguinarinae,  grs.  ij.  M.  Ft.  pil.  no.  xx.  Sig.  :  One, 
three  times  a  day.  As  stillingia  appears  to  have  similar  properties  as 
an  aphrodisiac,  the  following  combination  will  prove  useful :  IJ  Tinct. 
sanguinariae,  3  iij  ;  ext.  stillingiae  fl.,  3  v.  M.  Sig. :  Fifteen  to  twenty 
drops,  in  water,  three  times  a  day. 

As  an  alterant  in  chronic  syphilitic  and  strumous  affections,  san- 
guinarine may  be  used  in  the  same  class  of  cases  as  sarsaparilla,  guaiac, 
and  stillingia.  It  is  an  important  addition  to  a  decoction  of  woods  in- 
digenous to  our  soil,  used  as  a  substitute  for  the  more  expensive  and 
really  less  efficient  foreign  drugs  of  the  same  group. 

LOCAL  APPLICATIONS. — Sanguinaria,  having  feeble  escharotic  prop- 
erty, is  used  as  a  local  application  to  repress  exuberant  granulations, 
and  to  iU-conditioned  ulcers  to  change  their  character.  Several  cases 
have  been  reported,  indicating  the  power  of  sanguinaria  to  repress  the 
growth  and  destroy  nasal  polypi. 


362  AGENTS  INCREASING  WASTE. 

A  decoction  of  sanguinaria  is  a  useful  gargle  in  the  sore-throat 
of  scarlatina. 

Authorities  referred  to  : 

HUSEMANN,  DRS.  AUG.  TJND  THEO.     Die  Pflanzenstoffe,  p.  199. 

PORCHER,  DR.  FRANCIS  PEYRE.  Resources  of  the  Southern  Fields  and  Forests,  p.  31, 
et  seq. 

PHILLIPS,  DR.  C.  D.  F.     Materia  Medica  and  Therapeutics,  London,  1874,  p.  143. 

STILLE,  DR.  ALFRED.     Therapeutics  and  Materia  Medica,  fourth  edition,  vol.  ii,  p.  454. 

SMITH,  DR.  ROBERT  MEADE.  The  Physiological  Action  of  Sanguinarina.  The  Am. 
Jour.  Med.  Sci.,  October,  1876,  p.  346,  et  seq. 

Xanthexylum. — Prickly  ash.  The  bark  of  Xanthoxylum  ameri- 
canurn  Miller  and  of  X.  clava-fferculis  Lambert  (Nat.  Ord.  JRutacece, 
Xanthoxylece.) 

Extractum  Xanthoxyli  Fluidum. — Fluid  extract  of  xanthoxylum. 
Dose,  in  x —  3  j- 

A  decoction  may  be  made  by  boiling  an  ounce  of  the  bark  in  a 
quart  of  water  down  to  one  pint,  and  of  this  one  to  two  ounces  may 
be  used  every  four  hours.  A  tincture  may  also  be  prepared  with  two 
ounces  of  the  root  to  a  pint  of  diluted  alcohol,  of  which  the  dose  would 
be  3  ss —  3  ij.  The  official  fluid  extract  is  more  frequently  in  use;  the 
dose  of  this  is  in,  xv —  3  ij. 

COMPOSITION. — Xanthoxylum  contains  a  neutral  crystallizable  prin- 
ciple, which  is  known  as  xanthoxylin,  and  is  said  to  be  identical  with 
xanthopicrite,  and  the  latter  has  been  shown  to  be  berberine.  Besides 
this  important  constituent,  a  volatile  and  a  fixed  oil,  resin,  gum,  etc., 
are  contained  in  it. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  xanthoxylum  is  at  first 
sweetish,  and  somewhat  aromatic,  but  considerable  bitterness  is  soon 
developed,  followed  by  acridity,  which  remains  long  in  the  fauces.  It 
has  remarkable  sialagogue  property,  and  the  increased  flow  of  saliva 
occurs  from  the  systemic  effects,  as  well  as  from  the  local  impression 
on  the  mucous  membrane  of  the  mouth.  In  the  stomach  it  excites  a 
sensation  of  warmth,  and  increases  secretion  from  the  stomach  and  in- 
testinal mucous  membrane.  It  is  in  a  high  degree  probable  that  just 
as  its  presence  in  the  mouth  causes  salivation,  so  its  presence  in  the 
intestinal  canal  determines  the  flow  of  gastric,  duodenal,  hepatic,  and 
pancreatic  secretion.  The  action  of  the  heart  is  increased  by  xan- 
thoxylin,  the  arterial  tension  rises,  the  capillary  circulation  becomes 
more  energetic,  and  the  sweat-glands  are  made  to  pour  forth  a  more 
abundant  secretion.  Corresponding  effects  are  produced  in  the  kid- 
neys, and  increased  flow  of  urine  follows  its  administration. 

THEKAPY. — Xanthoxylum  is  a  domestic  remedy  for  toothache.  The 
bark,  chewed,  has  a  popular  reputation  for  paralysis  of  the  tongue.  A 
decoction  of  the  bark  is  an  efficient  local  application  to  the  throat  when, 


FRAXINUS  AMERICANA.  363 

In  cases  of  chronic  pharyngitis,  there  is  dryness  of  the  mucous  mem- 
brane. From  ten  to  thirty  minims  of  the  fluid  extract,  or  a  half  to  one 
drachm  of  the  tincture,  ter  in  die,  is  a  successful  remedy  for  an  ex- 
tremely obstinate  affection,  namely,  chronic  pharyngitis — the  mucus 
adhering  in  large,  thin,  dry  scales,  and  the  mucous  membrane  being 
glossy,  shining,  glazed,  and  dry,, 

The  active  principle  (xanthoxylin)  is  a  useful  stomachic  tonic  in 
atonic  dyspepsia.  "When,  however,  in  stomach,  intestinal,  or  hepatic 
disorders  the  object  is  to  promote  secretion,  the  preparations  of  xan- 
thoxylum  must  be  used.  Jaundice  due  to  catarrh  of  the  bile-ductsy  and 
that  form  of  jaundice  produced  by  acute  malarial  poisoning,  are  con- 
ditions in  which  xanthoxylum  is  distinctly  remedial.  Constipation, 
due  to  deficient  secretion,  is  also  removed  by  this  agent. 

Xanthoxylum  has  long  had  a  deserved  reputation  in  the  treatment 
of  chronic  rheumatism.  It  is  adapted  to  muscular  rheumatism,  myal- 
gia, and  such  local  muscular  disorders  as  torticollis  (recent  cases),  lum- 
bago, etc.  It  may  be  used  with  advantage,  locally,  in  these  affec- 
tions. The  curative  power  which  it  possesses  in  chronic  rheumatism 
is  doubtless  due  to  its  eliminant  action  on  the  mucous  and  cutaneous 
surfaces. 

Xanthoxylum  is  a  remedy  for  constitutional  syphilis  of  equal  merit 
with  guaiac,  mezereon,  stillingia,  etc.,  and  is  greatly  more  effective 
than  sarsaparilla. 

Decoction  of  xanthoxylum  has  been  used  with  success  in  the  treat- 
ment of  dropsy. 

Fraxinus  Americana. — The  inner  bark  of  the  root.     (Not  official.) 

PREPARATION. —  Vinum  Fraxini.  The  inner  bark  of  the  root  col- 
lected in  November,  eight  ounces  ;  stronger  white  wine,  or  sherry, 
two  pints.  The  root-bark  should  be  macerated  in  the  wine  three  or 
four  days  ;  after  percolation,  to  every  25  parts  there  should  be  added 
2  parts  of  glycerin  and  1  part  of  alcohol.  The  dose  of  the  wine  thus 
prepared  is  a  teaspoonful  or  two,  three  times  a  day,  before  meals. 

ACTIONS  AND  USES. — There  has  been  no  adequate  study  of  the 
physiological  actions  of  fraxinus.  Its  employment  is,  thus  far,  merely 
empirical.  We  owe  to  Dr.  Charles  P.  Turner,  of  Philadelphia,  the 
knowledge  now  in  our  possession  regarding  its  therapeutical  powers. 
It  belongs  to  the  group  of  alterative  medicines,  if  we  may  still  use  this 
rather  obsolete  term.  Administered  in  certain  diseases,  it  modifies  the 
local  morbid  process,  or  cures  it  without  any  recognizable  disturbance 
of  the  functions.  The  chief  use  of  it  thus  far  has  been  in  the  treat- 
ment of  certain  uterine  disorders.  Dr.  Turner  has  found  it  to  have  a 
curative  action  in  chronic  metritis,  and  in  the  disorders  consequent  on 
this  condition  of  the  uterus.  In  the  various  forms  of  dysmenorrhcea, 
especially  the  congestive  variety,  it  has  proved  to  be  very  effective. 
Lest  disappointment  may  be  experienced  from  its  use,  Dr.  Turner 


364  AGENTS  INCREASING  WASTE. 

assures  us  that  the  administration  of  the  wine  must  be  kept  up  for 
several  weeks  or  months.  When  administered  for  dysmenorrhcea,  it 
should  be  taken  diligently  in  the  interval,  and,  when  given  for  metri- 
tis,  it  should  be  taken  assiduously  for  several  months.  How  much  is 
due  to  time,  and  how  much  to  the  remedy,  has  not  been  shown. 
Authorities  referred  to  : 

HCSEMANN,  DRS.  AUG.  UNO  THEO.     Die  Pflanzenstoffe,  pp.  80,  717,  1108. 
PORCHER,  DR.  F.  PEYRE.     Resources  of  the  Southern  Fields  and  Forests,  p.  161. 

Viburnum  Opulus.— Cramp  bark.  The  bark  of  Viburnum  opulus 
Linn 6  (Nat.  Ord.  Caprifoliacece). 

Viburnum  Prunifolium.— Black  haw.  The  bark  of  V.  prunifolium 
Linne  (Nat.  Ord.  Caprifoliacece). 

Extractum  Viburni  Opuli  Fluidum. — Fluid  extract  of  viburnum 
opulus.  Dose,  TTI,  x —  3  ss  —  3  j. 

Extractum  Viburni  Prunifolii  Fluidum. — Fluid  extract  of  vibur- 
num prunifolium.  Dose,  TTl  x —  3  ss  —  3  j. 

COMPOSITION. — According  to  Hermann  Allen,  besides  a  bitter  brown 
and  yellow  resin,  viburnum  contains  viburnine  (Kramer),  an  active 
principle.  This  principle  has  not  been  utilized  in  medical  practice. 

ACTIONS  AND  USES. — Recently,  Dr.  Theodore  Sperman,  of  Edin- 
burgh, has  made  the  viburnums  the  subject  of  physiological  investiga- 
tion. He  confirms  the  existence  of  an  active  principle,  which,  how- 
ever, is  present  in  small  amount  (^  per  cent).  That  this  alkaloid  rep- 
resents the  powers  of  viburnum,  he  was  successful  in  determining  by 
experiment  on  animals,  producing  the  same  effects  in  them  by  its  ad- 
ministration as  he  had  caused  by  the  crude  drug.  The  active  prin- 
ciple is  a  sedative,  slows  the  heart-beat,  and  lowers  the  vascular  ten- 
sion, the  cardiac  movements  being  arrested  in  the  diastole.  It  induces 
drowsiness,  lessens  reflex  activity,  and  causes  paresis  of  the  muscular 
system  and  inco-ordination  of  movements.  The  experiments  on  ani- 
mals were  confirmed  by  observations  on  man.  Some  drowsiness,  slug- 
gishness of  movement,  lowering  of  the  blood  pressure,  diminution  of 
sensibility,  and  lessening  of  the  reflexes  result  from  its  administration 
in  full  doses  to  the  human  subject.  Toxic  symptoms  were  not  caused 
by  large  doses.  The  headache  and  disturbances  of  vision  noted  by 
some  observers  in  the  course  of  its  medicinal  administration  did  not 
happen  in  the  cases  studied  by  Dr.  Sperman.  There  is,  however,  a 
general  agreement  that  viburnum  is  not  an  active  substance.  No 
obvious  effects  were  produced  in  guinea  pigs  by  considerable  doses 
(Monelar).  Wilson,  of  Liverpool,  reports  dryness  of  the  mouth,  dis- 
orders of  vision,  and  general  numbness  as  a  result  of  the  action  of 
strong  doses.  Jenks,  of  Detroit,  maintains  that  it  has  a  special  action 
on  the  uterus  through  the  sympathetic  system  of  nerves  ;  that  it  is  a 
uterine  sedative.  This  is  a  pure  assumption,  and  rests  entirely  on  the 


VIBURNUM   PRUNIFOLIUM.  365 

supposed  power  of  viburnum  to  prevent  abortion  when  threatened,  and 
to  prevent  or  arrest  the  pains  of  dysmenorrhoea.  It  is  indicated  in 
cases  of  habitual  abortion  in  which  it  may  be  supposed  an  irritable 
state  of  the  uterus  exists,  so  that  uterine  action  sets  in  at  a  certain  stage 
of  development  of  the  foetus.  When  the  fo3tus  has  died,  or  utero- 
placental  haemorrhage  has  taken  place,  this  remedy  has  little  influence 
over  the  result.  In  uterine  colic  and  after-pains  there  are  numerous 
reports  of  its  good  effects.  It  has  also  proved  useful  in  the  treatment 
of  dysmenorrhosa.  Experience  has  shown  that  it  acts  more  efficiently 
when  administered  for  some  days — a  week  or  more — in  anticipation 
of  the  menstrual  flow.  According  to  Jenks,  Monelar,  and  others,  it  is 
a  valuable  remedy  for  the  menorrhagia  of  the  menopause.  In  a  vari- 
ety of  uterine  maladies  accompanied  by  excessive  and  too  frequent 
menstrual  flow  this  remedy  is  held  to  be  an  efficient  agent  for  relief. 
So  many  pathological  states  are  represented  in  the  chief  symptom  that 
it  may  be  doubted  whether  viburnum  has  any  real  power  over  them, 
and  it  can  be  claimed  only  that  it  affects  favorably  and  restrains  the 
hsemorrhagic  tendency.  It  is  the  author's  judgment  that  the  remedy 
has  been  greatly  overrated  by  its  advocates,  but  he  admits  it  to  a 
place  in  this  work  because  it  has  been  added  to  the  list  of  the  U.  S. 
Pharmacopoeia. 

It  is  in  a  high  degree  probable  that  the  viburnum  opulus  is 
more  effective  than  the  V.  prunifolium.  The  fluid  extract  is  the 
official  representative  of  both. 


REMEDIES  USED  TO  DESTROY  MICROBES  OR  MOR- 
BIFIC GERMS,  AND  TO  PREVENT  OR  ARREST 
SEPTIC  PROCESSES  (ANTISEPTICS,  OR  GERMI- 
CIDES}. 

ANTISEPTICS. 

THOSE  remedies  are  entitled  antiseptic  which  are  employed  to  ar- 
rest fermentative  processes.  It  is  now  generally  admitted  that  every 
kind  of  fermentation  is  correlative  of  the  growth  and  multiplication 
of  a  living  organism.  In  various  diseases,  microzymes,  vibrio,  bac- 
teria, either  stand  in  a  causative  relation  to  the  morbid  process,  or 
are  necessary  to  its  evolution  and  development. 

To  illustrate  the  commanding  importance  of  pathogenic  organ- 
isms in  modern  pathology,  it  is  only  necessary  to  mention  a  few  of 
the  more  noteworthy  discoveries  in  the  new  science  of  bacteriology — 
for  example,  the  spirochaete  plicatillis  of  relapsing  fever,  the  bacil- 
lus of  tubercle,  the  coccus  of  pneumonia,  the  comma  bacillus  of  chol- 


366  ANTISEPTICS. 

era,  etc.  The  mere  finding  of  minute  organisms  does  not  suffice  to 
prove  that  their  presence  is  anything  more  than  accidental.  To  dem- 
onstrate a  causative  relation,  cultures  of  the  organism,  and  afterward 
successful  inoculations,  are  requisite. 

Very  admirable  practical  results  have  followed  the  discovery  of 
the  alkaloid-like  ptomaines  in  the  intestinal  canal.  Fermentative 
processes  set  up  by  germs  introduced  from  without  produce  these- 
substances  when  the  local  conditions  are  favorable.  The  formation 
of  ptomaines,  and  of  such  actively  poisonous  substances  as  tyrotoxi- 
con,  correspond  to  or  imitate  methods  by  which  the  active  principles 
of  plants  are  produced.  Increasing  experiences,  and  the  accurate  sci- 
entific methods  now  applied  to  the  whole  question,  have  demonstrated 
that  various  maladies — some  supposed  to  be  constitutional  in  charac- 
ter— are  due  to  these  poisons,  which,  when  formed,  diffuse  into  the 
blood,  setting  up  the  morbid  process  characteristic  of  each  agent. 

The  remedies  of  this  group — antiseptics — have  the  power,  when 
brought  into  contact  with  the  minute  organisms  or  disease-germs  men- 
tioned above,  to  destroy  their  vitality,  and  to  arrest  the  fermentation 
process,  or  zymosis,  which  they  either  initiate  or  promote.  There  is  a 
distinct  relation  between  the  antiseptic  and  antipyretic  properties  of 
various  members  of  this  group,  and  they  have  the  power  to  depress 
temperature  in  the  same  ratio  that  they  are  active  in  destroying  dis- 
ease ferments  and  germs.  Some  of  these  remedies,  e.  g.,  quinine,  sul- 
phurous acid,  the  sulphites,  etc.,  have  already  been  discussed  in  Part 
II.  Under  this  head  there  remain  for  consideration  several  important 
agents  whose  applications  are  distinctly  antiseptic. 

Oxygenium. — Oxygen.  Oxygene,  FT.  ;  Sauerstoff,  Ger.  (Not 
official.) 

PREPARATION. — The  most  convenient  mode  of  preparing  oxygen 
for  medical  purposes  is  to  heat  in  a  gun-barrel-shaped  brass  or  iron 
retort  a  mixture  composed  of  five  parts  of  chlorate  of  potassium  and 
one  part  of  binoxide  of  manganese.  When  heated  to  dull  red,  the 
chlorate  yields  up  its  oxygen,  being  reduced  to  chloride.  The  gas  may 
be  most  conveniently  collected  over  water,  which  dissolves  but  little 
of  the  oxygen,  but  takes  up  all  the  chlorine  that  may  be  accidentally 
present. 

It  is  a  permanent,  elastic  gas,  inodorous,  without  taste,  incom- 
bustible, but  uniting  with  bodies  in  a  state  of  combustion.  It 
is  very  slightly  soluble  in  water  at  the  ordinary  temperature  and 
pressure. 

DOSE. — The  quantity  of  oxygen  which  may  be  inhaled,  in  the  or- 
dinary medicinal  applications  of  this  gas,  ranges  from  one  to  five  gal- 
lons. The  simplest  apparatus  will  suffice,  but  an  elastic  bag,  with  a 
suitable  mouth-piece,  is  usually  employed  for  this  purpose. 


OXYGEN.  367 

PHYSIOLOGICAL  ACTIONS. — If  the  important  rdle  which  oxygen 
plays  in  the  economy  of  Nature  furnished  a  measure  of  its  powers 
when  administered  as  a  remedy,  it  would  be  a  most  important  thera- 
peutic agent.  When  inhaled  in  the  pure  state  (not  as  air),  it  produces 
singularly  little  constitutional  disturbance.  A  sensation  of  warmth  in 
the  larynx,  trachea,  and  bronchi,  is  first  experienced  ;  the  pulse,  as  a 
rule,  somewhat  increases,  though  it  may  be  lessened  in  frequency  ;  a 
sense  of  mental  exhilaration  and  a  disposition  to  greater  bodily  activity 
are  produced  ;  the  appetite  becomes  keener  ;  but  no  constant  influ- 
ence on  the  excretions  has  been  noted  (Demarquay).  Experiments 
on  animals  have  demonstrated  that  the  inhalation  of  oxygen  per  se 
does  not  have  an  injurious  effect  on  animal  life  (A.  H.  Smith).  On 
the  contrary,  as  Hayem  has  recently  shown,  the  administration  of 
oxygen  in  from  forty  to  ninety  litres  per  day,  given  in  two  doses  and 
mixed  with  a  determinate  quantity  of  air,  energizes  to  a  considerable 
degree  the  nutritive  functions ;  it  increases  the  appetite,  slightly  ele- 
vates the  temperature,  stimulates  the  cardiac  movements,  and  aug- 
ments the  body-weight.  These  results  are  due  in  the  main  to  the  ef- 
fect of  oxygen  on  the  blood  ;  it  increases  the  number  and  stimulates 
the  organic  activity  of  the  red  blood-globules.  Although  this  action 
is  not  constant,  the  effects  may  become  so  by  the  greater  nutrition- 
al changes  which  are  thus  promoted.  When  the  inhalations  are  sus- 
pended, these  effects  on  the  blood  cease.  Anne's  results,  obtained  by 
a  course  of  experiment  on  himself,  entirely  confirm  those  obtained  by 
Hayem. 

THERAPY. — Oxygen  is  indicated  and  has  been  used  with  success  in 
diseases  of  the  respiratory  organs,  characterized  by  dyspnoea,  due  to 
causes  interfering  with  the  oxygenation  of  the  blood,  in  emphysema, 
asthma,  croup,  asphyxia,  chloroform  narcosis,  asphyxia  from  toxic 
gases,  etc.  In  these  cases  oxygen  acts  in  a  manner  which  is  perfectly 
obvious  :  the  labor  of  breathing  and  the  damage  to  the  respiratory 
center  are  lessened  by  the  addition  to  the  blood  of  oxygen  in  larger  quan- 
tity than  is  supplied  by  the  air.  In  these  cases,  pure  oxygen,  or  a  mix- 
ture of  one  part  of  the  gas  to  two  or  three  of  air,  may  be  employed. 
The  more  extreme  the  dyspnoea,  the  greater  the  necessity  for  undi- 
luted oxygen. 

Oxygen  is  also  indicated,  and  has  been  successfully  employed,  in 
certain  diseases  characterized  by  insufficient  oxidation  :  chlorosis,  anae- 
mia, leucocythemia,  diabetes,  albuminuria,  etc.  In  such  cases  the  in- 
ternal administration  of  chalybeate  medicines,  or  mineral  waters, 
should  accompany  the  inhalations  of  oxygen.  Pure  oxygen  is  not  ne- 
cessary ;  an  admixture  with  three  parts  of  air  will  suffice,  and  the 
inhalation  should  be  made  morning  and  evening. 

The  evidence  is  satisfactory  that  oxygen-inhalations  produce  good 
results  in  some  cases  of  phthisis.  Those  cases  appear  to  be  most  bene- 


368  ANTISEPTICS. 

fited  in  which  emaciation,  dyspeptic  symptoms,  etc.,  have  occurred, 
without  marked  change  in  the  condition  of  the  lungs.  When  hectic 
fever  comes  on,  and  excavations  have  occurred,  the  utility  of  oxygen 
has  ended,  except  as  a  palliative  of  dyspno3a.  Pinard  reports  a  case 
of  vomiting  of  pregnancy,  uncontrollable  by  other  means,  promptly 
arrested  by  oxygen  inhalations.  Hayem  gives  similar  facts,  and  also 
reports  the  good  effects  of  this  remedy  in  gastralgia,  dyspepsia,  and 
other  functional  disorders  of  the  stomach.  In  cancer,  chronic  catarrh, 
and  dilatation  of  the  stomach,  it  affords  relief  without  having  a  cura- 
tive action. 

Ozone. — Active  oxygen. — Hydrogen  Dioxide. 

The  peculiar  odor  of  ozone  explains  the  name  given  it  by  its  dis- 
coverer, Schonbein,  who  long  maintained  alone  the  genuineness  of 
this  form  of  oxygen.  It  is  now  agreed  by  chemists  that  it  is  an 
allotropic  modification  of  oxygen,  in  which  three  atoms  are  condensed 
into  two. 

The  medical  properties  of  ozone  have  been  most  successfully 
studied  by  Binz.  It  is  an  active  oxygen,  a  powerful  oxidizing  agent, 
and  therefore  is  so  destructive  as  to  be  dangerous  to  handle.  The 
tissues  of  the  human  body  are  affected  by  it  in  a  peculiar  man- 
ner. It  sets  up  an  acute  catarrh  of  the  respiratory  mucous  mem- 
brane if  breathed  in  quantity.  The  coagulability  of  albumen  is  de- 
stroyed by  it.  It  has  been  asserted  that  it  causes  pneumonia  under 
certain  unknown  conditions. 

Binz  finds  that  ozone  is  a  cerebral  sedative,  that  it  induces  drowsi- 
ness and  stupor  ;  but  this  must  be  secondary  to  a  primary  stimulant 
effect,  and  may  be  due  to  changes  in  the  protoplasm,  on  which  it  acts 
with  great  energy. 

Aqua  Hydrogenii  Dioxidi. — Solution  of  hydrogen  dioxide.  Per- 
oxide of  hydrogen.  "A  slightly  acid,  aqueous  solution  of  hydrogen 
dioxide,  containing,  when  freshly  prepared,  about  three  per  cent  by 
weight  of  the  pure  dioxide,  corresponding  to  about  ten  volumes  of 
available  oxygen."  Barium  dioxide,  300  grms.,  and  a  sufficient  quan- 
tity of  phosphoric  and  sulphuric  acids  with  distilled  water  are  the  ma- 
terials from  which  it  is  prepared.  The  resulting  solution  is  a  colorless 
liquid,  without  odor,  slightly  acidulous  to  the  taste,  and  producing  a 
peculiar  sensation  in  the  mouth,  with  a  soapy  froth.  It  loses  its 
strength  by  keeping. 

This  official  preparation  may  be  prescribed  by  dilution  with  water, 
one  fourth  to  one  sixth,  and  the  dose  is  f  3  j — f  §  ss. 

Hydrogen  dioxide  is  a  powerful  oxidizing  agent,  and  is  therefore 
destructive  of  organic  poisons  and  pathogenic  organisms.  It  acts  on 
the  gases  of  decomposition  and  thus  removes  foul  odors.  It  has  been 
proved  to  possess  the  power  to  destroy  the  bacilli  of  charbon  and  the 


CHLORINE.  369 

microbes  of  typhoid,  cholera,  diphtheria,  and  scarlet  fever.  It  is  there- 
fore a  powerful  antiseptic  application,  and  of  great  value  in  the  treat- 
ment of  diphtheria  wherever  it  can  be  brought  in  contact  with  the 
morbid  process.  By  means  of  a  nasal  syringe,  it  can  be  applied,  di- 
luted one  half,  to  the  nasal  passages,  or  undiluted  in  spray,  or  by  means 
of  a  probang  to  the  throat.  In  scarlet  fever,  for  the  throat  and  nasal 
manifestations,  it  is  a  valuable  means  of  relief.  In  gonorrhoea  it  is  an 
excellent  injection,  destroying  the  gonococcus  and  arresting  the  for- 
mation of  pus.  According  to  the  severity  of  the  symptoms,  it  may  be 
used  in  the  strength  of  the  official  solution  or  diluted  one  half  or  one 
fourth.  It  is  a  good  application  to  soft  chancre.  For  suppurating 
cavities,  discharging  abscesses,  sinuses,  etc.,  it  can  be  injected  freely, 
destroying  foul  odors  and  stopping  suppuration. 

It  is  one  of  the  most  convenient  and  least  objectionable  applica- 
tions for  disinfecting  the  hands  and  instruments.  For  bleaching  the 
hair  it  is  a  safe  and  efficient  means.  Being  an  active  oxidizing  agent, 
and  rapidly  losing  its  properties  in  contact  with  organic  matter,  sys- 
temic effects  can  hardly  be  produced  by  it  in  nearly  the  same  degree. 
The  effects  which  have  been  claimed  for  it  as  a  remedy  in  various 
constitutional  states  are  not  supported  in  recent  experiences.  That 
its  action  must  be  regarded  as  confined  to  the  point  of  contact  is 
proved  by  the  effects  which  ensue  there  :  it  coagulates  albumin,  effer- 
vesces freely,  and  covers  the  ulcerated  surface  with  a  whitish  coating. 
In  contact  with  the  mucous  membrane  a  similar  action  takes  place, 
and  this  means  the  more  or  less  complete  disintegration  of  the  dioxide, 
whence  it  follows  that  the  strong  claims  put  forth  regarding  its  anti- 
septic powers  must  be  modified.  The  remarkable  assertions  published, 
and  which  have  been  embodied  in  the  above  remarks,  are  for  the  most 
part  based  on  theoretical  considerations. 

Authorities  referred  to  : 

ANDREWS,  DR.  J.  B.  The  Detroit  Review  of  Medicine  and  Surgery,  December,  1871, 
p.  571. 

ANNE,  DR.  HENRI.     These  de  Paris,  1880. 

BINZ,  PROF.  DR.     Arch.  f.  experiment.  Pathol.  und  Pharmacol.,  for  1884. 

BIRCH,  DR.  The  Therapeutic  Action  of  Oxygen,  London,  1857.  The  British  Medical 
Journal,  December  24  and  31,  1859. 

BRICHETEAC,  DR.  F.     Bulletin  General  de  Therapeutique,  vol.  Ixx,  p.  162. 

DEMARQUAY,  DR.     Essai  de  Pneumatologie  Medicate,  etc.,  Paris,  1866. 

HACKLEY,  DR.  C.  E.     New  York  Medical  Journal,  vol.  ix,  p.  597. 

MACKEY,  EDWARD.     The  Practitioner,  vol.  ii,  p.  278. 

PINARD,  DR.     Annuaire  de  Therapeutique,  1881,  p.  109. 

SMITH,  DR.  A.  H.     New  York  Medical  Journal,  vol.  xi,  p.  152. 

WALDENBURG,  DR.  L.  Die  locale  Behandlung  der  Krankheiten  der  Athmungsorgane, 
Berlin,  1872,  p.  690,  et  seq. 

Chlorinium. — Chlorine.      Chlore,  Fr.;    Chlor,  Ger.     (Not  official.) 
PBOPERTIES. — Chlorine  is  a  greenish-colored  gas,  of  a  persistent, 
26 


370  ANTISEPTICS. 

penetrating,  suffocating,  and  characteristic  odor.  It  is  soluble  in  water 
in  the  proportion  of  two  volumes  (of  gas)  to  one. 

Aqua  Chlori. — Chlorine-water  is  a  greenish-yellow  liquid,  possess- 
ing the  suffocating  odor  of  chlorine. 

Liquor  Sodce  Chloratce. — Solution  of  chlorinated  soda.  A  trans- 
parent liquid,  of  a  greenish-yellow  color,  having  a  slight  odor  of  chlo- 
rine, a  sharp,  saline  taste,  and  an  alkaline  reaction. 

Calx  Chlorata. — Chlorinated  lime.  Chloride  of  lime.  A  grayish- 
white  substance,  in  powder  or  friable  lumps,  dry  or  but  slightly  moist, 
and  nearly  entirely  dissolved  by  dilute  muriatic  acid,  with  the  escape 
of  chlorine.  It  should  contain  at  least  25  per  cent  of  chlorine. 

PHYSIOLOGICAL  ACTIONS. — Chlorine  as  a  gas,  or  in  solution  in  wa- 
ter, is  an  active  irritant.  Applied  to  the  skin  for  some  minutes,  it 
causes  heat  and  burning,  increased  diaphoresis,  and,  if  the  contact  be 
sufficiently  prolonged,  vesication.  Inhaled  in  very  small  quantity, 
largely  diluted  with  air,  this  gas  induces  a  sensation  of  warmth  in  the 
chest,  and  increases  the  bronchial  mucus.  In  considerable  quantity  it 
is  a  violent  irritant,  excites  spasm  of  the  glottis,  and  sets  up  active 
inflammation  of  the  larynx,  bronchi,  and  lungs. 

Chlorine  is  without  action  when  moisture  is  not  present.  Water  is 
decomposed  by  it,  chlorhydric  acid  is  formed,  and  oxygen  get  free  as 
active  oxygen  or  ozone.  The  antiseptic  properties  of  chlorine  are, 
therefore,  due  in  large  part  to  the  oxidizing  powers  of  the  liberated 
ozone.  The  sulphur  and  phosphorus  compounds  with  hydrogen  are 
decomposed  by  chlorine.  When  this  gas  is  brought  into  contact  with 
sulphureted  hydrogen,  chlorhydric  acid  is  formed  and  sulphur  is -pre- 
cipitated. On  these  chemical  facts  rest  the  deodorant  and  disinfectant 
powers  of  chlorine.  Binz  has  lately  made  an  elaborate  study  of  the 
effects  of  chlorine,  and  he  finds  that  in  animals  it  has  a  distinct  nar- 
cotic effect  ;  that  it  suspends  the  functions  of  the  cerebrum,  but  does 
not  impair  the  contractility  of  muscle,  or  the  irritability  of  nerves. 

THERAPY. — Chlorine  gas  will  arrest  putrefactive  decomposition  of 
animal  matters,  and  may,  therefore,  be  employed  as  a  preservative  of 
anatomical  preparations.  As  a  deodorant  and  disinfectant  it  may  be 
used  to  destroy  foul  effluvia  and  disease-germs.  It  is  irrespirable  in 
sufficient  quantity  to  affect  disease-germs  in  the  living  subject,  and  it 
destroys  the  colors  and  even  texture  of  fabrics,  so  that  it  is  rarely  used 
for  disinfection  of  the  person  or  of  the  clothing  of  patients. 

Chlorine-water,  chlorinated  soda,  and  solutions  of  chlorinated  lime 
are  employed  locally  in  scarlet  fever,  diphtheria,  aphthae,  and  gangrene 
of  the  mouth  and  fauces.  Their  chief  utility  consists  in  removing 
fetor,  but  they  probably,  also,  exert  a  toxic  influence  on  disease-germs. 
IJ  Aquae  chlori,  §  ss  ;  aquae  destil.,  §  iij  ;  syrupi  simpl.,  f  ss.  M. 
Sig. :  As  a  gargle  or  lotion  for  the  mouth.  IJ  Calcis  chlor.,  3  ss ; 
mucilaginis,  f  ss  ;  aquae  destil.,  f  iijss.  M.  Sig. :  Lotion.  To  correct 


BROMINE.  371 

fetor  of  the  breath,  the  following  formula  may  be  used  :  1J  Calcis 
chlorat.,  3  iij  ;  aquae  destil.,  alcoholis,  aa  §  ij ;  ol.  rosae,  gtt.  iv.  M. 
Sig.  :  A  teaspoonful  to  a  tumblerful  of  water. 

Chlorine-water  was  formerly  much  employed  in  scarlet  fever,  ty- 
phoid, typhus,  etc.  Its  use  in  these  affections  was  predicated  on  it& 
power  to  arrest  the  growths  and  development  of  the  morbid  ferments. 
It  need  hardly  be  stated  that  such  notions  are  no  longer  entertained. 

These  chlorine  preparations  are  unquestionably  serviceable  as  deter- 
gent, deodorant,  and  antiseptic  applications  to  sloughing  and  gangre- 
nous wounds.  A  solution  of  chlorinated  soda  is  employed  to  prevent 
infection  by  animal  poisons,  the  bite  of  serpents  and  insects,  and  the 
syphilitic  virus. 

Formerly  chlorine-water  and  chlorinated  soda  were  used  in  chronic 
hepatic  affections,  but  there  is  no  evidence  that  they  are  serviceable. 

The  toxic  effects  of  chlorine  gas  may  be  prevented  by  ammoniacal 
gas,  forming  ammonium  chloride.  Albumen  is  the  most  suitable  and 
convenient  antidote  to  the  chlorine  preparations  taken  into  the  stom- 
ach. It  should  be  given  freely  in  the  form  of  milk,  eggs,  flour,  etc. 

Bromum. — Bromine.  Brome,  Fr. ;  Brom,  Ger.  A  dark-red  liquid, 
having  a  strong,  disagreeable  odor.  It  is  sparingly  soluble  in  water, 
more  soluble  in  alcohol,  and  still  more  so  in  ether. 

PHYSIOLOGICAL  ACTIONS. — The  actions  of  bromine,  considered  from 
the  chemical  point  of  view,  are  similar  to  those  of  chlorine  :  it  decom- 
poses hydrogen  compounds,  forming  bromhydric  acid,  and  precipitating 
or  separating  the  element  associated  with  hydrogen.  It  is  therefore  a 
deodorant  and  antiseptic.  The  vapor  of  bromine  is  intensely  irritant 
to  the  air-passages.  It  combines  with  the  water  and  sets  free  ozone, 
which  energetically  attacks  the  mucous  membrane.  In  sufficient  quan- 
tity, laryngitis,  bronchitis,  and  pneumonia  will  be  produced  by  the 
inhalation  of  its  vapor.  Applied  in  the  liquid  form,  and  undiluted, 
bromine  acts  as  an  energetic  and  very  painful  escharotic.  A  brownish 
slough  is  formed,  which  is  afterward  slowly  detached.  Internally,  by 
the  stomach,  bromine  acts  as  a  corrosive  poison,  producing  violent  gas- 
tritis, and  the  phenomena  of  depression  and  collapse,  which  attend  the 
action  of  corrosive  poisons  in  general. 

THERAPY. — The  vapor  of  bromine  is  an  efficient  remedy  in  acute 
coryza  and  hay-asthma :  ]J  Bromi,  3  ss  ;  alcoholis,  f  iv.  M.  Sig. : 
For  inhalation.  A  small  quantity  of  this  solution  may  be  placed  in 
a  wide-mouthed  vial,  and  vaporized  by  the  warmth  of  the  hand.  The 
vapor  should  be  snuffed  into  the  nose.  It  probably  acts,  as  already 
explained,  by  setting  free  ozone.  The  activity  of  the  pollen  of  plants, 
the  presence  of  which  gives  rise  to  the  symptoms  of  hay-asthma,  is 
destroyed.  The  offensiveness  of  an  ozcena  may  be  removed  by  the 
same  expedient.  Chronic  nasal  catarrh  may  not  unfrequently  be 


372  ANTISEPTICS. 

greatly  benefited  by  the  vapor  of  bromine.  Hammond  has  pro- 
posed the  internal  use  of  a  solution  of  bromine,  as  a  substitute  for 
the  bromides  in  the  treatment  of  epilepsy.  Besides  its  disagree- 
able qualities,  and  its  irritant  action,  it  has  no  advantages  over  the 
bromides. 

The  most  important  use  of  bromine  is  as  an  escharotic.  For  the 
destruction  of  chancre,  it  is  probably  the  best  caustic.  Hospital  gan- 
grene, the  experience  of  the  rebellion  demonstrated,  was  more  cer- 
tainly arrested  by  bromine  than  by  any  other  escharotic. 

For  the  destruction  of  carcinoma  uteri,  this  agent  is  preferred  by 
some  eminent  gynaecologists.  When  used  for  these  purposes,  pure 
bromine  is  applied,  by  means  of  a  glass  rod,  thoroughly,  to  the  dis- 
eased or  sloughing  or  gangrenous  surface. 

The  objections  to  the  use  of  bromine  are  its  fetid  odor,  its  vola- 
tility (boils  at  117°  Fahr.),  and  the  pain  which  attends  its  escharotic 
action. 

Gaseous  Enemata  and  Inhalations. — Although  some  observations 
have  been  made  on  this  topic  (pages  8  and  9),  the  remarkable  de- 
velopment the  method  has  undergone,  and  the  absorbed  attention 
given  to  the  whole  subject  by  the  medical  profession  and  the  pub- 
lic, seem  to  require  that  some  additional  information  be  laid  before 
our  readers. 

Rectal  injections  of  gas,  as  now  employed,  we  owe  to  Bergeon,  of 
Lyons,  France.  It  is  a  curious  fact,  however,  that  the  method  is  a 
mere  revival  of  a  practice  carried  on  about  a  century  ago.  Fallen 
into  complete  oblivion,  the  practice  has  been  revived  by  a  set  of  cir- 
cumstances rather  accidental  than  designed.  Rectal  injections  are 
among  the  measures  utilized  at  medicinal  springs  to  procure  the  maxi- 
mum effects  from  the  waters,  especially  of  those,  like  the  sulphurous, 
that  are  disagreeable  to  the  sense  of  taste.  It  was  ascertained  that 
the  gases  contained  in  these  waters — carbonic-acid  and  sulphydric-acid 
gases — are  the  constituents  that  accomplish  the  good  effects  observed 
in  cases  of  phthisis,  and  hence  the  next  step  consisted  in  the  applica- 
tion of  the  gases  themselves.  The  experimental  observations  of 
Bernard  were  then  recalled,  and  also  his  explanation  of  the  remark- 
able fact  that  these  gases  thrown  into  the  rectum  escape  by  the  lungs, 
and  do  not  therefore  reach  the  cerebro-spinal  centers.  Further  his- 
torical researches  have  brought  to  light  the  observations  made  toward 
the  close  of  the  eighteenth  century,  and  every  point  almost  is  found 
to  be  completely  anticipated.  Priestley,  the  discoverer,  and  Bed- 
does  and  Percival,  the  clinicians,  are  thus  disclosed  to  us  as  having 
used  the  same  gases,  by  the  same  method,  and  for  the  same  disease. 
Dr.  Bergeon  has  invented  a  useful  contrivance  for  making,  wash- 
ing, storing  up,  and  injecting  the  gases,  and  in  an  incredibly  short 


GASEOUS  ENEMATA  AND  INHALATIONS.  373 

time  his  method  and  apparatus  have  been  employed  in  all  civilized 
countries. 

It  need  hardly  be  formally  asserted  that  improvements,  or,  at 
least,  modifications  in  the  method,  have  been  proposed.  The  inhala- 
tion of  the  same  gases  has  been  substituted  for  the  injection,  by  Dr. 
Dupont,  of  Lyons,  and  with  manifest  advantage.  The  sedative  effects 
of  carbonic-acid  gas,  and  the  germicide  action  of  sulphureted  hydro- 
gen, are  obtained  directly  by  inhalation,  and  without  the  need  of  ap- 
paratus. There  is,  however,  now,  a  material  having  active  germicide 
powers,  which  is  applied  by  inhalation  with  entire  facility.  We 
refer  to  the  combination  of  gases,  liquefied,  known  as  "  Pictet  liquid.'* 
It  consists  of  sulphurous-acid  and  carbonic-acid  gases,  liquefied  by  a 
pressure  of  three  atmospheres,  and  stored  in  siphon  bottles.  When 
the  valve  of  the  bottle  is  opened  the  gases  escape,  and  so  intense  is 
the  cold  caused  by  the  rapid  evaporation  that  a  part  of  the  carbonic 
anhydride  is  frozen  into  snow.  Pictet  liquid  is  a  powerful  germicide, 
and  hence  its  utility  in  affections  of  the  broncho-pulmonary  tract,  and 
to  prevent  the  development — the  pullulation — of  the  bacillus  tuber- 
culosis. If  the  reader  will  refer  to  the  article  on  sulphurous  acid,  he 
will  find  there  some  observations  on  the  powers  of  this  substance 
as  a  remedy  in  tuberculosis,  and  on  the  comparative  safety  of  its 
inhalation. 

So  powerful  a  preparation  as  the  Pictet  liquid  must  be  inhaled 
with  care  and  discretion,  but,  as  pyridine  is  inhaled,  this  liquid  can  be. 
A  closet,  or  room  of  small  dimensions,  which  can  be  closed,  is  selected  ; 
all  carpets,  hangings,  bedding,  and  furniture,  except  a  small  table  and 
chair,  are  removed  ;  the  slightest  pressure  on  the  valve  permits  a 
little  gas  to  escape,  and  diffusion  through  the  air  of  the  room  then  oc- 
curs. As,  indeed,  only  the  patient  can  judge  accurately  of  the  effect 
produced,  he  should  be  instructed  to  permit  the  gas  to  escape  in  very 
minute  quantity  until  the  amount  desired  is  obtained.  A  peculiar 
brassy  taste,  a  slight  sense  of  constriction  of  the  throat,  a  little  cough, 
and  a  faint  feeling  of  oppression,  are  the  effects  to  be  obtained  and  to 
be  kept  up  for  an  hour  or  two  at  each  sitting,  twice  or  three  times  a 
day.  If  begun  with  caution,  and  conducted  with  discretion,  the  very 
best  results  may  be  expected. 

Sufficient  experience  has  now  been  had  to  enable  a  judgment  to  be 
formed  of  the  real  value  of  gas  enemata  in  the  treatment  of  pulmonary 
diseases.  There  are,  and  have  been  from  the  first,  several  embar- 
rassing considerations  in  the  way  of  correct  conclusions.  The  novelty 
of  the  expedient,  the  high  claims  put  forth,  the  reported  cures,  and 
sudden  enthusiasm,  inflamed  alike  the  imaginations  of  patient  and 
physician,  and  a  sober  estimate  of  the  actual  value  of  gas-injections 
was  well-nigh  impossible.  Thus  much  may  be  maintained  as  true, 
however — many  patients  are  quickly  benefited,  cough,  expectoration, 


374  ANTISEPTICS. 

fever,  and  sweats  subsiding,  while  the  appetite  improves,  and  the  gen- 
eral condition  grows  rapidly  better  ;  but  it  is  found  presently  that 
the  bacillus  does  not  disappear,  and  that  the  improvement  is  more 
apparent  than  real,  is  not  maintained,  and  that  the  continued  use  of 
gas-injections  becomes  irksome,  at  last  impossible.  In  not  a  few  in- 
stances the  practice  can  not  be  carried  out  because  of  the  local  irrita- 
tion ;  and  there  are  many  phthisical  subjects  not  amenable  to  the 
method  at  all,  or  have  a  natural  inaptitude  that  admits  of  no  training. 
There  appears  to  be  a  growing  conviction  that  those  phthisical  sub- 
jects who  have  experienced  much  benefit  from  the  treatment  owed 
this  result  to  the  influences  so  strongly  affecting  the  imagination  of 
both  patient  and  practitioner. 

Various  examples  of  asthma,  of  emphysema,  and  of  chronic  bron- 
chitis have  been  reported  cured,  but  the  fallacy  underlying  these 
statements  is  only  too  obvious.  Spasmodic  asthma — the  neurosis — 
it  is  probable,  can  be  cured,  and  a  single  gas-injection  might  suffice ; 
but  the  conditions  are  greatly  different  in  the  other  maladies,  and, 
although  very  striking  improvement  may  be  witnessed,  cures  do  not 
necessarily  follow,  nor,  indeed,  have  they  been  effected.  After  a 
candid  survey  of  the  whole  subject,  the  author  finds  himself  in  this 
attitude — that  the  inhalation  of  gases  is  a  more  rational,  effective, 
and  convenient  method  of  treating  pulmonary  diseases  than  by  rectal 
injections. 

Besides  the  gases  referred  to  in  this  section  there  are  certain  vapor- 
izable  liquids  and  solids  that  are  utilized  in  the  treatment  of  pulmo- 
nary affections  by  the  method  of  inhalation  that  will  be  considered 
elsewhere  in  this  work.  Under  their  respective  heads  observations 
on  such  vaporizable  liquids  as  pyridine,  carbon  sulphide,  ethyl-iodide, 
and  ethyl-bromide  will  be  found,  and  the  attention  of  the  reader  is 
therefore  directed  to  them.  Such  vaporizable  solids  as  iodine  and 
iodoform  are  also  available  for  the  method  of  inhalation,  but  they 
require  a  special  arrangement  for  converting  the  solid  into  vapor  by 
means  of  heat.  Various  special  contrivances  exist  for  producing  effects 
of  a  similar  kind,  when  chloride  of  ammonium  is  formed  by  the  union 
of  the  vapors  composing  it. 

Referred  to,  for  gas  injections  : 

BEDDOES,  DR.     Quoted  by  Dupont. 

BERGEON,  DR.     Bui.  Gen.  de  Therap.     Various  articles  during  1886  and  188Y. 

DUJARDIN-BEAUMETZ.     Bui.  Gen.  de  Therap.    November,  1886. 

DCPONT,  DR.  MAURICE.     Bui.  Gen.  de  Therap.    January  15, 1887. 

DURAND-FARDEL,  DR.     Quoted. 

MINOT,  DR.  FRANCIS.     The  Medical  Record  for  1887. 

PAUL,  DR.  C.     Apparatus  for  Gas  Injections. 

PEBCIVAL,  DR.     On  Fixed  Air.     1768. 

PRIESTLEY,  Da.     Experiences  mth  Different  Kinds  of  Fixed  Air.     1774. 


CARBOLIC   ACID.  375 

Acidum  Carbolicum. — Carbolic  acid.  Phenique  acide,  Fr. ;  Car- 
bolsdure,  Ger.  A  product  of  the  distillation  of  coal-tar.  Is  either 
in  acicular  crystals  or  in  crystalline  masses  ;  white  or  colorless 
when  perfectly  pure,  but,  even  when  slightly  impure,  either  reddish 
or  becoming  so  on  exposure  ;  deliquescent  and  readily  assuming 
the  liquid  state  in  the  presence  of  a  little  water,  yet  not  dissolv- 
ing ;  of  a  strong  odor  and  taste,  recalling  those  of  creosote,  but 
distinct ;  fusible  at  from  93°  to  106°,  forming  an  oily  liquid.  It 
is  soluble  in  from  twenty  to  thirty-three  parts  of  water,  the  purest 
being  most  soluble.  Alcohol,  ether,  chloroform,  glycerin,  and  the 
essential  oils,  dissolve  it  freely.  It  combines  with  alkalies  and  oth- 
er salifiable  bases,  but  its  compounds  have  still  an  alkaline  reaction 
and  are  decomposed  by  the  feeblest  acids,  even  by  carbonic  acid. 
Dose,  gr.  £— gr.  j. 

Acidum  Carbolicum  Crudum. — Impure  carbolic  acid.  Is  either 
colorless  or  has  a  brown  shade.  It  consists  of  carbolic  and  cresylic 
acids,  in  variable  proportion,  with  impurities  derived  from  coal-tar, 
which  vary  from  ten  to  thirty  per  cent. 

Glyceritum  Acidi  Carbolici. — Glycerite  of  carbolic  acid.  (Twenty 
grm.  of  carbolic  acid  ;  80  grm.  of  glycerin.) 

Aqua  Acidi  Carbolici. — Carbolic-acid  water  (not  official).  (Gly- 
cerite of  carbolic  acid,  3  x ;  water,  one  pint.)  Dose,  a  teaspoonful  to 
a  half  ounce. 

Unguentum  Acidi  Carbolici. — Ointment  of  carbolic  acid.  (Car- 
bolic acid,  5  grm. ;  ointment,  95  grm.) 

ANTAGONISTS  AND  INCOMPATIBLES. — Combination  with  alkalies  di- 
minishes, but  does  .not  entirely  check,  the  physiological  activity  of 
carbolic  acid.  Saccharate  of  lime,  or  lime,  is  probably  the  most  effi- 
cient antagonist  from  the  chemical  point  of  view  (Th.  Husemann). 
In  cases  of  poisoning,  this  substance  should  be  given  freely.  The 
mucous  membrane  should  be  protected  as  far  as  possible  by  the  ad- 
ministration of  vegetable  demulcents,  but  not  by  oils  and  glycerin, 
which  favor  absorption.  I  am  indebted  to  Dr.  A.  C.  Post,  of  New 
York,  in  a  verbal  communication,  for  the  important  fact  that  atropine 
is  a  physiological  antagonist  to  the  systemic  symptoms  induced  by 
carbolic  acid.  He  was  induced  to  administer  atropine  in  a  case  of 
poisoning  by  carbolic  acid,  on  observing  the  minutely  contracted  pu- 
pils and  the  failing  circulation.  The  result  was  successful.  Similar 
success  has  attended  the  same  practice  in  other  cases.  Experiments 
on  animals  have  also  demonstrated  the  existence  of  this  antagonism, 
which  may  now  be  regarded  as  an  established  fact.  The  rules  for 
guidance  in  the  administration  of  atropine  are  the  same  as  in  other 
cases  :  a  sufficient  quantity  of  the  antagonist  is  administered  to  main- 
tain dilatation  of  the  pupil  and  to  overcome  the  depression  of  the  cir- 


376  ANTISEPTICS. 

culation  and  respiration.     Elimination  should  also  be  promoted  by  th« 
free  use  of  diluents. 

SYNERGISTS. — All  of  the  phenols,  the  antiseptics,  the  motor  depres^ 
sants,  etc.,  increase  the  effects  of  carbolic  acid. 

PHYSIOLOGICAL  ACTIONS. — Applied  to  the  integument  or  to  the 
mucous  membrane,  carbolic  acid  produces  a  burning  sensation  of 
short  duration,  and  there  is  formed  a  whitish,  superficial  eschar,  which 
subsequently  becomes  brownish.  The  taste  of  carbolic  acid  is  sweet- 
ish, cooling,  and  then  pungent  and  hot.  When  swallowed  by  accident 
or  design,  the  mucous  membrane  appears  as  if  brushed  over  with  a 
strong  solution  of  nitrate  of  silver,  and  becomes  hard  and  dry  like 
leather.  This  appearance  is  observable  about  the  lips,  fauces,  the 
ossophagus,  the  cardiac  and  pyloric  extremities  of  the  stomach,  and 
the  summits  of  the  folds  of  the  mucous  membrane  in  the  organ  gen- 
erally. This  change  in  the  condition  of  the  membrane  is  due  to  the 
power  of  carbolic  acid  to  coagulate  the  albumen  of  the  tissues.  Vom- 
iting is  not  constant,  even  when  toxic  doses  are  swallowed,  and  the 
vomited  matters  smell  of  the  poison.  From  medicinal  doses,  a  cooling, 
rather  grateful  sedative  effect  is  experienced  in  the  stomach.  It  dif- 
fuses into  the  blood  with  great  facility,  from  the  stomach,  from  the 
external  integument,  and  from  wounded  surfaces.  Cases  of  poison- 
ing have  resulted  from  application  to  a  patch  of  psoriasis  (Toel),  to 
scabies  (Hoppe-Seyler,  Machin),  to  the  uterine  cavity,  after  the  enu- 
cleation  of  a  fibroid  (Rheinstadter),  to  abscesses  (Kohler,  Wallace, 
White),  to  the  rectum  for  the  relief  of  ascarides  (Pinkham,  Mi- 
chaelis),  and  to  the  integument  and  wounds,  in  cases  of  antiseptic 
surgery.  Diffusion  takes  place  with  such  rapidity,  from  these  various 
sources,  that  formidable  symptoms  arise  in  a  few  minutes.  The 
amount  necessary  to  produce  distinct  effects  varies  ;  besides  the  dif- 
ference due  to  age,  there  are  variations  in  susceptibility.  A  one-per-cent 
solution  has  caused  serious  symptoms  when  injected  into  an  abscess 
and  into  the  rectum.  Six  drops  of  the  pure  acid  have  caused  danger- 
ous symptoms,  and  a  teaspoonful  has  terminated  fatally,  but  one  case 
is  reported  in  which  this  amount  was  recovered  from  when  taken  by  a 
child  two  and  a  half  years  old  (Dessau).  A  tablespoonful  has  caused 
death  in  several  instances  (Cowling,  Packer,  and  others).  In  Hoppe- 
Seyler's  cases,  while  the  two  apprentices  were  rubbing  each  other's 
backs,  both  were  seized  suddenly  with  giddiness,  vertigo,  and  tension 
of  the  head,  and  quickly  passed  into  unconsciousness.  These  effects 
are  also  experienced  when  the  poison  is  taken  into  the  stomach.  The 
warnings  of  danger,  which  may  be  expected  when  the  remedy  is 
brought  in  contact  with  the  tissues  at  any  point,  are,  besides  the  local 
irritation,  sudden  vertigo,  contracted  pupils,  pallor  of  the  face,  em- 
barrassed respiration,  and  feeble  circulation.  When  the  dose  is  a  fatal 
One,  unconsciousness  quickly  supervenes,  the  breathing  becomes  ster 


CARBOLIC  ACID.  377 

torous,  the  surface  grows  cold,  the  action  of  the  heart  gets  more  and 
more  feeble,  and  death  finally  occurs  from  failure  of  respiration.  Con- 
vulsions occur  in  animals,  but  in  man  this  symptom  is  wanting,  or  at 
most  fibrillary  trembling,  and  some  trismus  of  the  jaws,  are  present. 

The  changes  in  the  blood  induced  by  carbolic  acid  have  been  much 
disputed.  That  it  enters  the  blood  as  carbolic  acid  seems  positively 
established,  although,  having  acid  properties,  it  may  become  a  carbolate. 
The  acid  has  been  discovered  in  the  blood  by  Hoppe-Seyler.  That  it 
appropriates  oxygen  and  thus  undergoes  some  change  in  the  blood  is 
highly  probable.  Husemann  maintains  that  the  blood  in  carbolic-acid 
poisoning  is  very  much  altered  in  character,  becoming  dark  in  color 
and  coagulating  with  difficulty,  but  in  the  reports  of  various  post-mor- 
tem examinations  it  is  remarked  that  the  blood  was  coagulated  in  the 
heart  and  great  venous  trunks.  Outside  of  the  body  the  blood  is 
quickly  changed  on  the  addition  of  carbolic  acid,  but  these  changes  do 
not  correspond  to  those  which  occur  within  the  body.  The  action  of 
the  heart  is  at  first  slowed,  but  toward  the  end  it  becomes  rapid.  The 
blood-pressure  falls  considerably  below  the  normal,  due,  Hoppe-Seyler 
says,  to  vaso -motor  paresis.  The  first  slowing  of  the  heart  is  caused 
by  stimulation  of  the  end-organs  of  the  vagus,  and  is  prevented  by 
division  of  the  trunk  of  the  nerve.  The  subsequent  rapid  action  is 
due  to  the  removal  of  the  inhibition  from  paralysis  of  the  vagus.  Res- 
piration is  at  first  stimulated  and  the  respiratory  acts  are  more  frequent, 
but  they  are  also  more  shallow.  Division  of  the  pneumogastrics  does 
not  entirely  prevent  this  stimulation,  although  it  lessens  the  effect, 
whence  it  is  concluded  that  carbolic  acid  also  stimulates  the  respiratory 
center  in  the  medulla  (Salkowsky).  This  conclusion  is  strengthened 
by  the  fact  that,  if  the  vagi  are  previously  divided,  the  administration 
of  carbolic  acid  will  still  increase  the  respiratory  acts  for  a  time,  show- 
ing that  the  stimulation  of  respiration  must  be  effected  by  an  action 
on  the  end-organs  of  the  vagi  in  the  lungs  as  well  (Salkowsky).  Low- 
ering of  the  temperature  has  been  constantly  observed  in  the  experi- 
ments on  animals,  and  in  the  cases  of  poisoning  of  man.  The  surface 
of  the  body  is  cool,  and  more  or  less  livid.  There  are  several  factors 
concerned,  doubtless,  in  the  reduction  of  temperature.  The  diminu- 
tion in  the  blood-pressure  and  the  arrested  oxidation  are  the  chief. 
The  power  of  carbolic  acid  to  reduce  the  temperature  of  fever  is  also 
clear,  but  in  this  respect  it  is  inferior  to  salicylic  acid  (Eisenstein).  In 
cases  of  poisoning  the  reduction  of  temperature  reaches  several  de- 
grees, but  in  the  normal  condition  in  man  ordinary  medicinal  doses 
have  but  little  effect  in  this  direction. 

A  more  or  less  minutely  contracted  pupil  is  a  nearly  constant  phe- 
nomenon in  carbolic-acid  poisoning.  It  can  hardly  be  doubtful  that 
this  effect  is  due  to  paralysis  of  the  radiating  fibers,  leaving  the  cir- 
cular fibers  unopposed.  Carbolic  acid  unquestionably  acts  on  the 


378  ANTISEPTICS. 

cerebral  lobes — on  the  centers  of  conscious  impressions — and  suspends 
their  functions.  Vertigo  and  singing  in  the  ears  occur,  and  then  con- 
sciousness is  lost,  the  reflexes  are  suspended,  and  complete  muscular 
resolution  ensues.  In  warm-blooded  animals  clonic  convulsions  are 
produced,  succeeded  by  paralysis.  By  direct  application,  as  Bill  was 
the  first  to  demonstrate,  carbolic  acid  suspends  the  irritability  of  the 
sensory  nerves.  If  a  tract  of  the  integument  be  painted  over  with 
pure  carbolic  acid,  an  incision  may  be  made  into  the  part  without  the 
least  pain  being  experienced.  The  peripheral  nerves,  sensory  and  mo- 
tor, are  not  affected  by  the  systemic  action.  The  muscles  after  poison- 
ing respond  energetically  to  the  usual  forms  of  stimulation.  It  follows, 
then,  that  the  action  of  the  poison  is  centric  and  not  peripheral  (Sal- 
kowsky,  Lemaire,  Rothe). 

The  elimination  of  carbolic  acid  takes  place  by  various  channels 
of  excretion,  chiefly  by  the  urine.  It  may  be  detected  by  the  odor  in 
the  breath  of  poisoned  animals  (Lemaire).  It  has  been  found  in  the 
saliva  by  Hoppe-Seyler,  but  Bill  could  not  detect  it  in  the  perspiration 
or  in  the  faeces.  Hoffmann  maintains  that  carbolic  acid  undergoes  oxi- 
dation in  the  blood,  but,  as  a  part  of  it  may  be  separated  unchanged 
from  the  urine,  this  statement  is  not  wholly  true.  That  much  of  the 
carbolic  acid  taken  is  oxidized  before  being  excreted  is  proved  by  the 
character  of  a  secondary  product  which  appears  in  the  urine.  One  of 
the  earliest  indications  of  the  toxic  action  of  carbolic  acid,  especially 
when  applied  locally,  is  a  dark-greenish,  blackish,  or  smoky  hue  of  the 
urine.  Although  this  appearance  does  not  actually  prove  that  danger 
to  life  is  imminent,  it  is  a  warning  to  be  heeded.  One  of  the  results 
of  the  oxidation  of  carbolic  acid  is  the  formation  of  oxalic  acid.  The 
same  process  takes  place  in  animals,  in  whom  carbolic  acid  is  excreted 
as  oxalic.  Doubt  has  been  thrown  on  the  methods  by  which  carbolic 
acid  is  detected  in  the  urine  of  those  taking  it,  through  the  experiments 
of  Stadeler,  who  has  discovered  that  carbolic  acid  is  present  in  normal 
urine.  Hoppe-Seyler,  however,  has  proved  that,  by  Stadeler's  process* 
carbolic  acid  is  made  from  the  indican  of  the  urine  (Hermann).  The 
elimination  of  carbolic  acid  taking  place  through  so  many  channels  is 
readily  effected,  and  probably  the  whole  amount  is  thrown  out  in 
twenty-four  hours.  When  death  occurs  very  quickly  in  fatal  cases  of 
poisoning,  the  tissues  and  organs  will  smell  distinctly  of  the  poison 
(Ogston).  Death  has  occurred  in  a  few  minutes — in  a  great  majority 
of  the  fatal  cases  within  two  hours  (Jeffreys),  and  is  rarely  postponed 
to  two  days.  The  amount  of  carbolic  acid  present  will  therefore  vary. 

There  are  no  characteristic  post-mortem  appearances,  except  the 
changes  wrought  at  the  points  of  contact  with  the  acid.  The  mucous 
membrane  of  the  mouth,  fauces,  oesophagus,  and  stomach,  where  acted 
on,  appears  corrugated,  tough,  and  discolored — whitish  changing  to 
brownish  discoloration,  surrounded  by  a  zone  of  hyperaemia,  or  capil- 


CARBOLIC  ACID.  379 

iary  haemorrhages  here  and  there  sloughing  off.  Congestion  of  the 
viscera  generally,  especially  of  the  brain  and  the  meninges,  is  a  con- 
stant phenomenon.  The  lungs  are  oedematous  as  well  as  congested. 
The  heart  may  be  distended  with  loose  clots,  and  relaxed,  or  empty 
and  contracted.  By  some  observers  changes  akin  to  those  of  phos- 
phorus-poisoning have  been  uniformly  discovered  (Neumann),  i.  e., 
acute  fatty  degeneration  of  liver,  heart,  kidneys,  and  other  organs, 
notably  the  renal  epithelium.  Husemann,  Salkowsky,  and  others, 
deny  the  reality  of  these  observations,  so  that  further  examinations 
are  necessary  to  determine  this  point. 

THERAPT. — Nausea  and  vomiting  due  to  an  irritable  state  of  the 
stomach-nerves  are  relieved  by  carbolic  acid.  Combination  with  bis- 
muth enhances  the  effect.  IJ  Acidi  carbolici,  grs.  iv  ;  bismuthi  sub- 
nitrat.,  3ij;  mucil.  acacise,  |  j;  aquae  menth.  pip.,  f  iij.  M.  Sig.  :  A 
tablespoonful  every  two,  three,  or  four  hours.  Attacks  of  cholera  mor- 
bus  and  cholera  infantwn  are  not  unfrequently  very  promptly  arrested 
by  the  exhibition  of  carbolic  acid,  or  the  combination  of  carbolic  acid 
and  bismuth-  Eructations  of  gas,  due  to  the  fermentation  of  foods, 
and  the  vomiting  of  yeast-like  matters,  especially  when  due  to  the 
presence  of  sarcina,  are  often  arrested  by  this  remedy.  Good  results 
have  been  obtained  by  the  use  of  carbolic  acid  in  Asiatic  cholera. 
Combination  with  iodine  is  said  to  be  more  effective  (Choleratropfen). 
3  Acidi  carbolici,  grs.  iv  ;  tinct.  iodi,  gtt.  xvj  ;  aquse  menth.  pip., 
|  iv.  M.  Sig. :  A  tablespoonful  every  hour,  or  oftener.  The  same 
formula  has  been  used  successfully  in  cholera  nostras  and  cholera  in- 
fantuin  (Rothe). 

Based  on  its  power  to  arrest  the  action  of  ferments,  carbolic  acid 
has  been  used,  with  certainly  temporary  good  results,  in  diabetes  of 
hepatic  origin  (Ebstein,  Habershon). 

Inhalations  of  carbolic-acid  spray  possess  a  high  degree  of  utility 
in  chronic  nasal  catarrh,  hay-asthma,  chronic  bronchitis,  and  whoop- 
ing-cough, A  solution  in  water,  to  the  proportion  of  one  per  cent,  is 
a  suitable  solution  for  this  purpose.  It  may  be  combined  with  the 
tincture  of  iodine.  The  efficacy  of  these  inhalations  in  hay-asthma 
and  in  whooping-cough  is  probably  due  to  the  fact  that  carbolic  acid 
destroys  the  minute  organisms  (cacobacteria,  pollen),  on  the  presence 
of  which  the  morbid  action  in  these  maladies  depends  (Letzerich).  The 
vapor  of  carbolate  of  iodine  may  be  inhaled  in  these  diseases.  The 
warmth  of  the  hand  suffices  to  vaporize  a  mixture  of  carbolic  acid  and 
tincture  of  iodine. 

In  pulmonary  phthisis,  when  there  is  much  teasing  cough,  or  when 
expectoration  is  profuse  and  foul-smelling,  these  inhalations  are  ser- 
viceable. In  gangrene  of  the  lung,  carbolic  spray  and  the  acid  inter- 
nally are  used  to  destroy  the  fetor.  A  one-per-cent  solution  of  car- 
bolic acid  and  a  mixture  of  carbolic  acid  and  iodine  have  been  injected 


380  ANTISEPTICS. 

with  asserted  advantage  into  phthisical  cavities  through  the  parietes 
of  the  thorax. 

Internally,  also,  creosote  and  carbolic  acid,  especially  the  former, 
have  been  used  with  conspicuously  good  results  in  the  treatment  of 
the  several  forms  of  consumption,  except  phthisis  florida.  Probably 
the  most  useful  observations  to  illustrate  this  point  are  those  of  MM. 
Bouchard  and  Gimbert.  They  used  pure  creosote  from  wood,  and  in 
the  following  formula :  Pure  creosote,  13*5  parts  ;  tincture  of  gentian, 
30  parts  ;  alcohol,  250  parts,  and  sufficient  Malaga  wine  to  make  up  a 
thousand  parts.  Of  this  solution  from  two  to  five  tablespoonfuls  are 
taken  daily.  In  other  cases  the  creosote  was  given  in  cod-liver  oil, 
which  is  an  excellent  vehicle — 2  parts  of  pure  creosote  to  150  parts  of 
cod-liver  oil.  The  daily  quantity  varied  from  six  to  nine  grains,  and 
in  rare  cases  from  twelve  to  fifteen  grains.  Of  ninety-three  cases  of 
phthisis  treated  with  this  remedy,  twenty-five  were  apparently  cured, 
twenty-nine  were  improved,  eighteen  remained  no  better,  and  twenty- 
one  died.  Creosote  thus  had  a  good  effect  in  fifty-four  out  of  ninety- 
three  cases.  The  evidences  of  improvement  consisted  in  the  diminution 
of  the  expectoration,  cough,  and  fever,  and  increase  in  the  appetite, 
strength,  and  weight  of  body.  The  diminution  of  the  expectoration, 
and  consequently  of  the  cough,  was  the  first  evidence  of  improvement, 
although  at  the  beginning  of  the  treatment  the  cough  is  apt  to  be  in- 
creased for  a  short  time  by  creosote.  If  the  cough  and  expectoration 
are  constantly  increased,  the  medicine  must  be  stopped.  The  danger 
of  haemoptysis  is  rather  lessened  than  increased  by  the  creosote  treat- 
ment. Schnitzler,  of  Vienna,  has  employed,  recently,  the  subcutane- 
ous injection  of  carbolic  acid  in  more  than  one  hundred  cases  of  con- 
sumption. He  practiced  the  injections  daily,  sometimes  twice  a  day, 
administering  each  time  from  one  eighth  to  one  fourth  of  a  grain. 
The  result  was,  in  most  cases,  the  fever  was  reduced,  the  pulse  became 
slower  and  stronger,  and  the  night-sweats  were  diminished.  He  con- 
cludes that  these  injections  are  nearly  if  not  quite  as  effective  in  re- 
lieving hectic  as  quinine. 

Influenced  by  the  germ  theory  of  disease,  carbolic  acid  has  been 
much  prescribed  in  the  treatment  of  typhoid  fever,  diphtheria,  scarlet 
fever,  erysipelas,  etc.  Whether  the  theory  be  true  or  false,  there  can 
be  no  doubt  of  the  good  effects  of  creosote  and  of  carbolic  acid  in 
these  diseases.  Pecholier,  of  Montpellier,  has  given  creosote  in  sixty 
cases  of  typhoid,  set  apart  for  study  of  the  results  of  the  action. 
Good  effects  were  obtained  ;  the  temperature  kept  down  ;  the  delir- 
ium and  insomnia  were  much  less  ;  the  intestinal  disturbance  declined, 
and  thus  the  violence  of  the  disease  was  distinctly  lessened.  M.  Cha- 
pelle  maintains  that  it  cuts  short  an  attack  of  typhoid.  In  the  other 
maladies  above  named,  the  evidence  of  the  good  effects  of  carbolic 
acid  is  constantly  accumulating.  Besides  the  internal  administration, 


CARBOLIC  ACID.  381 

local  application  to  the  fauces  of  spray,  or  suitable  solutions,  are  use- 
ful in  diphtheria  and  scarlet  fever  to  remove  fetor,  and  to  destroy  the 
germs  of  contagion  which  may  be  lodged  there.  Recently  Rothe  has 
treated  a  number  of  cases  of  typhoid  fever,  with  great  success,  by  a 
mixed  antiseptic  and  antipyretic  method,  in  which  he  employs  carbolic 
acid  and  iodine  administered  in  infusion  of  digitalis.  The  author  has 
for  several  years  treated  the  cases  of  typhoid  and  typho-malarial  fever 
so  called,  which  have  been  in  his  hands,  with  a  drop  each  of  tincture 
of  iodine  and  liquefied  carbolic  acid  every  two  or  three  hours,  with 
results  which  were  certainly  most  favorable.  As  Rothe  has  observed, 
this  antiseptic  treatment  lowers  the  heat,  lessens  the  diarrhoea,  im- 
proves the  mental  state,  and,  indeed,  diminishes  the  severity  of  the 
disease  remarkably.  The  value  of  carbolic  acid  as  a  remedy  in  mala- 
rial fevers  seems  now  conclusively  established.  The  experiences  of 
Eisenstein  in  the  Vienna  General  Hospital  are  especially  valuable. 
He  obtained  distinct  curative  effects  in  twenty-four  cases  of  the  tertian 
and  in  four  cases  of  the  quotidian  type  of  intermittents.  The  author 
has  found  the  combination  of  carbolic  acid  and  iodine  of  great  value 
in  chronic  malarial  infection,  and  in  the  more  acute  cases  after  quinine 
has  stopped  the  paroxysms.  As  an  antipyretic,  Eisenstein  justly  re- 
gards carbolic  acid  as  inferior  to  salicylic.  It  is  probable  that  resor- 
cin,  hydroquinone,  and  other  phenols,  will  prove  more  useful  than  either. 
Dr.  Lecaille  has  found  carbolic  acid  remarkably  efficacious  in  yellow 
fever,  and  even  after  the  occurrence  of  the  ominous  "  coffee-grounds  " 
vomit.  He  administers  it  both  subcutaneously  and  by  the  stomach. 

The  dose  of  carbolic  acid  for  internal  use  ranges  from  half  a  grain 
to  two  grains,  or  of  the  liquefied  acid  from  half  a  minim  to  two  min- 
ims. It  may  be  given  in  mint-water,  which  covers  the  odor  some- 
what. This  quantity  may  be  repeated  every  hour  or  two,  if  necessary, 
without  producing  ill  effects,  if  not  too  long  continued.  As  mentioned 
above,  the  quantity  given  by  Bouchard  and  Gimbert  sometimes 
reached  as  high  as  fifteen  grains  a  day.  The  mixture  of  bismuth, 
mucilage,  and  glycerin,  is  an  excellent  vehicle.  When  iodine  and 
carbolic  acid  are  given  together,  a  colorless  carbolate  is  formed  when 
they  are  dropped  into  water. 

PARENCHYMATOUS  INJECTION  OF  CARBOLIC  ACID. — The  deep-seated 
injection  of  carbolic  acid  has  been  proposed  and  successfully  practiced 
for  the  relief  of  various  morbid  states.  For  this  purpose  a  two-  to 
five-per-cent  solution  is  most  suitable.  A  solution  stronger  than  this 
may  excite  inflammation  in  the  part  and  coagulate  the  blood.  It  is 
directed  by  Huter  that  the  needle  of  the  hypodermatic  syringe  be  first 
inserted  into  the  inflamed  part,  and,  if  no  blood  flows  out  through  the 
needle,  it  will  be  known  that  a  vein  has  not  been  penetrated.  From 
twenty  to  thirty  minims  of  the  solution  are  then  injected.  The  injec- 
tions are  made  once  or  twice  a  day  in  acute  diseases,  and  on  alternate 


382  ANTISEPTICS. 

days,  or  less  frequently,  in  chronic  cases.  Very  remarkable  results 
have  been  obtained  from  these  injections  in  erysipelas  (Htiter,  Auf- 
recht)  and  in  pleuro-pneumonia  (Kunze). 

Dr.  Tessier,  of  the  Mauritius,  reports  that  intermittents  are  rapidly 
cured  by  the  injection  of  three  quarters  of  a  grain  of  carbolic  acid  dis- 
solved in  twenty  minims  of  water. 

The  parenchymatous  injection  of  carbolic  acid  is  more  especially 
adapted  to  the  treatment  of  certain  surgical  maladies.  Htiter  has 
employed  this  method  successfully  in  lupus,  chancroid,  secondary 
syphilitic,  abscesses,  ulcerations,  synovitis  (injected  into  the  affected 
joint),  fistulce,  enlarged  bursce,  hydrocele,  etc.  Levis,  of  Philadelphia, 
cures  hydrocele  by  injecting  liquid  carbolic  acid  into  the  sac  after 
drawing  off  the  fluid.  He  first  inserts  the  needle  of  the  syringe  so 
that  it  may  be  certain  the  point  rests  in  the  cavity.  Then  the  fluid  is 
drawn  off,  and  finally  the  acid,  a  drachm  or  two,  is  injected  through 
the  needle. 

LOCAL  APPLICATION  OF  CARBOLIC  ACID. — Itching  of  the  skin,  aris- 
ing from  any  cause,  is  allayed  by  sponging  the  part  with  a  solution  of 
carbolic  acid.  ^  Acid,  carbol.,  3  ij  ;  glycerini,  §  j ;  aqua  rosae  ad 
3  viij.  M.  Sig.  :  Lotion.  This  application  is  especially  serviceable 
in  pruriyo  and  prurigo  sinalis.  Carbolic  acid  is  an  effective  applica- 
tion in  parasitic  skin-diseases — -pityriasis  versicolor,  tinea  tonsurans, 
tinea  circinata,  favus,  scabies,  etc.  IJ  Acid,  carbol.,  3  j  ;  glycerini, 
|  j.  M.  Sig.:  Local  application  for  parasitic  skin-diseases.  The  in- 
ternal administration  of  carbolic  acid  should  be  conjoined  with  its  local 
use  in  prurigo,  chronic  eczema,  and  sycosis  par asitica. 

The  following  is  an  efficient  local  application  for  chilblains:  $ 
Acid,  carbol.,  3  j  ;  tinct.  iodi,  3  ij  ;  acid,  tannici,  3  ij  ;  cerat.  simpli- 
cis,  3"  iv.  M.  Sig.  :  Ointment. 

Undiluted  carbolic  acid  is  used  as  a  mild  escharotic  to  the  so-called 
mucous  patches,  to  condylomata,  vegetations,  etc.,  lupus,  scirrhus,  cau- 
liflower-growths, etc.  The  author  has  witnessed  results  which  appear 
to  him  to  justify  the  statement  that  carbolic  acid,  applied  undiluted 
to  the  cancerous  sore  and  injected  underneath,  limits  the  extension 
and  retards  the  growth  of  the  disease.  In  several  cases,  the  disease 
having  recurred  at  the  site  of  the  operation  for  its  removal,  the  author 
has  apparently  arrested  the  morbid  process  by  injecting  beneath  and 
into  the  new  formation  daily  a  syringeful  of  a  five-per-cent  solution 
of  carbolic  acid.  The  action  in  these  instances  seemed  to  be  local : 
there  were  none  of  the  evidences  of  systemic  impression  of  the  poison, 
and  no  diffusion  of  the  cancer-germs  took  place  from  the  point  of  in- 
fection. If  further  experience  confirms  these  observations,  we  have  in 
this  method  a  most  important  contribution  to  our  resources. 

Undiluted  carbolic  acid  is  an  efficient  application  to  ulcers  of  the 
cervix  uteri,  chronic  endo-cervicitis,  and  endo-metritis.  It  may  be  ap- 


CARBOLIC  ACID.  333 

plied  undiluted  without  risk  to  the  mucous  membrane  of  the  uterine 
cavity,  on  the  cotton-wrapped  probe,  after  preliminary  dilatation  of 
the  canal.  There  is,  probably,  no  better  means  of  treating  uterine 
catarrh. 

Solutions  of  carbolic  acid,  of  average  strength,  have  the  power  to 
check  suppuration,  and  to  correct  the  fetor  of  sloughing  and  ill-condi- 
tioned wounds.  The  methods  of  Mr.  Lister's  antiseptic  treatment  in- 
clude a  much  more  extended  application  of  carbolic  acid.  Embrac- 
ing the  fermentation  theory  of  M.  Pasteur,  Mr.  Lister  holds  to  the 
necessity  of  excluding  germs  from  contact  with  wounded  surfaces. 
Operations  by  the  method  of  Mr.  Lister  must  be  performed  under  and 
in  a  spray  of  carbolic  acid  (one  part  to  forty).  The  solution  may  be 
pulverized  by  the  ordinary  hand-ball  atomizer,  or  better  by  a  Siegle's 
steam  atomizer.  All  knives,  sponges,  and  ligatures  must  be  "  car- 
bolized  "  before  coming  into  contact  with  the  wounded  surface.  The 
antiseptic  dressing  is  thus  described  by  Mr.  Lister  :  "  It  consists  of 
two  pieces  of  folded  gauze  and  mackintosh  (fine  cotton  cloth  with  a 
layer  of  caoutchouc),  an  anterior  and  a  posterior  one.  The  wound  is 
covered  with  several  thicknesses  of  gauze  dipped  in  a  solution  of  car- 
bolic acid  (one  to  forty),  and  over  this  is  placed  the  folded  gauze  and 
mackintosh,  of  sufficient  size  to  extend  beyond  the  margins  of  the 
wound  in  all  directions."  The  dressing  is  confined  by  turns  of  a 
"  gauze  bandage,"  and  is  allowed  to  remain  undisturbed  for  from  two 
days  to  a  week,  "  the  general  rule  being  that  the  dressing  should  be 
changed  on  any  day  on  which  the  discharge  is  observed  to  have  ex- 
tended beyond  the  edge  of  the  folded  gauze." 

Antiseptic  gauze  consists  of  cotton  cloth  charged  with  the  follow- 
ing :  "  One  part  of  crystallized  carbolic  acid,  five  parts  of  common  res- 
in, and  seven  parts  of  solid  paraffin  " — the  paraffin  and  resin  are  first 
melted  together,  and  the  acid  is  then  incorporated  by  stirring.  A  very 
complicated  process,  too  elaborate  for  insertion  here,  is  described  by 
Mr.  Lister,  for  diffusing  the  above-described  mixture  equably  through 
the  cotton  cloth.  For  lubricating  instruments,  especially  catheters 
and  bougies,  he  advises  a  solution  of  one  part  of  carbolic  acid  in 
twenty  parts  of  olive-oil.  Carbolized  silk  sutures  are  "  prepared  by 
immersing  a  reel  of  the  silk  in  melted  beeswax,  mixed  with  about  a 
tenth  part  of  carbolic  acid,  and  drawing  the  thread  through  a  dry 
cloth  as  it  leaves  the  liquid,  to  remove  superfluous  wax." 

The  following  is  the  University  College  formula  for  the  prepara- 
tion of  carbolic-acid  plaster  :  "  Shellac,  75  ;  carbolic  acid,  25.  Melt 
the  shellac  with  8  of  the  acid,  and  then  add  the  remaining  17,  and  mix 
thoroughly.  The  mixture  should  be  spread  on  linen,  and  should  be 
coated  with  a  solution  of  gutta-percha  in  bisulphide  of  carbon." 

The  admirable  results  in  the  treatment  of  wounds  obtained  by  Lis« 
ter  have  been  fully  confirmed  by  various  competent  observers  (Nuss- 


384  ANTISEPTICS. 

baum,  Thiersch,  Volkmann,  Bardeleben),  and,  although  objectors  have 
risen  to  deny  the  superiority  of  the  method,  it  has  been  shown  that 
the  ill-success  complained  of  was  due  to  inattention  to  the  various  de- 
tails necessary. 

Toxic  SYMPTOMS  INDUCED  BY  CARBOLIC  ACID  WHEN  USED  EX- 
TERNALLY.— The  extraordinary  extent  to  which  carbolic  acid  is  now 
applied  in  surgical  practice  renders  it  necessary  to  devote  some  atten- 
tion to  the  symptoms  indicating  a  dangerous  degree  of  absorption. 
This  form  of  poisoning  occurs  under  two  forms  :  one,  sudden,  the 
patient  sinking  into  collapse  immediately  after  the  dressings  are  ap- 
plied ;  the  other,  occurring  insidiously,  after  some  weeks  of  treatment 
and  applications  of  the  antiseptic  dressings.  Kuster,  of  Berlin,  relates 
five  cases  of  the  first  form,  in  which  the  patients,  after  the  dressings 
were  applied,  sank  at  once  into  a  condition  of  collapse  like  the  state  of 
shock  from  a  most  formidable  surgical  operation.  Only  one  of  these 
cases  recovered.  The  diagnosis  of  this  toxic  state  from  surgical  shock 
will  be  referred  to  presently.  In  the  other  form  of  poisoning  the 
symptoms  appear  gradually,  and  are  apt  to  be'  attributed  to  a  com- 
mencing septicaemia.  Loss  of  appetite,  nausea,  feverishness,  head- 
ache, vertigo,  and  clonic  spasms,  are  first  experienced,  prostration  sets 
in,  and  a  more  or  less  profoundly  comatose  state  develops.  The  onset 
of  these  symptoms,  or  the  depression  which  initiates  the  morbid  phe- 
nomena in  the  first  form,  occurs  at  a  time  when  more  favorable  symp- 
toms are  properly  expected.  But  the  diagnosis  is  arrived  at  readily 
by  an  examination  of  the  urine.  The  change  in  the  color  and  the 
peculiar  odor  of  the  urine  observed  in  carbolic-acid  poisoning  have 
been  referred  to,  but  the  chemical  tests  are  more  important.  Accord- 
ing to  Baumann,  we  have,  in  Sonnenberg's  test,  the  best  means  of  de- 
termining the  presence  of  carbolic  acid.  This  test  depends  on  the  fact 
that  any  carbolic  acid  in  the  urine  unites  with  the  sulphates  to  form 
the  sulphocarbolates,  and  hence  it  consists  in  determining  the  amount 
of  normal  sulphates  present.  The  urine  is  first  acidulated  with  strong 
acetic  acid,  and  baric  chloride  is  then  added  in  excess.  A  copious 
precipitate,  consisting,  for  the  most  part,  of  baric  sulphate,  is  formed,  if 
the  urine  is  healthy  ;  but  if  it  contain  carbolic  acid,  scarcely  any  pre- 
cipitate will  be  thrown  down,  because  of  the  formation  of  soluble  sul- 
phocarbolates. The  researches  of  Baumann  have  furnished  us  with  an 
antidote  of  a  chemical  kind,  which  may  be  applied  if  there  is  time. 
He  has  shown  that  sodic  sulphide  forms  in  the  body,  with  carbolic 
acid,  the  innocuous  sulphocarbolate,  and  hence  a  soluble  sulphate,  as 
Glauber's  salts,  will  be  a  proper  antidote.  As,  however,  the  toxic  ac- 
tion of  carbolic  acid  is  very  speedy,  the  chemical  antidote  may  not 
have  time.  Under  these  circumstances  it  will  be  found,  probably, 
that  the  physiological  antagonist  is  more  speedy  and  effective.  Atro- 
pine  is  apparently  a  most  certain  antagonist.  It  has  succeeded  in  some 


CARBOLIC   ACID.  385 

rery  unpromising  cases,  and  in  my  experiments  on  animals  the  results 
have  been  most  favorable  to  the  existence  of  the  antagonism. 

Carbolic  acid  enters  into  the  composition  of  Morrell's  antiseptic 
fluid,  which  is  used  as  a  disinfectant  for  general  purposes,  and  for  the 
preservation  of  bodies.  The  following  is  the  formula  :  "Dissolve  13'5 
parts  of  arsenious  acid  and  6'9  parts  of  sodic  hydrate  in  15  to  20  parts 
of  water;  add  enough  carbolic  acid  until  the  clear  fluid,  after  stir- 
ring, appears  turbid  (that  is,  until  the  liquid  is  fully  saturated  with 
carbolic  acid),  and  dilute  with  water  to  make  100  parts." 

SULPHOCABBOLATES. — Sodii  Sulphocarbolas.  Sulphocarbolate  of 
sodium. 

Potassii  Sulphocarbolas ;  Calcii  Sulphocarbolas  /  Magnesii  Sul- 
phocarbolas, 

Of  these  salts,  the  first-named  is  the  most  important,  and  is  the 
only  one  official.  The  first  step  in  the  formation  of  these  salts  consists 
in  the  production  of  sulphocarbolic  acid,  obtained  by  dissolving  one 
part  of  crystallized  carbolic  acid  in  an  equal  weight  of  strong  sulphu- 
ric acid.  The  next  step  consists  in  the  formation  of  sulphocarbolate 
of  barium,  from  which  the  other  salts  are  obtained  by  double  decom- 
position. 

Sulphocarbolate  of  sodium  occurs  in  transparent  rhombic  prisms, 
which  are  permanent  in  the  air,  dissolve  in  about  five  parts  of  water, 
and  are  also  soluble  in  glycerin  and  alcohol.  Most  of  the  sulphocar- 
bolates  have  a  faint  pinkish  tint,  and  are,  like  the  soda-salts,  soluble  in 
water,  alcohol,  and  glycerin.  The  dose  for  internal  administration 
ranges  from  ten  to  thirty  grains.  Saturated  or  weaker  solutions  may 
be  employed  topically. 

These  preparations,  devised  by  Dr.  Sansom,  were  intended  to  secure 
the  antiseptic  and  antipyretic  action  of  carbolic  acid  without  any  of 
the  caustic  and  depressing  action  of  the  latter.  In  such  septic  diseases 
as  diphtheria,  the  eruptive  fevers,  puerperal  fever,  they  may  be  used 
freely.  There  seems  little  ground  for  the  assumption  that  the  carbolic 
acid  is  freed  from  its  associates  in  passing  through  the  organism,  for 
the  sulphocarbolates  do  not  have  the  effects  of  carbolic  acid,  and  the 
urine  does  not  have  the  greenish,  blackish,  or  smoky  hue  characteristic 
of  the  latter  remedy.  There  can  be  little  doubt  that  the  sulphocar- 
bolates are  excellent  topical  applications  to  the  inflamed  mucous  mem- 
brane, wherever  accessible.  The  author  has  had  good  results  from 
their  use  in  acute  inflammation  of  the  fauces,  in  tonsillitis,  in  catarrh 
of  the  nares,  in  otorrhcea,  and  also  in  gonorrhoea.  These  salts  are 
useful  as  deodorant  and  antiseptic  applications  to  unhealthy  wounds 
and  ulcerated  surfaces,  to  aphthae,  in  children,  etc.  Although  the 
sulphocarbolate  of  sodium  has  been  added  to  the  new  pharmacopoeia 
list,  it  must  be  admitted  that  the  sulphocarbolates  do  not  maintain  the 
position  to  which  they  were  first  introduced. 
27 


386  ANTISEPTICS. 

THE  SUBCUTANEOUS  INJECTION  OF  CARBOLIC  ACID. — Although  ref- 
erences have  been  made  to  the  injection  of  carbolic  acid,  it  is  desirable 
to  indicate  some  of  the  more  recent  applications  of  this  method.  For 
this  purpose  the  author  has  employed  a  five-per-cent  solution,  or  one 
grain  to  twenty  minims  of  sterilized  water.  This  is  injected  beneath 
the  affected  part  in  cases  of  epithelioma,  of  scirrhus,  of  sarcoma,  and 
other  malignant  growths.  Besides  the  extraordinary  improvement 
in  the  local  condition,  the  diffusion  of  the  infection  to  neighboring 
glands,  and  through  the  system  at  large,  has  in  this  way  seemed  to  be 
prevented.  The  author  has  reason  for  believing  that  by  this  practice 
cures  can  be  effected. 

Recently  the  subcutaneous  injection  of  carbolic  acid  has  proved 
effective  in  the  treatment  of  tetanus.  Unquestionably  under  its  use 
cases  of  tetanus  so  treated  have  got  well.  While  in  the  case  of  malig- 
nant growths  it  is  preferable  to  insert  the  solution  deeply  into  the  tis- 
sues beneath  the  malignant  growth,  in  tetanus  it  may  be  injected  at 
any  convenient  point.  Thus  far  no  toxic  symptoms  have  been  reported 
from  the  use  of  carbolic  acid  in  this  manner,  but  attention  should  be 
given  to  the  urine,  which  would  present  the  earliest  indications  of 
toxicity. 

Trichlorphenol. — A  preparation  of  much  promise  and  which  has 
yielded  good  results  is  that  named  triehlorphenol.  It  is  produced  by 
a  combination  of  chlorinated  lime  and  carbolic  acid.  A  saturated 
solution  of  chlorinated  lime  is  treated  with  a  saturated  solution  of 
carbolic  acid.  Trichlorphenate  of  calcium  is  a  product  of  the  reac- 
tion, and  remains  in  solution  held  by  the  chloride  of  calcium,  another 
product.  If  to  this  solution  some  hydrochloric  acid  is  added,  the  tri- 
chlorphenol  is  precipitated. 

A  method  of  extemporaneous  preparation  for  merely  topical  uses 
consists  in  the  following  :  One  pound  of  a  solution  of  carbolic  acid, 
four  per  cent  in  strength,  is  mixed  with  five  pounds  of  solution  of 
chlorinated  lime  and  then  filtered.  If,  for  some  purposes,  this  solu- 
tion is  too  strong,  it  can  be  diluted  with  boiling  water  to  the  required 
strength. 

According  to  Diannin,  who  first  proposed  this  preparation,  it  has 
an  antiseptic  power  twenty-five  times  greater  than  carbolic  acid,  and 
far  exceeds  thymol,  salicylic  acid,  and  chlorinated  lime.  It  has  proved 
highly  effective  in  erysipelas,  the  solution  painted  over  several  times 
a  day  (Yurinsky).  A  one-per-cent  solution  has  also  been  successfully 
used  in  the  treatment  of  ulcers  (Butckik).  Other  testimony  has  been 
published  as  to  its  utility  in  erysipelas,  as  an  injection  in  leucorrhoea 
and  in  dysentery.  On  the  other  hand,  Dr.  Thomaschewsky  has  been 
disappointed  in  his  clinical  trials,  finding  it  inferior  to  iodoform. 
The  truth,  as  is  usual  under  these  circumstances,  probably  lies  in 
the  means. 


CREOSOTE.  387 

Creosotum. —  Creosote. — A  mixture  of  phenols,  chiefly  guaiacol  and 
creosol,  obtained  during  the  distillation  of  wood-tar,  preferably  of  that 
derived  from  the  beech. 

An  almost  colorless,  yellowish  or  pinkish,  highly  refractive,  oily 
liquid,  having  a  penetrating  smoky  odor  and  a  burning,  caustic  taste  ; 
usually  becoming  darker  in  tint  on  exposure  to  light.  Specific  gravity, 
not  below  1070  at  15°  C.  (59°  Fahr.).  Soluble  in  about  150  parts  of 
water  at  15°  C.  (59°  Fahr.),  but  without  forming  a  perfectly  clear 
solution.  With  120  parts  of  hot  water  it  forms  a  clear  liquid,  which 
on  cooling  becomes  turbid  from  the  separation  of  minute  oily  drops. 
Soluble  in  all  proportions  in  absolute  alcohol,  ether,  chloroform,  ben- 
zine, carbon-disulphide,  acetic  acid,  and  fixed  and  volatile  oils. 

A  combination  of  creosote  and  tincture  of  iodine  is  used  success- 
fully by  inhalation.  The  method  is  simple  :  To  a  cup  of  hot  water 
on  a  table  add  a  few  drops  of  the  mixture,  and,  as  the  fumes  arise,  by 
means  of  a  paper  cone  or  shield  they  should  be  directed  to  the  mouth 
or  nose.  Successive  deep  inspirations  should  then  be  made. 

Creosote  is  neutral  or  only  faintly  acid  to  litmus-paper.  Dose, 
TiUj — niv. 

PREPARATIONS. — Aqua  creosoti.  Creosote,  10  c.  c. ;  distilled  water, 
990  c.  c. 

Guaiacol. — Methyl-pyrocatechin  is  the  chemical  designation,  and  it 
consists  for  the  most  part  of  creosote — from  60  to  90  per  cent.  It  is 
a  colorless,  limpid,  oily  liquid,  with  a  pleasant  aromatic  odor,  having 
some  suggestion  of  creosote.  It  is  soluble  in  water  in  the  proportion 
of  1  to  85.  Dose,  if[\] — niv.  Can  be  administered  in  pill  or  capsule, 
or  dissolved  in  oil  (cod-liver  oil),  or  in  brandy  or  whisky. 

The  value  of  creosote  as  a  remedy  for  gastric  disturbance — catarrh 
and  other  forms  in  which  nausea  and  vomiting  are  pronounced  symp- 
toms— has  long  been  recognized..  Since  guaiacol  has  been  introduced 
into  medical  practice  it  has  largely  taken  the  place  of  creosote.  It  is 
less  disagreeable  in  taste  and  odor,  and  is  far  less  toxic.  It  is  fre- 
quently given  with  bismuth.  I£  Guaiacol,  3  j  ;  bismuth,  subnitrat.. 
vel  subcarb.,  3  iv;  glycerini,  f  |  j  ;  aquae  chloroform,  f  §  j ;  aquae  des- 
til.,  f  §  ij.  M.  Sig.:  One  or  two  teaspoonfuls  in  water  three  times  a 
day.  Such  a  combination  is  highly  useful  as  a  corrective  in  the  ileo- 
colitis  of  children,  in  diarrhoea,  etc. 

Guaiacol  has  been  much  given  within  the  last  few  years  in  phthisis. 
The  testimony  is  somewhat  conflicting,  but  on  the  whole  it  is  evident 
that  in  cases  not  too  far  advanced  it  is  beneficial.  It  does  not  appear 
to  have  any  toxic  influence  on  the  bacillus.  It  does  lessen  cough  and 
expectoration,  diminishes  the  fever  and  sweats,  and  promotes  nutri- 
tion. Beginning  with  one  drop,  the  dose  is  raised  as  rapidly  as  pos- 
sible to  three  to  six  drops  and  more  three  times  a  day.  It  is  a  good 
plan  to  give  it  in  cod-liver  oil.  Guaiacol  is  also  applied  locally  to  the 


388  ANTISEPTICS. 

walls  of  the  chest  in  some  cases  where  pain  indicates  the  localization 
of  inflammatory  action.  It  is  a  valuable  local  application  in  cases  of 
rheumatism  and  gout,  along  the  course  of  the  nerve  in  sciatica  and 
other  neuralfjioi. 

Guaiacol  is  also  used  as  an  antiseptic  dressing,  in  solution  or  oint- 
ment, in  treatment  of  affections  of  the  skin,  in  wounds  or  injuries 
where  such  applications  are  required,  and  under  the  same  conditions 
in  which  creosote  and  carbolic  acid  are  now  employed. 

Benzoyl-Guaiacol— Benzosol — Benzoate  of  Guaiacol. — These  names 
have  been  applied  to  a  combination  of  benzoic  acid  with  guaiacol. 
Benzosol  is  the  most  frequently  used  of  these  designations.  It  con- 
tains about  54  per  cent  of  guaiacol,  and  is  a  colorless,  odorless,  and 
nearly  tasteless  powder.  It  is  insoluble  in  water,  and  is  best  exhibited 
in  powder.  It  may  also  be  pleasantly  given  mixed  with  chocolate,  or 
be  taken  in  capsules.  The  dose  ranges  from  2  to  10  grains. 

Creosotal. — By  the  action  of  carbon  dioxide  on  creosote,  creosotal 
is  produced,  and  it  is  therefore  the  carbonate  of  creosote,  just  as  the 
benzoic  acid,  combining  with  guaiacol,  becomes  the  benzoate  of  guai- 
acol. Creosotal  is  a  viscid,  oily  liquid,  insoluble  in  water.  The  dose 
is  from  15  minims  to  3  j. 

Phenosalyl. — Under  this  designation  is  prepared  a  mixture  of  car- 
bolic, salicylic,  and  benzoic  acids  by  heat,  and  then  dissolved  in  lactic 
acid.  It  is  said  that  to  the  mixture  thus  made  menthol  and  eucalyptol 
dissolved  in  glycerin  are  added.  Phenosalyl  is  a  clear,  sirupy  liquid, 
which  dissolves  readily  in  warm  water,  and  to  some  extent  in  cold 
water  (seven  parts  to  one  hundred  parts).  It  has  a  pleasing  and 
non-diffusing  odor,  which  does  not  cling  to  clothing  and  instruments. 
The  dose  for  internal  administration  ranges  from  10  minims  to  30 
minims.  A  solution  for  topical  use  varies  from  1  per  cent  to  10  per 
cent. 

As  respects  the  germicide  power  of  these  three  remedies,  the  most 
effective  is  phenosalyl ;  the  most  suitable  as  a  substitute  for  creosote 
or  guaiacol  in  the  treatment  of  phthisis  is  benzosol.  It  is  as  active  as 
creosote  as  a  remedy,  while  it  is  far  more  manageable.  It  diminishes 
cough,  lessens  expectoration,  and  stops  the  hectic  fever,  while  the 
appetite  and  general  nutrition  steadily  improve. 

Phenosalyl  containing  several  antiseptics  should  be  an  effective 
remedy,  but  the  therapeutic  value  of  such  a  combination  is  not  meas- 
ured by  the  standard  of  its  chief  ingredient.  It  is  said  to  be  a  more 
effective  germicide  than  carbolic  acid.  The  most  resistant  of  the 
pathogenic  organisms  is  the  staphylococcus  pyogenes  aureus,  and  this 
is  destroyed  by  a  one-per-cent  solution  of  phenosalyl.  It  has  proved 
to  be  equally  effective  against  the  bacillus  of  cholera,  the  bacillus  of 
tubercle,  the  pneumococcus.,  and  other  forms  of  pathogenic  bacilli. 
Although  so  destructive  of  organisms,  it  is  not  irritating  to  the  skin, 


SALICIN.  389 

and  does  not  corrode  instruments.  It  has  been  employed  chiefly  in 
obstetric  practice  as  an  antiseptic  topical  application,  in  catarrh  of  the 
bladder  by  irrigation,  in  gonorrhoea,  and  in  various  skin  diseases.  In 
gastro-intestinal  catarrh,  in  phthisis,  and  other  wasting  diseases,  it  may 
be  substitiited  for  other  remedies  of  the  group. 

Salix. — Salix.  The  bark  of  Salix  alba  Linn6,  and  of  other  species 
of  Salix  (Nat.  Ord.  Salicacece). 

Salicimim.  —  Salicin.  A  neutral  principle  obtained  from  several 
species  of  Salix  and  Populus  (Nat.  Ord.  Salicacece}.  Colorless,  white, 
silky,  shining  crystals,  permanent  in  the  air,  odorless,  having  a  very 
bitter  taste  and  a  neutral  reaction.  Soluble  in  28  parts  of  water,  and 
in  30  parts  of  alcohol  at  59°  Fahr.  ;  insoluble  in  ether  or  chloroform. 
Dose,  3j — 3  ij.  So  little  soluble,  and  light  in  weight  and  bulky,  it 
were  better  administered  in  a  wafer,  powder,  or  emulsion. 

ACTIOXS  AXD  USES. — Salicin  promotes  appetite  and  the  digestion — 
properties  which  it  possesses  in  common  with  other  bitters.  It  is  an 
antiferment,  and  has  antiseptic  powers  similar  to  quinine  and  salicylic 
acid.  The  latter  is  a  derivative  of  salicin.  It  is  destructive  to  bac- 
teria and  vibrio,  and  prevents  the  reaction  of  amygdalin  and  emulsin, 
and  of  ptyalin  on  starch.  It  does  not  produce  very  sensible  effects 
even  in  large  doses,  and  is  without  toxic  activity.  It  has  been  used 
as  a  substitute  for  quinine  in  the  cases  of  disease  to  the  treatment  of 
which  the  latter  is  applied,  especially  in  the  treatment  of  intermittent. 
It  is,  however,  much  inferior  to  quinine. 

Salicin  is  an  excellent  stomachic  tonic  in  atonic  dyspepsia,  and  is  a 
serviceable  remedy  to  prevent  the  fermentations  which  take  place  in 
the  foods  in  cases  of  gastro-intestinal  catarrh.  In  the  chronic  diar- 
rhoea of  children,  it  has  been  employed  successfully.  The  good  results 
obtained  from  it  in  these  cases  are  doubtless  due  to  its  antiferment 
properties  and  its  lack  of  irritating  qualities. 

The  most  important  use  of  salicin  thus  far  proposed  is  in  the  treat- 
ment of  acute  rheumatism.  Its  utility  has  been  zealously  maintained  by 
Dr.  Maclagan,  to  whom,  also,  we  are  indebted  for  much  information  in 
regard  to  its  therapeutical  properties.  He  asserts  that  the  more  acute 
the  case  the  more  beneficial  the  remedy  ;  that  the  good  effects  are 
always  experienced  within  forty-eight  hours;  that  relief  of  pain  and  fall 
of  temperature  are  the  earliest  effects  produced.  Maclagan  gives  from 
ten  to  thirty  grains  every  two,  three,  or  four  hours,  in  powder  mixed 
with  water.  "  Fifteen  grains  every  three  hours  is  a  medium  dose." 

Much  confirmatory  evidence  has  been  published  ;  but,  on  the  whole, 
salicin  is  generally  regarded  as  inferior  to  salicylic  acid.  There  are 
conditions  of  the  system,  however,  in  which  salicin  should  be  pre- 
ferred to  any  of  its  congeners.  In  those  cases  characterized  by  weak 
heart,  whether  from  adherent  pericardium,  myocarditis,  fatty  degen- 
eration, or  other  causes,  salicylic  acid  may  be  dangerous.  Again, 


390  ANTISEPTICS. 

when  the  vaso-motor  system  is  depressed,  salicin  is  far  safer.     As  the 
curative  results  obtained  from  salicin  are  but  little  inferior  to  those 
from  salicylic  acid,  whenever  the  latter  is  contraindicated  the  former 
may  be  confidently  relied  on,  if  efficiently  administered. 
Authorities  referred  to : 

HUSEMANN,  DRS.  AUG.  UND  THEOD.     Pflanzenstoffe,  p.  959,  et  seq. 
MACLAGAN,  DR.  T.     The  Treatment  of  A  cute  Rheumatism,  by  Salicin.     The  Lancet, 
March,  1876. 

Acidum  Salicylicum. — Salicylic  acid.  Acide  salicylique,  Fr. ;  Sali- 
cylsaure,  Ger.  An  organic  acid,  existing  naturally  in  combination  in 
various  plants,  but  most  largely  prepared  synthetically  from  carbolic 
acid. 

PKOPERTIES. — Salicylic  acid  crystallizes  in  needle-shaped  crystals, 
which  are  soluble  in  alcohol  and  ether,  and  in  hot  but  not  in  cold 
water.  It  is  without  smell,  and  its  taste  is  slight  and  not  disagreeable. 
The  solubility  of  salicylic  acid  in  cold  water  is  increased  by  the  pres- 
ence of  neutral  salts.  Three  parts  of  phosphate  of  sodium  will  render 
one  part  of  the  acid  easily  soluble  in  fifty  parts  of  water.  Borate  of 
sodium  is  still  more  efficient  in  promoting  the  solubility  of  the  acid, 
and,  as  boracic  acid  has  properties  corresponding  to  salicylic,  the  borate 
should  be  preferred  for  this  purpose.  It  has  been  shown  that  ten  parts 
of  salicylic  acid  can  be  dissolved  in  one  hundred  parts  of  water  by 
the  addition  of  eight  parts  of  borax  (Bose).  The  borax  should  be  first 
dissolved  by  the  aid  of  heat,  and  the  salicylic  acid  should  be  added 
gradually  to  the  hot  solution  of  borax.  On  cooling,  filtration  is  ne- 
cessary to  separate  a  small  quantity  of  undissolved  residue. 

The  dose  of  salicylic  acid  for  internal  administration  ranges  from 
ten  grains  to  one  drachm. 

Sodii  Salicylas.  —  Sodium  salicylate.  Dose,  grs.  xv —  3  j.  In 
wafer  or  powder  it  may  be  given  rapidly  until  the  requisite  quan- 
tity has  been  swallowed.  Salicylate  of  soda  may  be  prepared  extem- 
poraneously by  the  addition  of  salicylic  acid  to  a  solution  of  bicarbonate 
of  sodium.  If  the  alkali  is  in  excess,  the  resulting  solution  is  brown- 
ish or  purplish  in  color,  and  has  a  strong  odor  of  wintergreen.  This 
is  not  repulsive  to  most  patients. 

The  following  is  a  suitable  formula  :  $  Acidi  salicylici,  3  ij  5  sodii 
bicarb.,  3  j ;  aqu«e,  §  ij.  M.  Sig.  :  A  teaspoonful  every  two,  three,  or 
four  hours. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  mineral  acids,  the  me- 
tallic salts,  and  the  preparations  of  iron  in  general,  are  chemically  in- 
compatible. From  the  physiological  standpoint,  salicylic  acid  and 
the  salicylate  of  soda  are  antagonized  by  the  arterial  and  cerebral 
stimulants. 

SYNERGISTS. — The  effects  of  salicylic  acid  are  increased  in  all  di- 


SALICYLIC  ACID.  391 

rections  by  the  members  of  the  phenol  group,  by  the  arterial  depres- 
sants, and  by  the  anaesthetics  and  cerebral  sedatives. 

PHYSIOLOGICAL  ACTIONS. — In  small  doses,  salicylic  acid  may  stimu- 
late digestion,  but  in  considerable  quantity,  especially  if  frequently 
repeated,  it  causes  uneasiness  at  the  epigastrium,  nausea,  and  vomit- 
ing. This  inability  of  the  stomach  to  dispose  of  the  large  doses  of 
salicin,  salicylic  acid,  and  salicylate  of  soda,  required  in  the  treatment 
of  certain  diseases,  is  an  obstacle  to  their  use.  They  are  diffusible  and 
readily  enter  the  blood.  It  is  in  a  high  degree  probable  that  salicylic 
acid  combines  with  an  alkaline  base  and  enters  the  blood  as  a  salicyl- 
ate— as  a  salicylate  of  sodium,  according  to  Salkowsky.  Binz  holds 
that  the  free  carbonic  acid  present  in  the  blood  must  effect  the  separa- 
tion of  salicylic  acid  from  its  combinations,  and  hence  that  salicylate 
of  soda  must  act  as  salicylic  acid.  It  is  well  known,  of  course,  that 
salicylate  of  soda  does  not  possess  the  antiseptic  property  of  salicylic 
acid,  and,  as  both  act  similarly  after  their  medicinal  administration,  it 
seems  highly  probable  that  the  decomposition  just  mentioned  does 
actually  take  place.  An  observation  of  Kohler  seems  to  support  the 
theory  of  Binz.  Kohler  found  that,  while  ordinary  blood  containing 
salicylic  acid  did  not  yield  it  up  to  ether,  the  blood  of  asphyxia,  which 
contains  an  exceptional  quantity  of  carbonic  acid,  did  yield  up  its 
contained  salicylic  acid  to  ether.  The  blood  in  the  vessels  unques- 
tionably contains  more  carbonic  acid  than  that  which  has  been  exposed 
to  the  air.  Salicin,  as  Senator  first  demonstrated,  under  the  action  of 
ferments,  splits  up  into  saligerine  and  glucose,  and  saligerine  is  readily 
oxidized  into  salicylic  acid.  This  process  is  supposed  to  occur  in  the 
body,  and  hence  the  comparative  slowness  of  action  of  salicin  and 
similarity  in  its  effects  to  salicylic  acid.  Spencer,  examining  the  blood 
of  a  person  taking  salicin,  only  got  evidence  of  the  presence  of  the 
glucoside  but  not  of  the  salicylic  acid,  and  in  the  urine  of  the  same 
subject  found  but  a  small  part  of  the  acid  which  ought  to  have  ap- 
peared, whence  he  concludes  that  the  conversion  of  salicin  into  sali- 
cylic and  salicyluric  acids,  according  to  Senator,  is  but  partially  accom- 
plished in  the  organism.  These  observations  adequately  explain  the 
superior  activity  of  salicylic  acid  as  compared  with  salicin. 

In  health,  ordinary  doses  of  salicylic  acid  and  salicylate  of  sodium 
have  but  little  effect  on  the  circulation.  In  the  carefully  conducted 
experiments  of  Ringer  and  Morshead,  made  on  normal  subjects,  con- 
siderable doses  of  the  acid  increased  the  pulse-rate  from  ten  to  twenty 
beats,  but  more  or  less  feverishness  was  produced  by  the  irritant  ac- 
tion on  the  gastro-intestinal  mucous  membrane.  The  manometric 
studies  of  Kohler  demonstrated  that  this  agent  lowers  the  blood-press- 
ure, and  this  result  occurred  after  division  of  the  vagi,  the  depressors, 
and  the  spinal  cord,  whence  it  must  be  concluded  that  it  accomplishes 
this  result  by  a  direct  action  on  the  heart  and  vaso-motor  ganglia. 


392  ANTISEPTICS. 

More  recent  observations  by  Oltramare  show  that  when  salicylic  acid 
is  thrown  into  the  veins  the  first  effect  is  to  increase  the  energy  of  the 
systolic  contractions,  the  number  of  pulsations,  and  the  blood-pressure. 
These  effects,  he  finds,  are  due  to  a  direct  stimulation  of  the  heart  and 
of  the  motor  centers.  Under  the  influence  of  increasing  doses,  the 
vessels  dilate,  the  blood-pressure  falls,  and  finally  the  heart  is  arrested. 
There  is,  therefore,  a  general  agreement  as  to  the  increase  of  the  ac- 
tion, lowering  of  the  blood-pressure,  etc.,  as  studied  in  animals,  and 
observed  on  man  by  Ringer  and  Morshead.  Professor  Se"e,  however, 
fails  to  discover  any  effect  by  salicylic  acid  on  the  heart  or  blood- 
pressure,  but,  as  he  administered  the  remedy  by  the  stomach,  it  is 
probable  that  he  did  not  secure  admission  to  the  blood  of  a  sufficient 
amount. 

The  numerous  observations  made  on  the  effect  of  salicylic  acid  and 
salicylates  on  the  heat-function  are  in  close  accord.  In  health  it  is 
found  that,  unless  toxic  doses  are  taken,  the  temperature  is  but  slightly 
or  not  at  all  affected.  Riess,  one  of  the  first  to  make  observations  on 
this  point,  noted  a  constant  reduction  of  the  normal  temperature  ;  but 
See,  Ringer,  Ftirbringer,  and  others,  agree  that  in  health  this  agent 
does  not  affect  the  temperature.  Riess's  conclusions  were  based  on 
more  than  four  hundred  observations  of  the  internal  use  of  salicylic 
acid,  and  in  twenty-three  cases  he  ascertained  a  reduction  of  1'6° 
Fahr.,  produced  by  five  grammes  (nearly  eighty  grains).  If  fever  is 
present,  whether  produced  artificially  by  the  injection  of  septic  ma- 
terials, or  arising  spontaneously,  salicylic  acid  very  uniformly  effects 
a  considerable  reduction.  The  result,  however,  is  not  always  the  same. 
That  salicylic  acid  has  a  decided  antipyretic  action  is  denied  by  Zim- 
mermann,  Wolffberg,  and  some  others  ;  but  the  weight  of  testimony 
is  overwhelmingly  the  other  way.  It  is  certain  that  the  degree  of 
antipyretic  effect  varies  in  different  forms  of  fever  (Bartels,  Senator, 
Nathan,  and  others),  and  also  according  to  the  individual  susceptibility 
to  its  action.  The  phenomena  attending  the  reduction  of  temperature 
are  worthy  of  consideration.  At  the  onset  of  the  action,  in  ten  to 
fifteen  minutes  after  the  dose  is  swallowed,  some  increase  in  the  heart's 
action,  a  feeling  of  warmth  through  the  system,  and  flushing  of  the 
face  with  suffusion  of  the  eyes  are  experienced,  then  the  perspiration 
begins,  appearing  first  on  the  face,  then  on  the  chest,  abdomen,  and 
extremities,  and  presently  becomes  profuse.  Coincidently  with  the 
sweat,  the  decline  in  temperature  begins,  but  it  continues  after  the 
sweating.  There  is  no  ratio  between  the  amount  of  sweating  and  the 
reduction  of  fever-heat,  for  with  much  sweating  there  may  be  but 
slight  diminution  in  the  temperature,  and  with  little  sweating  a  marked 
decline.  In  febrile  cases  the  decline  of  temperature  varies  from  1°  to 
6°  Fahr.  (Riess,  Nathan,  Bartels,  Ewald,  and  others).  The  quantity 
of  salicylic  acid  necessary  to  effect  any  considerable  reduction  of  tern- 


SALICYLIC  ACID.  393 

perature  ranges  from  one  to  two  drachms.  The  effect  is  maintained 
from  five  to  twenty  hours,  when  a  repetition  of  the  dose  usually  be- 
comes necessary.  With  the  first  effect  of  the  agent  on  the  heart,  the 
pulse  rises,  but,  as  the  sweating  progresses,  more  or  less  slowing  of  the 
heart-beat  occurs.  There  are  differences  of  opinion,  however,  on  this 
point.  Thus,  Ewald,  Riess,  Goltdammer,  and  a  few  others,  hold  that 
the  pulse  is  little  if  at  all  affected  ;  but  the  usual  expression  is  that, 
after  a  preliminary  rise,  there  ensues  with  the  perspiration  and  lower- 
ing of  the  temperature  a  marked  decline  in  the  pulse-rate  (Buss,  Star- 
gard,  Nathan,  Moeli,  etc.). 

With  the  first  impression  of  this  agent  on  the  respiratory  center, 
the  number  of  respirations  is  increased,  but,  with  the  decline  of  tem- 
perature and  of  the  pulse,  they  are  lessened.  The  excretion  of  car- 
bonic acid,  Livon  shows,  is  the  greater,  the  larger  the  dose  of  salicylic 
acid,  estimated  during  the  period  of  increased  action  of  the  lungs. 
Under  the  influence  of  large  doses,  accumulation  of  the  acid  takes 
place  in  the  cerebro-spinal  fluid,  causing  an  excitation  of  the  roots  of 
the  pneumogastric  nerve,  but  the  excitation  is  succeeded  by  the  de- 
pression which  terminates  in  arrest  of  the  respiratory  function. 

As  the  effects  of  salicylic  acid  or  salicylate  of  sodium  develop,  more 
or  less  headache,  with  a  feeling  of  distention  and  frontal  oppression,  is 
experienced.  Buzzing  in  the  ears,  dullness  of  hearing,  and  even  deaf- 
ness, are  usual  symptoms  when  the  doses  are  large.  Vision  is  also 
affected,  the  sight  becoming  dim,  or  strabismus  or  ptosis  occurs.  In 
one  case  sudden  and  complete  amaurosis  came  on  (Gatti)  after  the  ad- 
ministration of  one  hundred  and  twenty-five  grains  of  salicylate  of 
soda  ;  the  pupils  were  widely  dilated,  the  sclerotic  and  cornea  acquired 
extreme  sensibility,  but  the  retina  was  unchanged,  and  the  vision  for- 
tunately was  restored  after  ten  hours  without  impairment.  In  other 
cases,  subacute  delirium,  or  delirium  with  refusal  of  food,  and  various 
delusions  (Daly)  have  occurred  while  patients  were  taking  consider- 
able doses.  Ordinarily,  however,  the  cerebral  effects  of  salicylic  acid 
are  not  unlike  those  of  quinine.  The  state  of  the  intracranial  circula- 
tion which  it  induces  has  not  been  studied.  According  to  Blanchier 
and  Rochefontaine,  salicylate  of  soda  depresses  the  functions  of  the 
central  nervous  system,  but  the  irritability  of  both  sensory  and  motor 
nerves  and  the  contractility  of  muscle  remain  unimpaired. 

Animals  to  whom  salicylate  of  sodium  is  administered  daily  for 
some  time,  emaciate  rapidly  (Chirone  and  Petrucci).  The  toxic  dose 
for  the  dog,  ass,  and  horse,  according  to  Oltramare,  is  one  gramme 
per  kilogramme  of  the  body-weight.  Death  is  due  to  paralysis  of  the 
heart,  and  not  from  asphyxia,  as  has  been  heretofore  supposed  (Oltra- 
mare). After  death  the  abdominal  viscera  are  intensely  congested, 
unless  the  medulla  be  divided,  when  a  marked  degree  of  anaemia  suc- 
ceeds to  the  hyperaemia.  It  is  this  fact  chiefly  which  induces  Oltra- 


394  ANTISEPTICS. 

mare  to  maintain  that  salicylate  of  sodium  acts  on  the  vaso-motor 
center  in  the  medulla. 

On  man  as  well  as  on  animals  sometimes  salicylic  acid  produces  se- 
rious symptoms.  The  intoxication,  with  delirium  and  delusions  which 
it  causes  in  certain  subjects,  especially  those  suffering  from  acute  rheu- 
matism, has  been  referred  to.  In  drunkards  it  is  especially  apt  to  act 
unfavorably,  bringing  on  in  them  violent  delirium.  In  rare  instances 
salicylic  acid  and  the  salicylates  have  induced  a  condition  of  collapse, 
with  restlessness,  delirium,  great  dyspnosa,  feeble  pulse,  and  involun- 
tary evacuations.  The  vaso-motor  paresis,  which  is  a  result  of  large 
doses  in  feeble  subjects,  may  be  accompanied  by  great  relaxation  of 
the  skin,  the  rapid  formation  of  bed-sores,  etc.  Dr.  Tuckwell,  of  the 
Radcliffe  Infirmary,  Oxford,  gives  the  following  symptoms  as  occur- 
ring in  two  cases  under  his  observation  :  "  Loud,  deep,  and  sighing  res- 
piration ;  a  strange  restlessness,  gradually  increasing  to  delirium,  and 
not  unlike  that  of  delirium  tremens,  with  involuntary  evacuation  of 
urine  and  faeces  in  the  worst  of  the  two  cases  ;  a  slow  and  laboring 
pulse  ;  an  olive-green  color  of  the  urine."  No  fatal  case,  distinctly 
due  to  these  preparations,  has  been  reported,  but  many  have  occurred 
in  which  very  dangerous  symptoms  arose  ;  but,  fortunately,  all  dis- 
appeared on  stopping  the  administration  of  the  remedy.  The  existence 
of  albuminuria  is  an  important  factor  in  the  causation  of  bad  results 
(Huber). 

The  rate  of  diffusion  of  salicylic  acid  has  been  closely  studied  by 
Blanchier  and  Rochefontaine,  with  the  following  results  :  When  in- 
jected into  the  veins  of  a  dog,  salicylate  of  soda  appeared  in  the  saliva 
in  four  to  five  minutes  ;  in  the  urine,  eight  to  ten  minutes  ;  and  in  the 
bile  and  pancreatic  secretion,  in  fifteen  to  twenty  minutes.  When 
taken  into  the  stomach,  it  appeared  in  the  saliva  in  twenty  minutes, 
and  in  the  urine  in  forty- five  minutes.  In  man  salicylic  acid  is  ex- 
creted chiefly,  almost  wholly,  by  the  kidneys,  and  appears  in  the  urine 
in  twenty  minutes  after  it  is  taken  into  the  stomach.  It  is  excreted 
as  salicyluric  acid,  which  may  be  seen  as  a  deposit  at  the  bottom  of 
the  vessel,  "  of  a  white,  feathery  consistence."  The  urine  presents  a 
more  or  less  deep  greenish  tint.  The  presence  of  the  acid  is  readily 
ascertained  by  the  solution  of  chloride-of-iron  test.  To  the  urine  sus- 
pected to  contain  salicylic  acid,  add  slowly,  drop  by  drop,  the  chloride- 
of-iron  solution ;  phosphate  of  iron  is  first  formed,  which  is  whitish  in 
color,  but  presently,  if  salicylic  acid  be  present  in  a  free  state,  a  violet 
color  is  developed.  The  urine,  during  a  course  of  the  acid  or  of  the 
salicylates,  frequently  contains  albumen,  due,  doubtless,  to  the  irrita- 
tion of  the  kidneys  as  elimination  is  going  on.  The  facts  do  not  yet 
warrant  any  conclusion  in  regard  to  the  damage  which  may  be  perma- 
nently inflicted  on  the  kidneys  by  the  prolonged  administration  of  this 
agent.  The  influence  over  the  urinary  excretion  has  been  examined 


SALICYLIC  ACID.  395 

by  Bouchard.  There  is  reason  for  believing  that  the  urinary  water 
is  not  augmented,  the  extractives  are  somewhat  increased,  and  the 
phosphates  and  coloring-matter  are  unchanged.  Prof.  See  finds  that 
the  excretion  of  uric  acid  in  gouty  cases  is  promoted.  It  is  main- 
tained by  others  that  the  amount  of  urea  present  in  the  urine  is  greater 
than  normal.  Livon  and  J.  Bernard  have  ascertained  that  salicylic 
acid,  after  being  thrown  into  the  stomach  or  into  a  vein,  appears  with- 
in an  hour  or  two  in  the  saliva,  milk,  pancreatic  secretion,  bile,  as  well 
as  urine,  and  it  was  always  found  in  the  cerebro-spinal  fluid.  They 
conclude  that  it  acts  locally  at  these  points  of  contact  with  the  struc- 
ture of  organs.  Hence,  it  appears  highly  probable  that  the  local  stimu- 
lation increases  the  product  of  those  glands  through  which  the  acid 
or  its  salt  passes,  but  not  in  the  urine,  if  Bouchard's  observations  can 
be  relied  upon.  Albuminuria,  according  to  Gubler,  is  produced  by  it 
in  some  cases,  and  temporary  impotence  has  been  observed  in  others. 

THEKAPY. — The  applications  of  salicylic  acid  in  the  treatment  of 
disease  are  based  on  the  results  of  the  physiological  examination.  In 
the  diseases  of  the  stomach  characterized  by  fermentative  changes  in 
the  food,  as  in  catarrh,  dilatation  of  the  organ,  etc.,  salicylic  acid  is 
an  effective  remedy.  The  author  has  seen  admirable  results  from  its 
use  in  gastralgia,  even  when  distinctly  periodical.  In  the  vomiting 
of  a  pasty,  fermenting  mass  of  ingesta,  whether  or  not  accompanied 
by  the  organism,  sarcina,  or  other  germs  of  fermentation,  good  results 
are  derived  from  this  remedy.  In  these  stomachal  disorders,  the  best 
effects  are  had  from  ordinary  doses  (five  to  ten  grains),  given  in  a 
wafer,  either  in  anticipation  of  the  attack — as  of  gastralgia  appearing 
at  a  fixed  hour — or  during  the  process  of  fermentation  in  the  stomach 
contents.  As  a  portion  of  the  remedy  taken  passes  into  the  faeces,  it 
is  probable  that  salicylic  acid  is  just  as  effective  in  the  corresponding 
troubles  in  the  intestines.  Ilgin  reports  the  removal  of  tcenia  solium 
in  six  cases  by  the  administration  of  salicylic  acid,  in  eight-grain  doses 
every  hour  until  five  doses  were  taken — preceding  and  following  the 
acid  with  a  dose  of  castor-oil.  It  has  been  employed  successfully  in 
the  removal  of  ascarides,  by  local  application  and  by  internal  adminis- 
tration. An  enema  of  water  should  precede  the  salicylic-acid  solution, 
which  may  be  composed  of  borax  and  salicylic  acid  with  some  gly- 
cerin. ^  Acid,  salicylic.,  3  ss  ;  sodii  biborat.,  3  ss  ;  aquas,  Oj.  M. 
Sig.  :  Warm,  and  administer  the  whole  amount  at  one  time.  For  a 
young  child,  this  quantity  should  be  reduced  one  half,  or  more. 

"When  the  heart  is  weakened  from  any  cause,  salicylic  acid  and 
salicylate  of  soda  must  be  exhibited  with  caution.  The  experience 
thus  far  accumulated  warrants  the  assertion  that  the  dose  of  fifteen 
grains  of  the  former  and  twenty  of  the  latter  should  rarely  be  ex- 
ceeded, if  frequent  repetition  of  the  dose  is  practiced.  From  Riess, 
who  regards  salicylate  of  soda  as  a  specific  in  typhoid  fever,  to  Filatow, 


396  ANTISEPTICS. 

who  holds  that  it  is  worse  than  useless,  there  are  various  shades  of 
opinion,  with  the  weight  of  authority  decidedly  in  favor  of  the  view 
that  it  is  a  remedy  of  real  value.  Since  Riess,  no  one  has  claimed  in 
this  remedy  a  specific  for  typhoid,  but  it  is  generally  admitted  that  it 
renders  the  course  of  the  disease  milder  by  keeping  the  temperature 
within  safe  limits  (Tomkins,  Hallopeau,  Butt,  Immermann,  Senator, 
etc.).  Weiss  concludes,  after  an  experience  of  ninety-six  cases  of  ty- 
phoid in  children,  treated  with  salicylate  of  soda,  that  it  is  a  powerful 
antipyretic  in  the  typhoid  of  children,  and  that,  while  it  does  not 
shorten  the  course  of  the  disease,  it  renders  it  much  milder.  He  finds 
that  the  results  are  better,  when  the  typhoid  of  children  is  treated  by 
salicylate  of  soda,  than  have  hitherto  been  obtained  from  quinine  and 
cold  baths.  A  still  more  recent  English  experience  is  to  the  same  pur- 
port as  the  German.  Dr.  Tomkins  finds  that  in  the  salicylates  we 
have  the  means  of  reducing  fever-heat,  more  certain  and  more  agree- 
able than  by  the  cold  bath.  In  the  eruptive  fevers,  the  same  prin- 
ciples obtain  as  in  typhoid.  Salicylate  of  soda  is  preferable  to  sali- 
cylic acid,  because  it  is  less  irritating,  safer,  and  equally  effective  as 
an  antipyretic.  The  object  of  its  administration  is  to  reduce  the  heat, 
which  is  the  most  important  source  of  danger.  The  amount  required 
to  accomplish  this  object  is  now  definitely  known.  Twenty  grains  of 
the  soda  salt  may  be  given  every  two  hours,  until  the  temperature  is 
reduced  to  the  proper  point,  at  which  it  may  be  held  by  ten-grain 
doses  at  the  same  interval,  unless  the  occurrence  of  an  exacerbation 
requires  the  exhibition  of  a  larger  quantity.  In  the  case  of  children, 
the  daily  quantity  ranges  from  half  a  drachm  to  a  drachm.  Probably 
the  best  mode  of  administering  the  salt  is  in  the  form  of  wafer,  but 
when  these  can  not  be  obtained,  a  solution  may  be  readily  prepared, 
or  the  salt  may  be  constructed  extemporaneously  by  adding  the  acid 
to  a  solution  of  sodic  carbonate  as  follows  :  1J  Acid,  salicylic.,  ^  iv  ; 
sodii  bicarbonat.,  3  j  ;  aquae,  f  jss  ;  syrup,  simpl.,  §  ss.  M.  A  table- 
spoonful  contains  about  twenty  grains  salicylate  of  soda.  It  should  be 
borne  in  mind  that  this  remedy  is  not  safe  if  the  heart  is  very  weak, 
or  if  albuminuria  is  present. 

In  relapsing  fever,  according  to  Riess,  salicylic  acid  accomplishes 
something  more  than  the  mere  reduction  of  temperature.  Although 
it  does  not  prevent  the  usual  relapse,  even  when  administered  in  large 
doses  during  the  interval,  it  lessens  the  severity  and  duration  of  the 
relapse.  It  does  not  destroy  the  spirilla  in  the  blood,  nor  indeed 
lessen  their  activity  (Riess),  and  hence  can  not  be  a  curative  agent  in 
this  disease.  In  pyaemia,  septicaemia,  puerperal  fever,  diphtheria, 
etc.,  salicylate  of  sodium  is  used  under  the  same  rules  as  in  typhoid. 
The  indication  for  its  use  is  high  fever,  and  the  good  accomplished  by 
it  is  determined  by  the  degree  in  which  the  temperature  is  reduced. 
The  antiseptic  action  is  quite  secondary  to  the  antipyretic.  In  mala- 


SALICYLIC  ACID.  397 

rial  fevers  it  was  supposed  by  Senator  and  others,  in  the  enthusiasm 
attending  the  introduction  of  the  remedy,  that  salicylic  acid  would 
prove  equal  to  quinine.  If  administered  in  a  full  dose  just  before  the 
advent  of  a  paroxysm,  it  will  prevent  it,  but  it  does  not  possess  the 
curative  powers  of  quinine  over  the  effects  of  the  malarial  poison,  and 
hence  will  not  prevent  relapses.  By  using  salicylate  of  sodium  to 
abort  an  impending  paroxysm,  and  quinine  to  prevent  relapses,  the 
curative  result  will  be  attained  with  the  least  pecuniary  expenditure. 
In  the  mildest  cases  of  intermittents,  salicylate  of  sodium  may  be  de- 
pended on  alone,  but,  to  succeed,  it  must  be  administered  before  the 
expected  paroxysm. 

Out  of  the  enormous  mass  of  published  experience  in  regard  to  the 
value  of  salicylic  acid  in  acute  rheumatism,  it  is  difficult  to  select. 
From  the  first  trials  of  Buss,  followed  by  Strieker  and  Traube,  there 
has  been  an  almost  unanimous  expression  of  opinion  by  the  German 
physicians  in  regard  to  the  value  of  this  agent  in  rheumatism.  At 
first  it  was  supposed  that  the  disease  could  be  invariably  cut  short  in 
forty-eight  hours  to  three  days,  but  larger  observation  has  qualified 
these  opinions.  By  way  of  illustration  of  the  measure  of  success  now 
attained  in  Germany  with  salicylic  acid  in  rheumatism,  we  may  take 
the  recently  published  statistics  of  Diesterweg.  Of  one  hundred  cases 
treated  with  this  remedy,  the  disease  was  cut  short  in  thirty-six  or 
twenty-four  hours  ;  in  eighty-five,  within  the  period  of  forty-eight 
hours  ;  in  ninety-eight,  within  seventy-two  hours  ;  in  one  the  disease 
was  prolonged  to  eighty-four  hours  ;  and  in  one  the  remedy  had  no 
effect  on  the  disease.  It  is  not  intended  to  convey  the  impression  that 
the  cases  got  well  in  so  short  a  time,  only  that  the  fever  and  joint- 
swelling  and  pain  subsided,  and  convalescence  was  established.  Re- 
lapses occurred  in  eleven  cases,  and  cardiac  complications  in  five. 

In  France  the  treatment  of  acute  rheumatism  by  salicylic  acid  was 
taken  up  by  Jaccoud,  Lepine,  Gueneau  de  Mussy,  and  others,  but  es- 
pecially by  Prof.  See,  who  has  devoted  to  it  several  important  lectures. 
As  a  result  of  See's  observation,  he  concludes  that  salicylic  acid  has  a 
marked  and  peculiar  benefit  in  acute  rheumatism  ;  that  the  pains  in- 
variably cease  in  from  twelve  to  eighteen  hours  ;  that  the  articular 
swelling  disappears  at  the  end  of  three  days,  and  that  the  fever  sub- 
sides with  the  pains.  If  the  fever  persists,  other  joints  will  become 
affected.  Out  of  fifty-two  cases  treated  by  Prof.  See,  fifty-one  recov- 
ered in  from  two  to  three  days.  These  results  are  quite  equal  to  the 
German.  See  makes  an  important  observation  in  regard  to  the  ra- 
pidity with  which  salicylic  acid  and  salicylate  of  sodium  are  eliminated, 
and  the  necessity,  therefore,  of  continuing  the  remedy  for  some  time 
after  all  the  joint-troubles  have  ceased,  to  prevent  relapses.  Prof. 
Gubler  does  not  share  the  general  enthusiasm  as  to  the  value  of 
this  agent  in  rheumatism.  He  emphasizes  the  uncertainty  and  the 


398  ANTISEPTICS. 

dangers  attending  its  use,  and  maintains  that  it  has  no  antipyretic 
effects. 

In  England  salicylic  acid  and  salicylate  of  sodium  have  been  used 
with  a  large  measure  of  success,  but  the  rheumatism  of  England,  as  of 
this  country,  does  not  yield  with  the  promptness  characteristic  of  the 
Continental  disease.  The  general  results  of  the  treatment,  as  con- 
ducted in  England  by  Broadbent,  Carafy,  Spencer,  Boggs,  Greenhow, 
and  many  others,  is  very  much  as  expressed  by  the  last-named  in  his 
important  communication  to  the  Clinical  Society.  The  temperature 
speedily  falls,  sometimes  within  a  few  hours  and  almost  always  in  two 
or  three  days,  the  pulse  declines  at  the  same  time,  the  pains  subside 
correspondingly,  and  the  joint-swelling  diminishes  and  disappears 
within  three  or  four  days.  Greenhow  points  out  that  such  a  result  is 
not  a  cure  even  in  the  most  favorable  cases  ;  that  the  remedy  acts 
very  injuriously  on  the  heart  and  causes  a  deep  anaemia,  and  that, 
therefore,  the  duration  of  the  disease,  from  beginning  to  the  termina- 
tion, is  not  actually  shortened.  Dr.  Maclagan  (also  Charteris)  strongly 
urges  the  substitution  of  salicin,  on  the  ground  that  it  is  equally  effec- 
tive with  salicylic  acid  and  much  less  dangerous  ;  but  it  is  difficult  to 
appreciate  this  argument,  since  salicin  is  converted  into  salicylic  acid 
in  its  passage  through  the  system. 

In  this  country,  the  experience  of  the  Maine  physicians,  and  of  the 
medical  staff  of  the  Massachusetts  General  Hospital,  has  been  pub- 
lished, and  all  concede  that  it  has  good  effects.  As  regards  the  ex- 
perience at  the  Massachusetts  General  Hospital,  the  facts  are  as  follows : 
In  eight  cases  out  of  seventeen  treated  with  salicylic  acid,  the  duration 
of  the  longest  case  was  twenty-six  days,  and  the  shortest  five  days, 
the  improvement  being  very  marked  from  the  beginning  of  treatment. 
Of  three  patients  who  took  salicylate  of  soda  only,  the  duration  of  the 
disease  was  less  than  twelve  days  in  each  case,  the  shortest  being  two 
days.  In  the  remaining  nine  cases  the  duration  was  six  weeks  or  more. 

In  summing  up  the  testimony,  it  is  clear  that  salicylate  of  soda  is 
a  most  valuable  remedy  in  acute  rheumatism,  but  various  unpleasant, 
even  dangerous  symptoms  arise  in  some  cases.  Violent  headache,  ver- 
tigo, and  tinnitus  aurium,  are  common  ;  wild  delirium  is  an  occasional 
symptom  ;  weakness  of  the  heart,  obscuration  of  the  first  sound,  and 
profound  anaemia,  are  especially  noted  by  Greenhow  ;  very  great  gas- 
tro-intestinal  disturbance  is  now  and  then  produced.  Empis  narrates 
a  fatal  case  of  acute  rheumatism  which  was  treated  by  salicylic  acid. 
Great  depression  of  the  powers  of  life,  in  rare  instances  approaching 
collapse,  has  been  observed.  Sufficient  is  now  known  of  the  danger 
attending  the  salicylic  medication  of  acute  rheumatism,  to  justify  the 
author  in  urging  circumspection  on  the  attention  of  his  readers.  The 
robust  and  vigorous  rheumatics  are  proper  subjects  for  this  treatment, 
whereas,  in  the  pale,  feeble,  and  cachectic,  especially  those  with  weak 


SALICYLIC   ACID.  399 

hearts,  this  treatment  must  be  pursued  cautiously,  or  not  undertaken 
at  all.  Relapses  are  frequent,  probably  because  of  the  very  rapid 
elimination  of  the  remedy,  as  suggested  by  Prof.  See,  and  hence  its 
administration  must  be  continued  for  some  time  after  all  of  the  local 
and  systemic  symptoms  have  subsided. 

In  gout,  chronic  rheumatism,  myalgia,  and  lumbago,  salicylate  of 
sodium  often  acts  most  serviceably.  It  is  more  effective  the  more 
acute  the  malady,  as  a  rule,  but  it  sometimes  does  great  good  in  the 
most  chronic  cases.  Abbott  reports  the  cure  of  sciatica,  and  Brun  of 
rheumatismal  irido-choroiditis,  by  its  use.  The  author  has  succeeded 
in  some  instances  very  promptly  in  the  cure  of  sciatica  by  the  salicy- 
late of  soda — the  formula  used  being  that  for  the  extemporaneous  so- 
lution. The  cases  in  which  this  remedy  has  proved  most  efficacious, 
were  those  of  functional  disturbance  in  the  nerve,  the  muscles  being 
in  their  normal  condition,  and  the  pain  having  nocturnal  exacerbations. 

It  is  a  very  interesting  fact,  first  distinctly  stated  by  Dr.  Pye 
Smith,  of  Guy's  Hospital,  London,  that,  during  the  administration  of 
salicylic  acid  and  the  salicylates,  the  urine  exhibits  the  reaction  for 
sugar  on  the  application  of  Trommer's  test.  This  has  been  observed 
in  rheumatism  and  in  other  diseases  treated  with  this  agent.  The 
urine  is  a  little  increased  in  amount,  but  its  specific  gravity  is  not 
changed.  The  reduction  of  the  copper  is  effected  by  the  acid  or  by 
the  glycogen,  which  is  one  of  the  products  of  the  decomposition  of 
salicylic  acid.  JVIuller,  the  assistant  of  Eckstein  in  the  clinic  at  Kiel, 
has  published  some  important  observations  on  the  use  of  salicylate  of 
soda  in  the  treatment  of  diabetes.  It  appears  that  full  doses  of  the 
salt  cause  the  sugar  to  disappear  entirely,  but  this  is  not  a  permanent 
result,  for,  after  a  time,  the  sugar  returns.  A  very  great  tolerance  to 
the  remedy  exists  in  this  disease,  and  large  doses  may  be  taken  with 
impunity.  Bouchardat,  in  commenting  on  these  observations,  states 
that  he  has  not  had  good  results  from  this  treatment.  Since,  however, 
the  remedy  is  well  tolerated,  and  during  its  exhibition  in  considerable 
doses  the  sugar  disappears,  it  may  be  used  with  advantage  at  critical 
times  to  stop  the  waste. 

Salicylate  of  sodium  has  feeble  antiseptic  properties,  and  hence 
salicylic  acid,  which  is  even  superior  to  carbolic  acid  in  its  power  to 
destroy  minute  organisms  and  to  prevent  change  in  putrescible  mate- 
rials, should  be  preferred  for  all  topical  applications.  Being  free  from 
odor,  and  more  active  than  carbolic  acid,  it  should  be  used  instead 
of  carbolic  acid  for  most  purposes.  For  all  toilet  purposes,  it  is  decid- 
edly preferable.  It  is  an  excellent  addition  to  the  ordinary  powder 
dentifrices,  and  its  solution  with  borax  is  an  efficient  deodorant  in  fetid 
perspiration.  This  disagreeable  affection,  as  it  attacks  the  feet,  may 
be  relieved  by  dusting  the  feet  thoroughly  with  powdered  salicylic 
acid  before  putting  on  the  stockings.  It  is  useful,  also,  to  fill  the  in- 
terstices of  the  stockings  with  the  powder.  Extraordinary  success  has 


400  ANTISEPTICS. 

been  achieved  by  the  local  application  of  this  remedy  in  eczema  of  the 
head  and  face.  Those  cases  characterized  by  much  weeping  seem  to 
be  best  adapted  to  the  cure  by  salicylic  acid,  but  eczema  rubrum  and 
eczema  impetiginodes,  that  resisted  other  approved  means,  have  yield- 
sd  to  the  application  of  this  agent  (Wagner,  Will).  It  is  generally 
conceded  that,  as  a  local  application  to  syphilitic  ulcers,  salicylic  acid 
is  inferior  to  carbolic  acid. 

The  most  important  of  the  topical  uses  of  salicylic  acid  are  in  the 
antiseptic  treatment  of  wounds  and  injuries.  When  it  was  shown  that 
this  agent  had  a  power  to  destroy  the  activity  of  ferment  and  disease- 
germs  equal  to  that  of  carbolic  acid,  while  it  is  free  from  the  irritating 
quality  and  disagreeable  odor  of  the  latter,  Thiersch,  who  is  a  strong 
advocate  for  Lister's  antiseptic  method,  resorted  to  the  use  of  salicylic- 
acid  solutions.  Further  experience  has,  however,  rather  proved  the 
superiority  of  carbolic  acid  in  respect  to  the  germicide  and  antiseptic 
properties  for  which  these  remedies  are  now  so  largely  employed. 

To  cancer,  gangrenous  and  sloughing  wounds,  pure  salicylic  acid 
may  be  applied  in  powder.  To  prevent  the  contact  and  multiplication  of 
atmospheric  germs,  operative  procedures  may  be  conducted  in  salicylic 
spray,  the  sponges  and  dressings  may  be  saturated  with  salicylic  solu- 
tions, and  the  wound  irrigated  by  the  same.  In  order  to  carry  out  all 
the  details  of  the  antiseptic  method,  salicylic  acid  is  substituted  for  car- 
bolic in  the  forms  and  combinations  of  dressings  employed  by  Lister. 
Wounds  are  covered  with  cotton-wool,  impregnated  with  an  alcoholic 
solution  of  the  acid  in  the  proportion  of  3  and  10  per  cent.  As  cold 
water  takes  up  only  1  part  to  300,  which,  however,  is  strong  enough 
to  destroy  bacteria,  etc.,  the  addition  of  borax  is  generally  necessary 
to  obtain  a  solution  of  sufficient  strength  for  the  antiseptic  applications. 
A  salicylic-acid  plaster  may  be  prepared  as  follows  :  Salicylic  acid, 
3  ss —  3  j ;  white  wax,  3  j  ;  paraffin,  3  ij  ;  almond-oil,  3  ij.  The  in- 
gredients are  melted,  and  rubbed  up  together  in  a  heated  mortar 
(Will),  and  spread  on  muslin.  An  ointment  more  readily  melted  by 
the  heat  of  the  body  is  the  following :  sperm-oil,  3  jss ;  cacao-but- 
ter, 3  vss  ;  salicylic  acid,  3  ss —  3  j.  This  should  be  melted  together, 
thoroughly  incorporated,  and  spread  on  lint  (Will).  An  ointment 
for  the  same  purposes  may  be  prepared  in  a  simpler  way  by  the  ad- 
dition of  salicylic  acid  to  simple  cerate.  A  solution  of  salicylic  acid 
in  olive-oil,  in  the  proportion  of  one  drachm  to  eight  ounces,  is  an 
efficient  local  application  for  burns. 

Authorities  referred  to  : 

BOSE,  DR.  H.     Berliner  Jclinische  Wochenschrift,  1875,  No.  28. 

Buss,  DR.  E.  Die  antipyretische  Wirkung  der  Salicylsaure.  Cent.  f.  d.  med.  Wissen* 
schaften,  1875,  No.  18. 

FURBRINGER,  DR.     Zur  Wirkung  der  Salicylsaure,  pamphlet,  Jena,  1875. 

IMMERMANN,  PROF.  Quoted  in  Liebermdster's  Handbuch  der  Pathologie  und  Therapie 
des  Fiebers,  Leipzig,  1875,  p.  644. 


RESORCINUM.  401 

KOLBE,  PROF.  Ueber  die  antiseptischen  Eigenschafter  der  Salicylsdure.  Schmidfs  Jahr- 
biicher,  vol.  clxiii,  p.  229. 

LETZERICH,  DR.  LUDWIG.  Experimentellen  Untersuchungen  und  Beobachtungen  uber 
die  Wirkung  der  Salicylsdure  bei  der  Diphtherie.  Virchow's  Archiv,  Band  Ixiv,  p.  102. 

MOELI,  DR.     Berliner  klinische  Wochenschrift,  1875,  No.  30. 

SENATOR,  PROF.  DR.     Berliner  klinische  Wochenschrift,  No.  32. 

SQUIBB,  DR.  E.     Note  on  Salicylic  Acid,  Brooklyn,  1875. 

THIERSCH,  PROF.  DR.  Klinische  Ergebnisse  der  Lister'schen  Wundbehandlung,  etc. 
Volkmanri's  klinische  Vortrage,  Nos.  84  and  85. 

TRAUBE,  DR.  L.     Berliner  klinische  Wochenschrift,  No.  1,  1876. 

WILL,  DR.  J.  C.  OGILTIK.     On  Salicylic  Acid.     The  Lancet,  vol.  ii,  1875,  p.  8TO,etseq. 

Resorcinum. — Resorcin.     A  diatomic  phenol. 

HISTOBY. — Resorcin  is  a  chemical  compound,  discovered  by  Hlasi- 
wetz  and  Barth,  and  was  obtained  from  certain  resins  by  the  action  of 
fusing  alkalies.  They  assigned  to  the  new  compound  the  name  resorcin, 
partly  because  it  is  derived  from  a  resin,  and  partly  because  it  has 
some  similarity  to  orcin,  a  peculiar  substance  obtained  from  archil. 
Subsequently  resorcin  was  constructed  synthetically  by  Korner,  and 
at  the  present  time  it  is  obtained  in  various  ways,  the  product  being 
both  pure  and  cheap  (Andeer). 

PROPERTIES. — Resorcin  occurs  in  tabular  prismatic  crystals,  rather 
shining  and  lustrous,  somewhat  sweetish  to  the  taste,  with  a  little 
after-pungncy.  When  struck  or  rubbed  in  the  dark,  it  appears  phos- 
phorescent. In  odor  it  is  somewhat  like  phenol,  but  not  nearly  so 
pronounced.  It  is  soluble  at  59°  Fahr.  (15°  C.)  in  0'6  part  of  water, 
and  in  0'5  part  of  alcohol,  and  in  ether  and  glycerin.  It  is  dissolved 
by  all  liquids  except  chloroform  and  carbon  sulphide.  Aqueous  solu- 
tions exposed  to  the  air  and  light  assume  a  more  or  less  brownish 
tint,  but  without  any  apparent  change  in  quality.  Albuminous  liquids 
treated  with  a  concentrated  solution  of  resorcin  become  turbid  by  the 
formation  of  an  albuminate  of  resorcin.  Various  secondary  products 
are  obtained  from  it  by  the  action  of  chlorine,  iodine,  bromine,  nitric  and 
nitrous  acids,  etc.  In  the  process  by  which  resorcin  is  produced,  are 
also  hydroquinone  and  pyrocatechin.  The  best  vehicles,  according  to 
Andeer,  are  alcohol,  glycerin,  and  sirup  of  orange.  The  dose  for  usual 
purposes  ranges  from  five  to  fifteen  grains.  For  a  decided  antipyretic 
effect  a  drachm  may  be  given,  but  this  amount  could  not  be  fre- 
quently repeated.  Five  grains  may  be  given  every  two  hours  in  an 
ordinary  case. 

ANTAGONISTS. — From  the  physiological  standpoint,  resorcin  is  an- 
tagonized by  the  cerebral  excitants,  by  the  agents  which  raise  the 
arterial  tension,  and  by  the  cardiac  and  respiratory  stimulants — by 
atropine  especially.  The  local  caustic  action,  and  the  depression  in 
the  circulation  and  respiration,  are  the  effects  requiring  attention  in 
cases  of  poisoning  by  this  substance.  It  is  less  actively  toxic  than 
carbolic  acid. 
28 


402  ANTISEPTICS. 

SYNERGISTS. — Its  effects  are  promoted  by  quinine,  salicylic  acid, 
carbolic  acid,  etc. 

PHYSIOLOGICAL  ACTIONS. — Resorcin  does  not  irritate,  nor  is  it  ab- 
sorbed by  the  unbroken  integument.  The  solution  injected  into  the 
subcutaneous  tissues  produces  but  little  irritation,  and  never  inflam- 
mation and  abscess.  Applied  to  the  moistened  mucous  membrane,  it 
causes  vesication,  and  a  white  blister  forms,  like  that  from  carbolic 
acid.  It  has  decided  anti-ferment  properties,  arrests  decomposition  in 
animal  tissues,  deodorizes,  and  is  destructive  of  the  minute  organisms 
on  the  presence  of  which  putrefactive  decomposition  is  dependent.  A 
one-per-cent  solution  will  prevent  the  decomposition  of  urine  when 
exposed  to  the  air  for  months  (Andeer).  Applied  to  unhealthy  wounds, 
it  arrests  the  decomposition,  destroys  the  fetor,  and  promotes  healthy 
cicatrization  (Dujardin-Beaumetz). 

The  action  of  lethal  doses  is  necessarily  to  be  studied  on  animals. 
Murrell  has,  it  is  true,  given  a  good  account  of  the  symptoms  produced 
by  an  overdose,  but  the  details  can  be  obtained  only  by  experiments 
on  animals.  Soon  after  the  administration  of  a  full  dose — thirty  cen- 
tigrammes (about  five  grains)  of  resorcin  per  kilogramme  (about  thirty- 
five  ounces)  weight  of  the  animal  experimented  on — trembling  begins, 
due  to  fibrillary  contractions  of  the  muscles,  and  this  passes  into  gen- 
eral clonic  convulsions  of  an  epileptiform  type.  These  convulsions 
regularly  increase  in  severity,  and,  reaching  their  maximum  in  a  few 
minutes,  as  regularly  decline,  the  whole  duration  of  this  phase  of  the 
action  being  about  two  hours,  sometimes  longer.  The  spinal  cord  is 
doubtless  the  seat  of  the  action,  since  the  irritability  of  the  peripheral 
nerves  and  muscles  is  diminished  only,  and  not  entirely  destroyed. 
The  general  sensibility  is  preserved,  whence  it  must  be  concluded  that 
the  action  of  resorcin  is  on  the  motor  elements  (Callias).  The  blood 
seems  not  to  be  altered  in  respect  to  its  composition  or  properties  ;  it 
presents  a  normal  appearance,  coagulates  in  the  usual  manner,  and  the 
venous  blood,  exposed  to  the  air,  assumes  the  proper  red  hue. 

The  lethal  dose,  according  to  weight,  is  ninety  centigrammes  per 
one  kilogramme.  The  phenomena  observed  when  such  a  dose  is  ad- 
ministered are  the  same  as  those  above  sketched,  except  that  sensibility 
is  impaired  as  well  as  motility. 

Resorcin,  through  the  action  on  the  nervous  system,  affects  the 
respiration  and  circulation  when  the  dose  is  large.  At  first  the  respi- 
ration is  greatly  increased  in  frequency,  becomes  convulsive  and  jerk- 
ing, and  afterward  shallow  and  weak  but  rapid.  The  action  of  the 
heart  also  becomes  rapid,  the  pulse  weak  and  somewhat  irregular,  but 
the  respiration  ceases  before  the  action  of  the  heart.  The  temperature 
rises,  and  just  before  death  attains  to  103°  to  105°  Fahr.  This  increase 
of  the  body-heat  is  doubtless  correctly  attributed  to  the  extreme  mus- 
cular action  (Dujardin-Beaumetz),  and  not  to  irritation  of  a  hypo- 


RESORCIN.  403 

thetical  heat-center.  Resorcin,  which  acts  in  many  respects  so  like 
quinine,  however,  differs  from  this  agent  remarkably  in  respect  to  the 
lethal  effects. 

When  a  considerable  dose  of  resorcin  (thirty  to  sixty  grains)  is 
administered  to  a  person  in  a  fever,  in  a  few  minutes  a  sense  of  heat 
is  felt  about  the  epigastrium,  and  spreads  thence  over  the  system  ;  the 
face  flushes  and  grows  hot,  the  eyes  glisten,  the  breathing  and  pulse 
are  accelerated,  and  dizziness,  with  ringing  in  the  ears,  and  frontal 
headache,  are  experienced.  A  good  deal  of  discomfort,  oppression  of 
the  chest,  and  a  sense  of  distention  of  the  head,  are  usually  produced, 
but  these  sensations  subside  in  from  ten  to  fifteen  minutes,  the  skin 
then  grows  moist,  and  in  a  few  minutes  more  a  profuse  perspiration 
is  pouring  out  on  the  surface  of  the  body.  The  pulse  then  falls,  cool- 
ness succeeds  to  heat,  languor  to  tension,  and  the  temperature  of  the 
body  declines  several  degrees.  If  the  feverish  state  has  no  special 
features,  the  lessening  of  the  pulse  and  reduction  of  temperature  to 
the  normal  occurs  in  about  an  hour.  The  pulse  may  be  slowed  one 
third,  and  the  reduction  of  temperature  be  as  much  as  three  or  more 
degrees  of  Centigrade  or  five  degrees  Fahr.  (Lichtheim).  The  reduc- 
tion of  temperature  in  fever  is  of  comparatively  brief  duration,  lasting 
from  two  to  four  hours.  When  the  rise  of  temperature  begins  again, 
a  sense  of  chilliness  is  experienced,  which  may  even  take  the  form  of 
a  distinct  rigor.  Lichtheim  observed  great  differences  in  the  power 
of  resorcin  in  different  fevers.  The  less  the  tendency  to  spontaneous 
remissions,  the  less  the  antipyretic  effect.  The  fever  accompanying 
pneumonia  and  erysipelas  was  less  amenable  to  the  action  of  resorcin 
than  was  typhoid  fever,  but  no  form  of  fever  entirely  resists  its  action. 
In  the  normal,  the  action  on  animals  and  on  man  corresponds  closely. 
The  correspondence  also  exists  in  respect  to  the  action  in  pathological 
states,  as  above  stated.  To  the  information  thus  obtained  may  ,be 
added  the  experiences  on  healthy  men,  as  furnished  us  by  Andeer,  by 
Baumann  and  Preusse,  Fauber,  and  others.  In  small  doses,  the  circu- 
lation, respiration,  and  temperature  are  but  little  affected.  Andeer, 
from  a  dose  of  ten  grammes  (one  hundred  and  fifty-five  grains),  suf- 
fered from  dizziness,  confused  vision,  deafness,  considerable  salivation  ; 
presently  extreme  vertigo  and  loss  of  consciousness  occurred,  and  then 
general  clonic  convulsions  and  tetanic  rigidity  of  the  muscles  of  the 
neck  came  on.  There  was  no  decline  of  temperature.  All  of  the 
effects  subsided  in  five  hours.  The  preliminary  stage  of  excitement 
produced  by  resorcin  is  often  accompanied  with  excitement  and  de- 
lirium. In  one  case  a  deep  stupor  ;  in  others,  muscular  trembling  and 
incoherence  of  speech  were  observed. 

The  elimination  of  resorcin  takes  place  almost  entirely  by  the 
urine,  and  it  is  effected  quite  rapidly,  for  the  greater  part  absorbed  is 
excreted  in  an  hour.  The  state  of  the  kidneys,  therefore,  must  influ- 


404  ANTISEPTICS. 

ence  the  rate  of  elimination,  and  correspondingly  the  duration  of  the 
physiological  or  therapeutical  actions.  The  tests  for  ascertaining  the 
presence  of  resorcin  are  not  sensitive  for  small  quantities.  The  most 
easily  applied  is  the  solution  of  perchloride  of  iron,  which  causes, 
when  resorcin  is  present,  a  deep  violet,  almost  black,  color. 

THERAPY. — A  close  correspondence  exists  in  the  therapeutical  ap- 
plications of  the  members  of  the  phenol  group,  and  Lichtheim  traces 
a  distinct  parallelism  between  their  anti-fermentative  and  antipyretic 
action.  Resorcin,  having  much  less  irritating  property,  is  generally 
preferable  to  carbolic  acid  for  internal  and  for  subcutaneous  use.  In 
catarrh  of  the  stomach,  gastralgia,  ulceration,  and  fermentative  indi- 
gestion, Andeer  reports  on  a  series  of  three  hundred  cases  in  which  it 
acted  most  favorably.  He  prescribed  chiefly  a  three-per-cent  solution. 
In  fevers  it  has  been  given  with  a  view  both  to  its  antiseptic  and  anti- 
pyretic actions.  It  is  not  a  specific,  and  is  only  serviceable  in  the  ratio 
in  which  it  reduces  heat.  In  erysipelas,  puerperal  fever,  septicaemia, 
and  diphtheria,  resorcin  may  exert  an  antiseptic  effect.  For  the  same 
reason  it  may  be  applied  to  the  treatment  of  ulcerative  endocarditis, 
but  in  intermittent  fever,  in  which  considerable  success  has  been 
achieved,  it  remains  inferior  to  the  cinchona  alkaloids,  although  com- 
ing nearer  to  these  remedies  than  any  other  in  curative  power. 

Resorcin  has  been  used  by  Dujardin  -  Beaumetz,  Andeer,  and 
others,  with  great  success  locally  in  syphilitic  and  other  sores  of  an 
unhealthy  or  sloughing  character.  Its  solution  may  be  applied  as 
spray  in  affections  of  the  nose  and  throat,  catarrhal,  ulcerating,  or 
specific.  Andeer  finds  it  useful  in  diphtheritic  affections  and  in 
anthrax.  The  later  experiences  have  confirmed  the  original  reports. 
It  is  applied  freely  as  powder  by  insufflation,  and,  as  it  has  very 
slight  causticity,  no  ill  result  follows,  and  a  powerful  germicide  action 
takes  place. 

Phenoresorcin. — By  the  term  phenoresorcin  is  meant,  by  River- 
din,  a  mixture  of  carbolic  acid  and  resorcin  :  sixty-seven  parts  of  the 
former  and  thirty-three  parts  of  the  latter.  This  mixture  crystallizes 
by  cooling,  and  on  the  addition  of  ten  per  cent  of  water  becomes 
a  liquid  which  mixes  with  water  in  all  proportions.  Combining  thus 
the  virtues  of  both  remedies,  phenoresorcin  offers  many  advantages, 
and  may  well  repay  more  elaborate  investigations. 

Hydroquinon  and  Pyrocatechin ;  Kairine  and  Kairoline ;  Chino- 
line. — In  the  search  for  an  artificial  quinine,  produced  by  a  syntheti- 
cal process,  various  substances,  more  or  less  closely  related,  have  been 
formed.  Of  these,  hydroquinone  and  pyrocatechine  are  very  similar 
in  all  respects  to  resorcin.  They  correspond  in  physiological  actions, 
and  have  the  same  power  to  depress  febrile  temperature.  They  are 
also  closely  allied  to  quinine  chemically,  and  possess  distinct  antiperi- 
odic  power.  When  first  produced,  they  were  proposed  as  substitutes 


CHINOLIN.  405 

for  quinine  ;  the  close  chemical  relationship  was  supposed  to  imply 
an  equally  close  physiological  affinity.  Further  studies  have  shown 
that,  while  these  agents  are  very  useful,  they  are  inferior  in  all  respects 
to  quinine.  Hydroquinon  and  pyrocatechin  are  very  closely  allied  to 
resorcin. 

The  actions  of  kairin,  hydroquinon,  etc.,  have  not  proved  satisfac- 
tory, and  so  much  depression  has  been  caused  by  them  as  to  be  dan- 
gerous. The  more  recent  and  manageable  remedies,  considered  fur- 
ther on,  have  now  displaced  them  entirely. 

Itairin  is  a  powder  having  a  pale  buff  color,  is  slightly  soluble  in 
water,  and  has  a  bitter,  somewhat  aromatic,  and,  to  most  persons,  a 
very  disagreeable  taste.  If  inclosed  in  a  wafer,  which  is  the  most 
agreeable  mode  of  administering  it,  a  quantity  of  water  should  be  taken 
after  it,  to  prevent  the  caustic  action  on  the  mucous  membrane. 

Kairolin  is,  chemically,  methyl-hydride  of  chinolin.  It  is  very 
much  less  active  than  kairin,  but  the  effects  when  produced  are  more 
lasting.  The  dose  of  kairin,  as  an  antipyretic,  is  from  fifteen  to  thirty 
grains,  given  in  anticipation  of  the  febrile  rise,  or  it  may  be  admin- 
istered in  smaller  doses  at  intervals — for  example,  five  grains  every 
hour,  until  the  desired  impression  is  effected.  Kairolin,  being  less 
active  by  half,  must  be  given  in  corresponding  quantity. 

Chinolin. — So  long  ago  as  1834  this  substance  was  separated  from 
coal-tar  by  Runge,  and  given  the  name  LeuJcoline.  Subsequently  it 
was  obtained  by  Gerhardt  from  the  cinchona  alkaloids,  and  by  him  the 
name  chinoline  or  quinoline  was  assigned  to  it.  Lately,  chinolin  has 
been  produced  synthetically  by  Skraup,  by  acting  on  aniline  or  nitro- 
benzol  with  glycerin  in  the  presence  of  some  dehydrating  agent. 
Thus  prepared,  chinolin  is  an  oily,  highly  refracting  liquid  and  basic 
substance,  which  combines  with  acids  to  form  salts.  All  of  the  salts, 
except  the  tartrate,  are  very  deliquescent,  crystallizing  with  difficulty, 
and  soon  losing  their  form  ;  but  the  tartrate  is  in  lustrous  crystals, 
stable  even  in  a  damp  atmosphere,  and  yet  sufficiently  soluble  in  water. 
According  to  Donath,  chinolin  is  not  more  closely  allied  to  quinine 
in  physiological  and  therapeutical  actions  than  it  is  chemically.  Al- 
though these  confident  expectations,  that  in  chinolin  we  have  an 
adequate  substitute  for  quinine,  have  not  been  realized,  this  remedy 
is  still  entitled  to  be  regarded  as  a  valuable  antiseptic  and  antipyretic. 
Donath  has  shown  that  a  two-per-cent  solution  will  prevent  the  de- 
velopment of  bacteria  in  decomposing  solutions.  Its  power  to  reduce 
febrile  heat  is  the  same  as  that  of  the  other  agents  of  the  group,  except 
that  it  is  greater.  Indeed,  chinolin  is  supposed  to  be  nearly  as  active 
as  quinine  as  an  antipyretic.  All  of  these  phenol  derivatives  and  con- 
geners— resorcin,  hydroquinon,  pyrocatechin,  chinolin,  etc. — possess 
the  power  to  reduce  fever-heat,  while  they  are  powerless  to  affect  the 
normal  temperature.  The  fall  of  temperature  is  preceded  by  a  short 


406  ANTISEPTICS. 

period  of  excitement — of  increased  rate  of  cardiac  movement,  warmth 
of  the  surface,  flushing  of  the  face,  etc. ;  then  perspiration  begins,  the 
temperature  declines,  the  pulse  slows  and  becomes  weaker,  and  the 
respirations  lessen  in  number.  The  degree  of  antipyretic  effect,  and 
its  duration,  vary  with  the  different  members  of  the  group. 

Thallinum. — Thallin.  This  is  a  proprietary  designation  to  take 
the  place  of  the  difficult  chemical  name — tetrahydroparamethyloxy- 
quinoline.  It  must  not  be  confounded  with  thallium,  the  name  of 
one  of  the  elements. 

In  its  natural  state  thallin  is  a  liquid,  oily  substance,  having 
strongly  basic  qualities.  It  combines  with  acids  to  form  salts,  which 
occur  in  crystals.  We  have  thus  thallini  sulphas,  thallini  hydro- 
chloras,  thallini  tartras,  etc.  The  salts  are  soluble  in  water,  the  sul- 
phate in  the  proportion  of  one  to  five,  and  more  freely  in  boiling 
water.  The  dose  ranges  from  two  to  five  grains. 

As  respects  physiological  action,  thallin  corresponds  to  the  other 
members  of  the  series  ;  it  is  antipyretic  and  analgesic.  It  is  very 
active  in  reducing  febrile  temperature,  the  decline  beginning  within 
an  hour,  and  reaching  the  lowest  point  in  about  three  hours,  when 
reaction  sets  in.  A  sweat  is  followed  by  a  rigor,  which  announces  the 
beginning  of  a  rise  in  temperature.  The  amount  of  sweating  corre- 
sponds to  the  dose,  and  the  chill  is  more  or  less  severe  accordingly,  but 
neither  of  these  symptoms  is  as  pronounced  as  they  are  in  the  case  of 
any  other  remedies  of  the  same  group.  The  action  of  the  heart  and 
the  respiration  are  reduced  correspondingly  to  the  amount  of  thallin 
administered,  and  the  blood-pressure  falls  also  in  the  same  ratio. 
A  toxic  dose  arrests  the  heart  in  the  diastole.  The  effects  of  thallin 
on  the  blood  are  similar  to  those  of  the  other  agents  of  this  class  :  it 
decomposes  the  haemoglobin,  and  the  blood  assumes  a  brownish  tint. 
In  this  way  the  respiratory  function  of  the  blood  is  impaired,  and 
hence  the  temperature  falls,  the  excretion  of  urea  lessens,  and  the  ex- 
halation of  carbonic  acid  diminishes.  It  does  not  lessen  to  any  con- 
siderable extent  the  sensibility  of  the  sensory  nerves,  nor  is  it  an  active 
hypnotic.  Toxic  doses  in  animals  cause  insensibility  and  muscular 
resolution.  Thallin  is  not  an  analgesic.  It  can  not  be  administered 
for  a  long  time  or  in  large  doses  without  risk  of  inducing  asphyxia 
from  destruction  of  the  haemoglobin  and  arrest  of  the  respiratory 
function  of  the  blood. 

THERAPY. — Thallin  is  an  antipyretic  and  an  antiseptic.  It  has 
been  used  in  typhoid  fever  as  a  means  of  reducing  the  temperature. 
It  is  very  certain,  but  some  disadvantages  attend  its  action.  If  con- 
siderable doses — five  grains  to  fifteen  grains  a  day — have  been  given, 
with  the  decline  in  temperature  there  occurs  a  more  or  less  profuse 
sweat,  and  chills  usher  in  another  pyretic  stage.  Its  utility  is  doubt- 


SALOL.  407 

ful  in  typhoid  fever.  In  other  febrile  maladies,  in  acute  rheumatism, 
erysipelas,  tuberculosis,  etc.,  the  reduction  of  temperature  promptly 
follows  the  exhibition  of  thallin  ;  but  the  effect  is  maintained  for 
three  or  four  hours  only,  and  then  occur  the  sweats  and  the  chills 
announcing  the  beginning  of  another  febrile  movement.  It  has  no 
pain-relieving  power  in  acute  rheumatism  or  other  rheumatic  affec- 
tions, although  it  reduces  the  temperature. 

Steffen  praises  the  action  of  thallin  in  the  febrile  diseases  of  child- 
hood. He  gives  one  half  grain  to  two  grains  twice  or  three  times  in  the 
twenty-four  hours.  As  the  salts  of  thallin,  preferably  the  sulphate 
or  tartrate,  are  soluble  in  water,  they  can  be  administered  hypoder- 
matically.  The  effect  is  much  more  powerful  when  given  in  this  way. 
When  taken  by  the  stomach,  if  considerable  doses  are  required  to 
lower  the  temperature,  Erlich  finds  it  better  to  give  small  doses  more 
frequently,  instead  of  a  few  large  doses  at  longer  intervals. 

Salicetol. — This  is  a  combination  of  acetol  and  salicylic  acid.  It 
occurs  as  a  white  crystalline  powder,  having  a  bitter  taste,  but  is  odor- 
less, and  is  but  slightly  soluble  in  water.  It  is  free  from  toxic  prop- 
erties, and  is  claimed  to  be  innocuous  even  in  the  largest  doses.  It  is 
an  efficient  antiseptic,  and  when  brought  in  contact  with  a  wounded 
surface  it  is  resolved  into  its  constituent  parts,  without  changing  the 
structure  of  the  parts  to  which  it  is  applied.  Compared  with  salol, 
salicetol  contains  more  salicylic  acid. 

Salophen. — Acetyl-para-amido-salol.  A  non-toxic  compound,  being 
an  effective  substitute  for  salicylic  acid,  and  having  none  of  the  un- 
pleasant after  effects  of  that  agent.  It  is  given  in  doses  of  sixteen 
grains,  in  wafer  or  capsule,  three  or  four  times  a  day.  It  has  proved 
especially  useful  in  influenza,  in  acute  rheumatism,  sciatica,  neuralgia, 
chorea,  etc. 

Further  clinical  experiences  must  demonstrate  the  relative  thera- 
peutical value  of  these  combinations. 

Salol. — The  name  applied  to  this  agent  harmonizes  with  such  as 
phenol,  naphthol,  and  others,  now  in  general  use.  It  is  a  salicylate  of 
phenol.  As  it  appears  in  commerce  it  is  a  white  powder,  having  a 
crystalline  structure.  It  is  entirely  insoluble  in  water,  and  hence, 
when  first  used  by  Georgi  in  the  form  of  powder,  its  antiseptic  pow- 
ers remained  undetermined.  It  is  made  by  combining  salicylic  and 
carbolic  acids — sixty  of  the  former  and  forty  of  the  latter  by  weight. 
The  insolubility  of  salol  in  water  explains  its  lack  of  taste.  It  is 
asserted  that  it  is  equally  insoluble  in  the  gastric  juice,  but  dissolves 
freely  in  the  intestinal  juices  after  the  pancreatic  has  joined.  More 
recent  observations  throw  doubt  on  this  assumption,  and  show  rather 


408  ANTISEPTICS. 

that  the  separation  into  its  constituents  begins  in  the  stomach.  If,. 
however,  the  greater  part  of  the  carbolic  acid  remains  in  the  com- 
bination until  the  small  intestine  is  reached,  no  irritant  effects  occur 
in  the  stomach,  and  at  the  moment  it  is  freed  it  possesses  the  maxi- 
mum antiseptic  power  (Nenki  and  Sahli).  Dose,  gr.  v —  3  j. 

PROPERTIES — ACTIONS  AND  USES. — Salol  can  be  administered  in 
the  form  of  compressed  pellet,  of  powder,  pill,  or  wafer,  etc.,  and  as 
it  continues  intact  during  its  stay  in  the  stomach,  can  be  so  timed  in 
its  administration  as  to  act  on  the  intestinal  mucous  membrane  only, 
or  at  any  stage  of  the  process  of  intestinal  digestion.  Salol  is  the 
most  advantageous  if  not  the  most  powerful  germicide.  The  temper- 
ature of  the  body  has  been  reduced  by  it  from  104°  Fahr.  to  98° 
(Xenki,  Lepine,  etc.).  In  common  with  all  the  antipyretics,  the  decline 
in  the  body-heat  is  coincident  with  sweats,  more  or  less  profuse,  but 
not  the  exhausting  sweats  accompanied  with  profound  depression  of 
the  vital  powers — the  collapse,  even — which  are  caused  by  many  of  the 
same  group.  Furthermore,  salol  differs  from  many  of  the  antiseptic 
antipyretics  in  that  the  rise  of  fever  after  the  period  of  apyrexia  is 
not  signalized  by  a  chill,  a  rigor,  or  a  pernicious  cold  stage.  In 
general  it  may  be  asserted  that  salol  is  free  from  any  toxic  action, 
although  it  may  be  shown  hereafter  that  there  are  certain  subjects 
affected  in  a  very  unfavorable  manner  by  it.  Although  idiosyncrasy 
is  by  its  nature  exceptional,  it  should  not  be  forgotten  that  the  symp- 
toms present  under  these  circumstances  are  but  exaggerations  of  nat- 
ural conditions,  and  are  present,  probably,  in  all  cases,  yet,  for  the 
most  part,  are  not  recognizable  because  too  minute  and  ill-defined. 

We  owe  the  discovery  of  the  analgesic  property  of  the  chinoline  de- 
rivatives to  Lepine,  to  See,  and  several  Russian  observers  (Todorsky). 
Therapeutically,  the  anodyne  property  of  salol  is  exhibited  in  the 
cases  that  are  rheumatic  in  source.  It  has  also  been  shown  to  lower 
the  reflex  function  of  the  spinal  cord,  and  thus  to  abate  spasm. 

After  the  decomposition  of  salol  in  the  intestine — a  chemical  change 
wrought  by  the  pancreatic  juice — its  component  elements  are  no 
doubt  disposed  of  in  accordance  with  their  individual  affinities. 

Under  the  continued  administration  of  salol,  the  urine  changes  in 
appearance  just  as  it  does  when  carbolic  acid  is  the  agent  undergoing 
elimination.  We  can  not  conceive  the  possibility  of  Nenki's  asser- 
tion being  true  that  the  carbolic  acid  when  set  free  in  the  intestine 
forms  combinations  that  do  not  enter  the  blood.  When  the  quantity 
of  carbolic  acid  absorbed  is  large,  the  urine  becomes  darker,  and  finally 
almost  black  in  color.  The  test  for  carbolic  acid  and  salol  is  the 
same — i.  e.,  a  solution  of  perchloride  of  iron,  which  strikes  a  fine 
violet  color  on  being  added  to  urine  containing  them.  Hence  it  is 
proved  that  carbolic  acid  has  passed  from  the  intestine  through  the 
kidneys  into  the  urine.  The  intermediate  combinations  formed  are 


SALOL.  f    409 

not  well  known,  but  it  is  probable,  of  course,  that  when  liberated  in 
the  small  intestine  it  must  pursue  the  course  its  chemical  relations 
require,  as  we  have  before  stated. 

The  dose  of  salol  varies  with  the  circumstances — the  maximum, 
when  its  antipyretic  effects  are  to  be  produced,  being  about  sixty  grains. 
For  other  purposes  from  five  to  ten  grains  usually  suffice.  Although 
not  manifesting  any  toxic  activity  when  administered  in  the  doses 
mentioned,  it  is  quite  inconceivable  that  an  agent  containing  so  much 
carbolic  acid,  liberated  in  the  intestine,  should  not  have  the  powers 
of  a  poison  if  given  in  sufficient  amount.  We  repeat  the  caution 
already  given,  and  advise  our  readers  to  avoid  any  excess  in  prescrib- 
ing it  for  the  purposes  to  which  it  seems  to  be  so  well  adapted. 

THEBAPY. — If  the  intestinal  reaction  asserted  by  Sahli  really  oc- 
curs, a  rational  explanation  is  thus  afforded  of  the  curative  action 
of  salol  in  catarrhal  states  of  the  intestinal  mucous  membrane.  In 
duodenal  catarrh,  catarrh  of  the  bile-ducts  and  gall-bladder,  in  ins2ns- 
sation  of  the  bile,  and  in  jaundice,  it  must  prove  one  of  our  best  reme- 
dies, if  the  observations  thus  far  made  are  confirmed  by  future  expe- 
rience. It  is  said  to  liquefy  the  bile  ;  hence  its  remarkable  utility  in 
that  state  of  the  bile  known  as  inspissation,  in  which  deposits  form  in 
the  ducts,  thus  causing  at  last  occlusion ;  but,  unlike  calculi  in  this 
respect,  the  masses  of  inspissated  bile  occlude  slowly,  while  the  calculi 
block  the  canal  suddenly.  By  rendering  the  bile  more  fluid,  salol  con- 
tributes to  the  solution  of  inspissated  bile  and  of  calculi,  provided 
there  be  in  the  calculus  a  break  in  the  continuity  of  its  smooth  surface 
(Levachoff). 

Salol  has  also  the  antipyretic  property  of  its  congeners,  probably  in 
a  higher  degree  than  any  member  of  the  group.  It  is  the  more  valu- 
able as  a  remedy  for  fever,  because  it  has  no  taste,  and  does  not  dis- 
turb the  stomach.  It  has  another  important  advantage  :  the  rise  of 
temperature  which  comes  on  after  the  conclusion  of  the  antipyretic 
action  is  not  accompanied  by  the  chilliness,  the  rigor,  and  that  pro- 
found depression  of  the  vital  powers  approaching  collapse,  which  seem 
to  be  necessary  to  the  action  of  some — of  nearly  all,  in  a  greater  or  less 
degree — of  the  newer  antipyretics. 

The  first  triumphs  of  salol  were  won  in  the  treatment  of  acute 
rheumatism,  excelling,  as  it  apparently  does,  all  other  remedies  in  its 
power  to  abate  pain  and  lessen  fever.  If  all  the  conditions  be  pro- 
pitious, by  the  end  of  the  second  or  third  day  fever  and  joint-pain 
and  swelling  will  have  disappeared  ;  but  the  rule  of  practice  applica- 
ble to  all  other  remedies  is  equally  applicable  to  salol — that  it  is  ne- 
cessary to  keep  up  the  remedy  after  the  active  symptoms  have  ceased, 
because  of  the  danger  of  relapses.  The  duration  of  the  salol  treat- 
ment is  determined  by  the  success  in  avoiding  relapses  for  the  most 
part.  It  does  not  prevent  cardiac  complications,  any  more  than  do 


410  ANTISEPTICS. 

other  remedies.  The  author  has  reason  to  believe,  indeed,  that  a 
larger  percentage  of  the  cases  now  present  the  evidences  of  heart  mis- 
chief since  the  use  of  remedies  which  so  much  try  the  heart  by  their 
action  on  the  vascular  tension. 

It  is  now  quite  certain  that  salol  and  other  remedies  of  the  same 
class  have  the  power  to  relieve  the  pains  of  locomotor  ataxia  in  a  re- 
markable degree.  This  fact  is  the  more  interesting  because  heretofore 
only  the  ordinary  anodynes  were  available  for  this  purpose.  Recent 
experiences  have  brought  to  light,  also,  that  the  antiseptics — chinoline 
derivatives — have  analgesic  power  of  a  peculiar  kind,  in  that  they 
afford  remarkable  relief  in  painful  affections  due  to  a  pathological 
condition  of  the  peripheral  nerves,  such  as  that  present  in  locomotor 
ataxia,  neuritis,  etc.  In  this  group  we  may  include  the  cases  of  gen- 
uine migraine,  and  that  large  and  indeterminate  class,  called  rheu- 
matic, of  which  lumbago,  sciatica,  and  myalgia  are  representatives. 
The  dose  of  salol  for  these  purposes  will  be  from  three  to  ten  grains, 
three  or  four  times  a  day. 

The  topical  applications  of  salol  are  deduced  from  its  physiological 
actions.  It  is  applied  in  the  form  of  powder,  dusted  on  the  surface 
or  blown  on  by  an  insufflator  ;  in  solution  dissolved  in  alcohol,  turpen- 
tine, or  cotton-seed  oil,  and  mixed  with  vaseline  or  other  fats.  As  it 
has  no  odor,  and  is  more  effective  than  iodoform,  its  utility  is  evident. 
It  can  be  mixed  with  iodoform  or  iodol,  and  thus  the  actions  of  both 
may  be  carried  on  simultaneously. 

Admirable  results  have  been  obtained  from  it  in  ozcena,  ctorrhcea, 
gonorrhoea,  in  chancre,  and  chancroid  ulcers,  specific  and  common. 

If  the  experiences  of  the  future  justify  the  statements  of  the  pro- 
moters of  salol,  it  will  prove  a  valuable  addition  to  the  resources  of 
therapeutics,  especially  in  the  numerous  morbid  states  where  a  ger- 
micide only  can  remove  the  source  and  cause  of  all  the  mischief. 

Antipyrin. — The  chemical  name  of  this  remedy  is  dimethyloxy- 
quinizine,  which  is  so  unmanageable  that  it  could  hardly  be  brought 
into  general  use.  The  original  discoverers  and  promoters  of  the  new 
agent  bethought  themselves  to  name  it  antipyrin,  which  is  at  the 
same  time  a  convenient  designation,  a  trade  title  to  protect  the  pro- 
prietary rights,  and  a  word  significant  of  the  most  important  property 
possessed  by  the  new  remedy. 

PREPARATIONS  AND  PHYSIOLOGICAL  ACTIONS.  —  Antipyrin  is  a 
whitish  or  grayish-white  crystalline  powder,  slightly  but  not  persist- 
ently bitter  in  taste,  and  is  soluble  in  water  in  equal  parts  by  weight. 
It  has  basic  properties,  and  combines  with  acids  to  form,  salts.  The 
dose  is  determined  by  the  uses  to  which  it  is  applied,  and  varies  from  five 
to  sixty  grains — the  maximum  employed  to  reduce  fever-heat.  When 
massive  doses  are  given,  it  is  better  to  divide  into  smaller  sections,  and 


ANTIPYRIN.  411 

administer  at  short  intervals,  that  the  impression  may  be  made  as  a 
unit.  Having  ready  solubility,  it  may  be  prescribed  in  a  solution,  or 
injected  subcutaneously. 

Antipyrin  does  not  irritate  the  stomach,  but  is  a  stomachic  tonic, 
and  the  appetite  is  increased  rather  than  diminished.  On  the  intestine 
it  acts  as  an  antiseptic,  inhibits  microbes,  and  thus  prevents  fermenta- 
tive changes.  It  is  probable  that  it  increases  secretion,  and  stimulates 
the  intestinal  peristalsis  also. 

Antipyrin  diffuses  into  the  blood  promptly,  and,  when  the  quantity 
is  sufficient,  brings  about  important  changes  in  its  constitution  ;  the 
corpuscles  are  altered  in  form,  the  hsematin  separated,  and  the  whole 
mass  of  the  blood  assumes  in  consequence  a  chocolate  tint.  On  the 
organs  of  circulation  the  first  effect  is  excitant  in  character,  but  it  is 
brief  in  duration  ;  the  heart-beat  is  quicker  ;  there  is  a  flush,  and  a 
subjective  sensation  of  warmth.  Then  perspiration  begins,  and  may 
be  very  profuse  ;  the  pulse  lessens  in  frequency  ;  a  sense  of  chilliness 
or  a  chill  accompanies  the  pallor  of  the  surface,  and  the  temperature 
declines  from  one  to  five  degrees  according  to  the  nature  of  the  seiz- 
ure and  the  doses  given.  In  some  instances  the  decline  in  body-heat 
passes  below  normal,  but  this  result  is  observed  more  frequently  when 
some  other  of  this  antipyretic  group  is  used.  The  decline  of  the 
febrile  heat  begins  in  ten  to  twenty  minutes  after  the  dose  has  been 
given,  and  it  persists  from  an  hour  to  sixteen  hours  or  longer  accord- 
ing to  circumstances.  The  normal  temperature  of  the  body  is  not 
affected,  how  large  soever  are  the  doses  administered. 

Antipyrin  appears  to  be  free  from  one  source  of  danger  common 
to  the  germicide  antipyretics — the  profound  depression,  almost  collapse, 
which  comes  on  with  the  sweating  and  precedes  the  next  exacerba- 
tion of  the  fever,  and  in  fact  ushers  it  in.  Although  antipyrin  is  free 
from  this  dangerous  depression,  as  a  rule,  there  occur  in  certain  sub- 
jects, with  the  sweating,  some  cardiac  weakness  and  irregularity,  of 
an  unpleasant  character,  and  hence  it  can  not  be  asserted  that  this 
member  of  the  group  is  free  from  the  dangers  inseparable  from  the 
action  of  the  others,  but  it  is  far  less  toxic. 

Antipyrin  rather  lessens  the  reflexes,  and  it  possesses  some  anal- 
gesic property  corresponding  to  that  of  the  class. 

It  is  eliminated  chiefly  by  the  kidneys,  and  induces  the  changes  in 
the  urine  characteristic  of  the  group  to  which  it  belongs. 

THERAPY.  —  Having  been  discovered  by  Knorr,  the  power  to 
lessen  febrile  heat  was  first  investigated  by  Filehne,  Schmidt,  Xau- 
nyn,  Gerhardt,  and  others.  It  was  soon  ascertained  that  antipyrin  is 
an  effective  remedy  for  fever,  the  best,  up  to  the  present  time,  for  the 
relief  for  that  symptom,  but  not  possessed  of  any  power  to  alter  the 
morbid  condition  producing  the  feverish  state.  As  Huchard  has  hap- 
pily expressed  it,  "Antipyrin  is  an  antipyretic,  but  not  an  anti-pe- 


412  'ANTISEPTICS. 

rioclic."  It  has  been  proved  to  have  special  power  to  reduce  the  high 
temperature  of  tuberculosis.  It  does  not  act  with  equal  advantage  in 
all  cases,  and  inattention  to  the  proper  mode  of  administration  will 
impair  its  usefulness.  The  experience  thus  far  gained  has  shown 
that  a  few  full  doses  will  have  a  more  happy  effect  than  numerous 
small  doses  ;  but  in  either  case,  the  periods  of  apyrexia,  especially  the 
sweating  stage,  are  not  suitable,  and  if  administered  at  these  times 
there  is  danger  of  upsetting  the  stomach  and  increasing  the  cold 
sweat.  Fifteen  grains  after  the  onset  of  the  fever,  and  repeated  two 
or  three  times  in  as  many  hours,  according  to  necessity,  is  the  best 
mode  of  giving  it. 

Although  antipyrin  is  the  most  efficient  antipyretic  in  cases  of 
tuberculosis,  it  does  not  change  existing  morbid  states.  The  reduction 
of  temperature  effected  by  it  lasts  six  to  twenty-four  hours,  accord- 
ing to  the  quantity  given,  the  susceptibility  of  the  patients,  and  other 
circumstances,  and  when  the  elevated  temperature  comes  on  again  it 
may  continue  for  several  days  below  the  general  level  of  the  fever 
previously  (Huchard). 

The  published  experience  in  the  great  journals  of  professional  opin- 
ion, in  respect  to  the  utility  of  antipyrin  in  typhoid,  now  constitutes 
a  vast  literature  of  itself,  and  we  can  utilize  here  only  the  epoch-making 
papers.  That  antipyrin  is  a  safe  and  efficient  antipyretic  in  typhoid 
is  generally  admitted,  but  no  one  takes  the  position  that  it  has  a  cura- 
tive effect,  or  that  the  reduction  of  temperature  has  any  influence  of  a 
permanent  character  on  the  dangers  or  duration  of  the  fever.  In  the 
condition  of  hyperpyrexia  its  timely  administration  has  proved  very 
beneficial. 

In  the  symptomatic  fevers,  such  as  pneumonia,  the  action  of  anti- 
pyrin has  not  been  favorable,  although  reduction  of  temperature  is  a 
very  constant  result  of  its  administration.  In  no  form  of  febrile  dis- 
ease has  it  been  so  efficient  as  in  acute  rheumatism,  and  here  it  main- 
tains the  first  place  as  a  remedy  in  this  disease,  unless  the  advent  of 
salol  shall  consign  it  to  the  second  place.  In  acute  rheumatism  it  is  su- 
perior to  the  salicylates,  and  to  other  remedies,  unless  salol  prove  more 
efficient.  From  fifteen  to  twenty  grains,  every  three  to  six  hours,  will 
be  required  until  the  cessation  of  joint-pain  and  the  disappearance  of 
the  swelling.  Under  the  action  of  antipyrin,  as  has  been  the  result 
from  all  other  remedies,  a  tendency  to  relapse  is  observed  in  a  propor- 
tion of  the  cases,  and  hence  persistence  is  necessary  in  the  use  of  the 
remedy  for  some  days  after  the  attack  has  apparently  ceased,  but 
the  amount  given  should  be  slowly  reduced. 

Antipyrin  has  the  same  power  to  reduce  temperature  in  the  mala- 
rial as  in  other  fevers,  but  no  power  to  prevent  paroxysms — no  anti- 
periodic  quality.  Hence  it  can  never  be  used  successfully  in  intermit- 
tent and  remittent  fevers. 


METHYLENE   BLUE.  413 

The  antipyretic  quality,  which  at  the  outset  was  supposed  to  be 
the  one  attribute  of  the  chinoline  derivatives,  has  proved  to  be  less 
valuable  than  the  analgesic  property,  which  they  all  possess  to  a  vary- 
ing extent.  "When  Filehne  demonstrated  the  antipyretic  actions,  he 
did  not  pursue  the  investigations  into  the  effects  of  antipyrin  on  the 
nervous  system,  and  the  clinical  studies  which  followed  immediately 
throughout  Germany  (Guttmann,  Bielochowsky,  Pibram,  and  others) 
were  occupied  with  its  influence  over  the  temperature  in  the  course  of 
the  more  important  fevers. 

The  remarkable  relief  afforded  by  antipyrin  and  other  members 
of  the  group  in  acute  rheumatism  led  to  their  use  in  cases  of  neuritis, 
sciatica,  and  some  other  painful  diseases.  We  are  indebted  to  Professors 
Lepine  and  Huchard  more  especially  for  demonstrating  the  influence 
exerted  by  these  agents  over  certain  painful  affections.  It  seems  quite 
clear  that  the  relief  given  is  in  maladies  due  to  central  and  peripheric 
lesions  of  the  nerve  apparatus — for  example,  the  pains  of  locomotor 
ataxia,  neuralgia  of  the  fifth  nerve  associated  with  neuritis,  and  sci- 
atica due  to  the  same  cause. 

Affections  of  a  painful  character  are  amenable  to  the  action  of  an- 
tipyrin in  proportion  to  the  rheumatic  influence  or  diathesis  dominat- 
ing them.  By  subcutaneous  injection,  it  has  proved  to  be  very  effect- 
ive in  many  painful  affections  that  have  their  seat  in  the  nerves. 

The  members  of  this  group  of  remedies  have  the  power  to  diminish 
the  reflex  function,  and  hence  have  been  used  in  the  various  spasmodic 
affections,  as  epilepsy ',  chorea,  etc.,  with  a  measure  of  success,  but  not 
in  so  great  a  degree  as  to  become  substitutes  for  other  tried  remedies. 

Salipyrin. — By  the  combination  of  salicylic  acid  and  antipyrin  is  pro- 
duced a  crystallized  powder  having  many  of  the  qualities  of  both  ingre- 
dients. The  dose  varies  from  five  to  thirty  grains  three  or  four  times 
a  day.  The  diseases  in  which  it  is  employed  are  acute  rheumatism, 
sciatica,  meningitis,  migraine,  dysmenorrhcea,  and  other  affections. 

Methylene  Blue. — Pyoktanin  blue  is  one  of  the  anilin  colors,  utilized 
by  its  proposers  as  an  antiseptic,  under  the  name  pyoktanin,  so  called 
because  of  its  power  to  restrain  suppuration.  It  was  first  employed 
by  Stilling,  who  demonstrated  the  property  to  inhibit  the  organisms  of 
suppuration,  for  which  he  employed  solutions  of  1  to  1,000,  to  100. 

In  its  physiological  actions  pyoktanin  corresponds  to  the  other 
derivatives  of  the  series,  but  it  has  some  special  powers.  Taken  by 
the  stomach  it  is  apt  to  cause  vomiting,  or  rather  regurgitation,  the 
contents  of  the  stomach  coming  up  without  effort.  What  is  brought 
up  thus  is  stained  a  deep  purplish  color.  There  is  more  or  less  stain- 
ing of  the  whole  canal.  It  is  very  diffusible.  When  applied  to  an 
ulcerated  surface  it  passes  into  the  cells  and  arrests  their  growth. 


414  ANTISEPTICS. 

When  it  enters  the  vessels  it  decomposes  the  haemoglobin,  colors  the 
blood  a  chocolate  tint,  fixes  the  blue  in  the  blood-corpuscles,  the  liver- 
cells,  and  the  mucous  membrane  of  the  gall-ducts,  and  the  whole  body 
acquires  a  bluish-purple  coloration.  It  lowers  the  blood-pressure, 
lessens  the  respiration,  diminishes  the  sensibility  of  the  sensory  nerves, 
and  is  more  or  less  hypnotic  and  antipyretic.  It  has,  however,  so 
much  toxic  action  on  the  blood  that  it  is  not  likely  to  be  employed 
in  the  class  of  cases  in  which  acetanilid,  antipyriu,  and  others  have 
been  of  late  so  successfully  employed.  The  pain-relieving  power  of 
pyoktanin  has,  however,  been  made  available  by  Immerwahr,  who  em- 
ployed it  successfully  at  Briegel's  policlinic  in  trigeminal  neuralgia, 
migraine  (alcoholic),  muscular  rheumatism,  herpes  zoster,  and  sciatica. 
Vicutic  employed  pyoktanin  by  subcutaneous  injection  (a  syringeful 
of  a  two-per-cent  solution)  in  the  same  kind  of  cases  as  those  just 
mentioned,  and  also  in  pill,  one  to  three  grains,  in  headache,  alcoholic 
neuritis,  acute  rheumatism,  the  pains  of  locomotor  ataxia,  etc. 

It  is,  however,  as  a  topical  application  to  suppurating  surfaces,  to 
ulcers  and  cancer,  that  pyoktanin  has  been  employed  with  the  greatest 
advantage.  In  the  hands  of  Mosetig-Moorhoff  it  has  proved  to  be  a 
remedy  of  real  value  in  the  treatment  of  cancer — if  not  curative,  at 
least  distinctly  retarding  the  growth  and  changing  its  aspect.  For 
this  purpose  a  solution  of  the  strength  of  1  to  500,  or  stronger,  is 
injected  beneath  and  about  the  tumor  and  into  its  substance.  There 
can  be  no  doubt  that  it  diffuses  into  the  cellular  elements,  so  that  they 
lose  their  vitality  and  the  morbid  action  is  arrested.  In  gonorrhoea, 
an  injection  of  pyoktanin  is  highly  effective  ;  it  is  especially  destruc- 
tive of  the  gonococcus.  A  solution  of  1  to  1,000  is  about  that  ordi- 
narily required.  Pyoktanin  has  also  been  used  with  success  in  the 
treatment  of  carbuncle,  abscesses,  and  suppurative  process  of  the  ear 
and  other  parts. 

Dr.  Ferreira,  of  Rio  Janeiro,  has  employed  pyoktanin  with  success 
in  the  treatment  of  intermittent  fever  in  infants.  It  is  easily  admin- 
istered, and  causes  no  nausea  or  vomiting.  It  acts,  he  supposes,  on 
the  germ  characteristic  of  the  malarial  disease,  and  also  as  an  antipy- 
retic. Ehrlich  and  Guttman  assert  that  this  agent  colors  the  plasmo- 
dia,  prevents  their  development,  and  causes  them  to  disappear  gradu- 
ally ;  but  other  observers  dispute  this  fact. 

Authorities  referred  to : 

BCRGHARD,  FREDERIC  F.  On  the  Action  of  Methyl  Violet,  especially  on  its  U»e  in 
Gonorrhoea.  Lancet,  May  23,  1891. 

COMBEMALE,  DR.  Recherches  expenmentales  et  cliniques  (upon  methylene  blue,  etc.). 
Bui.  Gen.  de  Therap.,  August  30,  1891. 

EGASSE,  ED.     Les  nouveauz  antiseptiques.     Bui.  Gen.  de  Therap.,  juin  15,  1891. 

IMMERWAHR,  DR.  ROBERT.  Ueber  des  Methylenblau  als  Antineuralgicum.  Dent, 
Wochenschrift.  Quoted  in  Virchow  u.  Hirsch's  Jahresbericht  for  1891. 


NAPHTA.LIN.  415 

STILLING,  DR.  J.  Ueber  Anilinfarbstoffe  ah  Antiseptica.  Archiv  fur  experiment. 
Pathologic  und  Pharmacologie,  Band  xxviii,  p.  351. 

WANCHER,  0.     Therapeutische  Monatshefte,  February,  1891,  p.  141. 

VICUTIC,  NICOLACS.     Wien.  Ztg.,  No.  44,  p.  494.     Quoted  by  V.  and  H.  for  1891. 

Naphtalin. — According  to  Fronmtiller,  naphtalin  (or  naphthalin) 
was  discovered  so  long  ago  as  1820,  but  its  applications  in  medical 
practice  have  been  developed  since  the  subjects  of  antiseptics  and  bac- 
teriology have  assumed  so  important  a  place  in  modern  pathology  and 
therapeutics.  It  is  now  obtained  in  quantity  from  a  by-product  of 
gas-manufacture,  and  after  purification  appears  in  commerce  in  the 
form  of  rather  brilliant,  rhombic  crystals,  having  a  somewhat  aromatic 
but  acrid,  burning  taste.  It  is  not  soluble  in  water,  but  dissolves  in 
ether  and  acetic  acid. 

The  best  form  for  the  administration  of  naphtalin  internally  is 
the  compressed  pellet,  and  this  form  secures  the  preservation  of  the 
drug  as  well  as  facilitates  the  administration.  Naphtalin  may  be 
combined  with  any  aromatic  powder — for  example,  the  official  pulvis 
aromaticits  compositus,  powdered  nutmeg,  or  cinnamon — and  given  as 
a  powder.  The  dose  ranges  from  one  quarter  of  a  grain  to  five  grains. 

Naphtalin  does  not  distress  the  stomach  nor  cause  nausea,  the 
present  experience  being  that  it  is  rather  a  stomachic  tonic.  It  is  sup- 
posed that  it  passes  unchanged  from  the  stomach  into  the  intestine, 
where  it  acts  as  an  antiseptic.  The  proof  of  this  action  is  afforded  by 
the  complete  deodorization  of  the  stools.  To  remove  the  fecal  odor 
from  a  mass  of  faeces  implies  the  possession  of  great  powers,  and  is 
conclusive  as  to  changes  occurring  in  the  naphtalin  itself.  It  follows 
that  the  fermentative  processes  producing  more  or  less  of  the  offensive 
compounds  of  sulphur,  phosphorus,  and  carbon,  must  be  arrested  by 
naphtalin. 

Although  insoluble  in  water,  this  remedy  diffuses  through  the  body, 
and  ultimately  escapes  in  part  from  the  lungs  and  kidneys,  but  largely 
in  the  fasces.  It  has  some  mysterious  influence  on  the  function  of 
nutrition,  or  on  the  trophic  nervous  system,  for,  when  given  to  dogs 
freely,  cataracts  form.  No  such  result  can  be  expected  from  its  me- 
dicinal use  in  man  ;  but  a  judicious  practitioner  will  hardly  risk  such 
a  result  by  large  doses,  protracted  administration,  and  careless  obser- 
vation. 

The  therapeutical  applications  are  based  on  the  studies  that  have 
been  made  of  its  physiological  actions  ;  they  are  both  internal  and 
external.  Dupasqvwer  advises  the  following  solution  for  the  stomachal 
administration  :  Naphtalin,  3j  ;  dissolve  in  boiling  alcohol  and  add 
sufficient  simple  sirup  to  make  up  to  eight  ounces.  A  tablespoonful 
can  be  taken  three  or  four  times  a  day.  This  formula  is  said  to  be  an 
excellent  expectorant,  and  to  remove  the  fetid  character  of  the  pus  in 
some  cases,  of  bronchorrhcea.  The  most  important  of  the  internal 


416  ANTISEPTICS. 

uses  of  naphtalin  is  in  the  treatment  of  diarrhoea,  dysentery,  round 
worms,  and  typhoid.  Rossbach  has  found  it  very  useful  in  the  first 
two,  and  the  author  has  had  excellent  results  in  some  cases  of  chronic 
dysentery.  Also,  it  has  appeared  to  the  author  to  be  of  great  relative 
utility  in  the  cases  of  diarrho3a  due  to  obstruction  of  the  portal  circu- 
lation. In  chronic  dysentery  and  diarrhoea,  acute  and  chronic,  it  has 
proved  very  successful  in  the  practice  of  Dolgopoloff. 

Xaphtalin  has  an  effect  on  the  genito-urinary  tract,  in  passing 
through  in  the  urine,  which  is  of  no  little  service  in  catarrhal  states  of 
tiie  mucous  membrane,  in  pyelitis,  cystitis,  etc.  Offensive  urine  is 
sweetened  by  it,  and  hence  an  impression  is  made  on  the  catarrhal  pro- 
cess. On  the  other  hand,  Prof.  Rossbach  asserts  that  in  certain  sub- 
jects its  administration  for  other  purposes  may  excite  a  violent  cystitis 
with  strangury,  and  that  it  must  be  administered  with  caution  when 
the  kidneys  are  damaged. 

The  external  uses  of  naphtalin  consist  in  applications  to  ulcers 
(syphilitic,  varicose  of  the  leg,  or  other  unhealthy  and  sloughing  forms), 
in  leucorrhoea  of  a  fetid  character,  in  gonorrho3a  and  cognate  affec- 
tions. Fronmuller  asserts  that  he  has  had  "marvelous  results"  in 
some  cases  of  bed-sores  caused  by  prolonged  decubitus.  The  same 
authority  affirms  its  superiority  to  iodoform  in  these  diseases. 

In  eczema,  pityriasis,  psoriasis,  etc.,  it  is  often  highly  beneficial. 
An  ointment  with  vaseline  (1  to  3)  is  recommended  when  there  is  in- 
telligent supervision. 

Naphtol. — There  are  two  naphtols,  derivatives  of  naphtalin,  but 
fota-naphtol  is  the  one  prescribed. 

Beta-Naphtol. — A  phenol  occurring  in  coal-tar,  but  usually  pre- 
pared artificially  from  naphtalin.  It  is  used  in  the  form  of  ointment 
with  Vaseline  dissolved  in  alcohol,  ether,  or  in  olive-oil,  in  the  propor- 
tion of  two  to  ten  per  cent.  Although  not  soluble  in  water,  it  is 
readily  diffusible,  and  may  bring  on  toxic  symptoms  if  too  lavishly 
applied  to  a  fresh  surface.  The  character  of  its  toxic  effects  is  simi- 
lar to  those  of  the  other  members  of  the  group,  and  need  not  be 
described  here. 

Asaprol. — A  derivative  of  naphtol  ft.  This  new  remedy  has  been 
carefully  studied  from  the  clinical  standpoint  by  Dujardin-Beaumetz 
and  Stockier.  As  it  offers  many  advantages  over  other  antiseptics  of 
this  group,  some  notice  of  its  actions  and  uses  is  desirable.  The  dose 
for  adults  ranges  from  one  to  ten  grammes  (15  grs.  to  3  ij).  It  is  best 
administered  in  the  form  of  wafer  or  capsule,  or,  as  it  is  very  soluble, 
in  solution  in  some  aromatic  water  with  sirup.  It  does  not  disorder 
the  stomach  nor  cause  headache,  vertigo,  or  singing  in  the  ears. 
Dyspeptics  take  it  without  any  increase  of  their  symptoms;  but  rather 


PYRIDINE.  417 

with  relief  to  some  of  them.  It  has  been  administered  in  subjects  af- 
fected with  albuminuria  without  adding  to  the  renal  mischief.  It  has 
been  taken  by  persons  unable  to  tolerate  sodium  salicylate,  quinine, 
and  antipyrin.  There  is  consequently  a  wide  range  of  applications  of 
asaprol  where  remedies  of  corresponding  powers  can  not  be  admin- 
istered. 

Asaprol  is  an  analgesic  and  antipyretic.  In  acute  rheumatism  it 
has  proved  to  be  as  efficacious  as  the  sodium  salicylate,  and  it  is  far 
better  supported  by  the  patient.  The  daily  amount  required  has 
ranged  between  3  j  and  3  iij,  the  individual  doses  being  one  gramme 
(15£  grs.).  In  certain  infectious  maladies,  as  typhoid  fever,  influenza, 
etc.,  it  has  been  specially  useful.  In  intercostal  neuralgia  and  neu- 
ralgia of  the  dental  branches  of  the  fifth  nerve  it  has  afforded  prompt 
relief.  Again,  in  sciatica  it  has  acted  favorably.  Neuroses,  of  which 
asthma  is  a  type,  have  proved  amenable  to  its  action. 

Pyridine. — Pyridine  is  a  volatile  liquid,  having  a  strong,  diffusive, 
and  somewhat  aromatic  odor.  Its  vapor  is  given  off  at  ordinary  tem- 
peratures, and  its  therapeutical  effects  are  obtained  by  inhalation.  We 
owe  the  valuable  suggestion  of  its  inhalation  for  certain  purposes  to 
Prof.  See,  who  ascertained  that  it  acts  on  the  reflex  function  of  the 
cord,  and  also  on  respiration.  The  special  purpose  for  which  it  is 
prescribed  is  the  treatment  of  asthma,  and  this  condition  is  relieved, 
what  cause  soever  may  have  developed  it.  The  manner  of  its  em- 
ployment is  simple :  it  consists  in  placing  a  saucer  containing  some 
pyridine  ( 3  j,  for  example)  in  a  large  closet  or  small  room  that  can 
be  tightly  closed,  the  patient  remaining  in  it  for  twenty  to  thirty 
minutes,  and  repeating  the  same  procedure  two,  three,  or  five  times 
a  day  as  may  be  necessary.  In  simple  asthma  a  cure  may  be  effected 
in  ten  to  thirty  days,  and  in  symptomatic  asthma,  emphysema,  etc., 
remarkable  relief  is  obtained.  Prof.  See  does  not  advise  pyridine  as 
the  sole  remedy,  for  the  iodides  constitute  the  true  curative  means,  in 
his  belief. 

With  the  inhalation  of  pyridine  vapor  can  be  combined  ethyl 
iodide,  the  latter  contributing  the  iodine  which  is  so  effective  of  itself 
in  many  cases  of  asthma. 

Pyridine  has  basic  properties,  and  forms  crystallizable  salts  with 
acids,  which,  however,  are  somewhat  unstable.  It  mixes  with  water 
in  all  proportions,  but,  as  it  is  exceedingly  volatile,  should  be  prepared 
as  required.  The  dose  for  internal  use  is  from  five  to  twenty  minims. 
Exhibited  in  this  way,  it  increases  the  power  of  the  cardiac  contrac- 
tions, raises  the  tension,  and  greatly  lessens  respiratory  embarrass- 
ment. Its  action  resembles  that  of  digitalis,  for  which  it  may  often 
be  substituted  with  distinct  advantage  (De  Renzi).  The  salts  can  be 
used  in  lieu  of  the  volatile  pyridine  in  many  cases. 
29 


418  ANTISEPTICS. 

Phenacetin. — Among  the  more  recent  contributions  to  the  antisep- 
tic and  antipyretic  group,  phenacetin  is  the  most  promising.  Although 
without  danger  in  the  dosage  necessary  for  therapeutic  purposes,  some 
persons  suffer  from  the  sweating,  chilliness,  and  weakness,  which  occur 
in  a  greater  degree  when  the  other  members  of  the  group  are  used. 
The  dose  of  phenacetin  ranges  from  ten  grains  to  thirty,  in  twenty- 
hour  hours,  and  three  grains  every  two,  three,  or  four  hours  will  have 
sufficient  effect  on  febrile  heat  for  the  most  part.  It  is  little  soluble  in 
water,  and  is  best  given  in  wafer,  capsule,  or  powder. 

Comparing  phenacetin  with  other  well-known  remedies  of  the  same 
class,  it  is  found  that  a  dose  of  ten  grains  is  equal  to  one  of  fifteen 
grains  of  antipyrin,  of  quinine,  and  of  kairin — to  thirty  grains  of 
salicylate  of  soda  and  thirty  grains  of  thallin.  Dose  for  dose  as  com- 
pared with  antifebrin  (acetanilid),  it  is  as  effective  in  reducing  heaty 
but  the  action  is  less  prompt,  and  yet  it  endures  longer. 

The  action  that  confers  on  phenacetin  its  antipyretic  power  is  the 
change  in  the  composition  of  the  red  blood-globules,  whereby  the 
oxidizing  effect  carried  on  by  these  bodies  is  lessened  or  arrested  en- 
tirely. It  is  poisonous  to  animals,  but  not  to  man  [Jfalmert,  Dujardin- 
JBeaumetz,  and  others]. 

Phenacetin  is  a  remedy  in  rheumatismal  affections  of  the  first  order. 
In  fevers,  as  an  antipyretic,  and  as  an  analgesic  in  painful  affections,  it 
is  as  useful  certainly,  if  not  more  so,  than  any  other  of  these  remedies. 

Saccharinum. — Saccharin,  as  it  has  been  happily  named,  is,  in  chem- 
ical language,  orthosulphaminbenzoic  acid.  The  name  is  based  on 
the  most  important  physical  quality — the  sweetness — but  it  is  an  acid, 
and  combines  with  bases  to  form  salts.  Thus  it  displaces  carbonic 
anhydride  from  its  combination  with  sodium,  and  forms  sodium  ortho- 
sulphaminbenzoate.  As  it  is  more  soluble  in  this  form,  the  taste  is 
sweeter.  Internally  it  may  be  prescribed  in  the  form  of  powder,  or 
mixed  in  any  food  or  drink  requiring  the  addition  of  sweet,  and  sub- 
cutaneously  it  can  be  injected  in  solution  in  combination  with  sodium 
bicarbonate.  The  dose  ranges  from  5  grains  to  3  j,  or  more  as  required. 

ACTIONS  AND  USES. — Saccharin  is  not  sugar,  although  one  of  the 
sweetest  substances  in  nature.  It  is  an  antiseptic  of  considerable 
power.  In  the  proportion  0*16  per  100  it  notably  diminishes  the  activ- 
ity of  the  ferment  of  beer.  In  a  mixture  of  saccharin  (0'32  per  100) 
and  of  urine  in  equal  proportions  no  amraoniacal  decomposition  oc- 
curred for  seven  days.  It  retards  the  activity  of  the  gastric  and  pan- 
creatic ferments,  and  it  has  an  inhibiting  influence  on  some  organisms, 
but  it  does  not  affect  the  powers  of  the  spirillum  of  cholera  and  other 
pathogenic  organisms.  According  to  Paschkis,  the  intravenous  injec- 
tion in  dogs  of  a  four-per-cent  solution  is  without  influence  on  the 
blood  pressure  or  on  the  action  of  the  heart.  According  to  Aducco 


ACIDUM   BORICUM.  419 

and  Mosso,  Salkowski,  Paschkis,  and  others,  it  is  comparatively  innocu- 
ous in  its  action  on  the  system,  and  passes  out  unchanged  by  the  urine. 
It  does  not  modify  the  action  of  some  active  agents  with  which  it  may 
be  combined  :  thus  saccharin-strychnine  and  saccharin-cocaine  have 
the  effects  of  the  bases.  The  taste  of  certain  medicaments — as  qui- 
nine, salicin,  tincture  of  chloride  of  iron,  antipyrin,  copaiba  and  sandal- 
wood  oils,  guaiacum,  hydrastis,  and  cascara  sagrada — is  successfully 
covered  by  saccharin  without  impaiinng  any  of  their  qualities  (Gans). 

The  flatulent  colic  of  children  is,  in  my  experience,  often  admirably 
relieved  by  the  giving  of  saccharin  in  two  to  five  grain  doses  after 
meals.  The  intestinal  pain  due  to  the  sudden  formation  of  gas,  and 
coming  on  in  two  to  four  hours  after  meals,  may  be  prevented  by  the 
timely  exhibition  of  this  remedy.  In  these  cases  the  remedy  may  be 
administered  in  any  suitable  food,  or  be  given  at  such  time  after  meals 
as  may  be  necessary  to  secure  its  admission  to  the  small  intestine. 

It  has  also  proved  beneficial  in  catarrh  of  the  duodenum,  catarrh 
of  the  bile-ducts,  and  in  sick  headache  due  to  intestinal  indigestion. 

It  has  been  utilized  as  a  dietetic  agent  and  substitute  for  cane- 
sugar  in  the  treatment  of  diabetes.  The  mistake  is  often  made  of  too 
lavish  use  of  the  substitute,  so  that  it  comes  to  pall  on  the  taste,  and 
a  disagreeable,  mawkish  sense  of  oversweetness  remains  constantly  in 
the  mouth.  There  is  reason  to  believe  that  saccharin  does  good  some- 
what as  a  remedy  for  the  hepatic  disturbance  which  underlies  the  pro- 
duction of  glycosuria. 

In  the  experimental  trials  with  saccharin  it  was  found  that,  given 
by  the  mouth,  the  tendency  of  the  urine  to  decompose  was  greatly 
lessened,  and  hence  it  has  been  proposed  to  employ  it  as  a  remedy  in 
catarrh  of  the  bladder  and  of  the  pelvis  of  the  kidney.  In  some  cases 
good  results  have  followed  this  practice. 

Authorities  referred  to : 

ADUCCO  ET  Mosso.     Quoted  by  Dujardin-Beaumetz,  Diet. 

GANS,  DR.  EDGAR.  Berliner  klin.  Woch.,  No.  13,  S.  281.  Virchow  und  HirscK's 
Jahresbericht  for  1890. 

PAUL,  CONSTANTIN.     Nouvelles  recherches  sur  Vaction  de  la  saccharin. 
PASCHKIS,  DR.      Wiener  Wochen.      Virchow  u.  Hirsch,  1890. 
SALKOWSKI,  DR.     Virchow's  Archiv,  Band  cxx,  p.  325. 

Acidum  Boricum. — Boric  acid.  Acide  boracique,  Fr. ;  Borsaure, 
Ger. 

PROPERTIES. — Boric  acid  occurs  in  glittering,  white,  scaly  crys- 
tals. It  is  soluble  in  twenty-six  parts  of  cold  and  in  three  parts  of 
warm  water,  and  is  freely  soluble  in  alcohol. 

Grlyceritum  Boroglycerini. — Boric  acid,  310  grm.  ;  glycerin  to 
make  1,000  grm. 

ACTIOXS  AND  USES. — Boric  acid  possesses  decided  antiseptic  and 
deodorant  properties.  It  arrests  fermentations  and  putrefactive  de- 


420  ANTISEPTICS. 

composition,  and  is  destructive  of  minute  organisms — bacteria,  vibrio, 
etc.  Applied  to  wounds,  it  is  free  from  irritating  effects  ;  it  lessens 
suppuration,  and  prevents  decomposition. 

Boracic  acid  occupied  an  important  place  in  Lister's  antiseptic 
method.  It  appears  to  be  as  effective  as  carbolic  acid,  and  is  even  less 
irritating  to  the  tissues  than  salicylic  acid.  A  saturated  solution  may 
be  employed  as  a  dressing  to  fresh  wounds  to  prevent  the  action  of 
atmospheric  germs,  or  to  arrest  decomposition  in  gangrenous,  slough- 
ing, or  ill-conditioned  wounds.  "  Boracic  lint  "  is  made  by  steeping 
lint  in  a  saturated  solution  of  boracic  acid  at  the  boiling-point  ;  and, 
after  drying,  it  is  found  to  hold  a  large  quantity  of  the  acid,  weighing 
nearly  twice  as  much  as  before  being  thus  treated. 

Mr.  Lister's  directions  for  the  application  of  boracic-acid  dressings 
to  ulcers  are  as  follows  :  "  The  first  step  is  to  cleanse  the  sore  and  the 
surrounding  skin  once  for  all  from  septic  impurity.  This  is  done  by 
treating  the  surface  of  the  sore  freely  with  a  solution  of  the  chloride 
of  zinc  (forty  grains  to  the  ounce)  ;  and  at  the  same  time  washing  the 
integument  with  a  strong  watery  solution  of  carbolic  acid,  which  is 
used  on  account  of  its  remarkable  power  of  penetrating  the  epidermis, 
while  for  the  sore  itself  the  solution  of  the  chloride  appears  to  be  more 
efficient.  This  preliminary  step  having  been  taken,  the  boracic  dress- 
ing is  at  once  employed  as  follows  :  A  piece  of  oiled-silk  protective, « 
of  sufficient  size  to  cover  the  sore  and  slightly  overlap  the  surrounding 
skin,  is  dipped  in  the  boracic  lotion  (a  saturated,  watery  solution)  and 
applied,  and  over  this  a  piece  of  boracic  lint  large  enough  to  extend 
for  an  inch  or  more  beyond  the  protective  on  all  sides,  the  whole  be- 
ing retained  in  position  with  a  bandage." 

Mr.  Lister  has  used  boracic  solutions  with  great  success  in  pruritus 
ani,  ulcers,  skin-grafting,  burns  and  scalds,  eczema,  in  operations  on  the 
penis,  etc.  By  Mr.  Watson,  these  solutions  have  been  employed  with 
excellent  results  in  the  dermatophyta  ;  for  example,  tinea  tonsurans 
and  t.  circinata — especially  "  in  that  very  troublesome  form  of  the  dis- 
ease which  affects  the  scrotum  and  inner  side  of  the  thigh." 

Boracic  ointment  may  be  made  as  follows  :  "  Take  of  boracic  acid 
finely  levigated,  one  part ;  white  wax,  one  part ;  paraffin,  two  parts ; 
almond-oil,  two  parts.  Melt  the  wax  and  paraffin  by  heating  them 
with  the  oil,  and  stir  the  mixture  briskly  along  with  the  boracic-acid 
powder  in  a  warm  mortar  until  the  mixture  thickens."  When  required 
for  use,  this  ointment  should  be  rubbed  up  with  a  little  glycerin  to 
the  proper  consistence,  and  then  spread  on  muslin  or  linen. 

Boracic  acid  may  be  employed  in  all  the  various  forms  and  combi- 
nations in  which  carbolic  and  salicylic  acids  are  now  used  by  the  anti- 
septic method. 

Borocitrate  of  magnesia,  originally  proposed  by  Becker,  has  been 
recently  strongly  urged  by  Madsen  as  a  solvent  of  urinary  calculi  of 


BENZOIN.  421 

the  uric-acid  variety.  It  may  be  extemporaneously  prepared  as  fol- 
lows :  $  Magnesii  carbonat.,  3  j  ;  acid,  citric.,  3  ij  ;  sodii  biborat., 
3  ij  ;  aquae  bul.,  f  viij.  M.  Sig. :  A  tablespoonful  three  or  four  times 
a  day. 

Tartraborate  of  potassium  is,  probably,  a  more  generally  useful 
remedy  for  the  purpose  above  indicated,  as  the  potash  compounds  of 
uric  acid  are  more  soluble  than  the  soda  compounds.  As  a  solvent  of 
uric-acid  calculi,  this  salt  is  preferable.  It  is  obtained  by  heating  to- 
gether four  parts  of  cream  of  tartar,  one  part  of  boracic  acid,  and  ten 
parts  of  water.  It  is  a  white  powder,  or  occurs  in  transparent  scales, 
has  an  acidulous  taste,  and  dissolves  in  two  parts  of  cold  water.  A 
scruple  may  be  given  three  or  four  times  a  day  in  water,  and  the  more 
largely  diluted  it  is,  the  better  when  used  for  the  solution  of  calculi. 

Authorities  referred  to  : 

HUSEMANN,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  erster  Band, 
p.  284. 

LISTER,  PROF.  JOSEPH.  On  Recent  Improvements  in  the  Details  of  Antiseptic  Surgery. 
TJie  Lancet,  vol.  i,  1875. 

WATSON,  MR.     Indian  Medical  Gazette.     The  Lancet,  vol.  ii,  1875,  p.  750. 

Benzoinum. — Benzoin.  A  balsamic  resin  obtained  from  Styrax  ben- 
zoin Dryander  (Nat.  Ord.  Styracece).  Benjoin,  Fr. ;  Benzoeharz,  Ger. 

COMPOSITION. — Benzoin  is  made  up  of  resins.  When  subjected  to 
dry  distillation  it  yields  benzoic  acid,  which  is  contained  in  it  in  the 
proportion  of  fourteen  to  eighteen  per  cent.  Certain  varieties  of  ben- 
zoin contain,  also,  cinnamic  acid. 

Tinctura  Benzoini. — Tincture  of  benzoin,  200  grm. ;  alcohol,  suf- 
ficient to  make  1,000  c.  c.  Dose,  3  ss —  3  j. 

Adeps  Benzoinatus. — Benzoinated  lard.  Benzoin,  20  grm.;  lard, 
1,000  grm. 

Tinctura  Benzoini  Composita. — Compound  tincture  of  benzoin. 
(Benzoin,  socotrine  aloes,  storax,  balsam  of  tolu,  alcohol.)  Dose,  3  ss 
-3ij. 

Acidum  Benzoicum. — Benzoic  acid.  Is  in  white,  feathery  crystals, 
of  a  peculiar,  agreeable  odor,  and  warm,  acidulous  taste,  sparingly  sol- 
uble in  cold  water,  more  soluble  in  boiling  water,  which  deposits  it  in 
part  on  cooling,  and  very  soluble  in  alcohol.  Dose,  gr.  v —  3  ss. 

Ammonii  Benzoas. — Ammonium  benzoate.  Is  in  minute,  white, 
shining,  thin,  four-sided,  laminar  crystals,  with  a  slight  odor  of  official 
benzoic  acid,  and  a  bitterish,  saline,  somewhat  balsamic  taste,  and 
slightly  acrid  but  persistent  after-taste.  It  is  soluble  in  five  parts  of 
water  and  in  twenty-eight  parts  of  alcohol.  Dose,  gr.  v —  3  ss. 

Sodii  Benzoas. — Sodium  benzoate.  A  white,  semi-crystalline  or 
amorphous  powder,  efflorescent  on  exposure  to  air,  odorless,  or  having 
a  faint  odor  of  benzoin,  of  a  sweetly  astringent  taste,  and  neutral 


422  ANTISEPTICS. 

reaction.  Soluble  in  1  '8  parts  of  water,  and  in  forty-five  parts  of  alco- 
hol at  60  Fahr.  Dose,  gr.  v  —  3  j. 

ACTIONS  AND  USES. — The  physiological  effects  of  benzoin  and  its 
preparations  are  due  to  benzoic  acid.  Taken  in  very  considerable 
doses  (  3  ss),  benzoic  acid  produces  some  epigastric  heat,  increases  the 
pulse-rate,  and  promotes  bronchial  and  cutaneous  transpiration.  The 
acidity  of  the  urine  is  rendered  more  decided  by  it.  A  large  part  of 
the  acid  is  excreted  by  the  kidneys  as  benzoic  acid,  and  a  part  under- 
goes conversion  into  hippuric  acid. 

Recent  observations  have  shown  that  benzoic  acid  has  decided  an- 
tiseptic properties  (Salkowsky).  It  manifests,  the  same  power  to  pre- 
vent fermentations  and  putrefaction,  and  to  destroy  minute  organisms, 
as  that  possessed  by  salicylic  and  boracic  acids. 

The  tinctures  of  benzoin  were  formerly  used  as  expectorants  in 
chronic  bronchial  affections.  They  are  now  sometimes  resorted  to  for 
the  local  treatment  (by  atomization)  of  chronic  laryngeal  affections. 
Their  most  important  use,  however,  is  in  the  treatment  of  foul-smelling 
wounds,  flabby  granulations,  etc.  Unhealthy  or  sloughing  wounds 
may  be  dressed  with  linen  or  cotton  cloths  saturated  with  the  tinctures, 
with  the  effect  to  destroy  fetor  and  stimulate  to  a  more  healthy  growth. 
Chapped  hands  and  lips  and  fissured  nipples  are  best  treated,  accord- 
ing to  Stille,  with  a  mixture  of  compound  tincture  of  benzoin  and 
glycerin.  Benzoic  acid  may  be  used  as  a  substitute  for  boracic  and 
salicylic  acids  in  the  antiseptic  treatment  of  wounds.  Its  solubility  in 
water  can  be  increased  by  the  addition  of  borax. 

Benzoate  of  ammonia  is  a  remedy  of  great  utility  when  the  urine  is 
ammoniacal  and  loaded  with  phosphates.  Under  its  use  the  urine  be- 
comes acid,  and  the  fermentative  changes  are  arrested.  In  chronic 
cystitis,  arising  from  any  cause,  this  remedy  should  be  prescribed  when 
the  urine  undergoes  the  alkaline  fermentation.  Incontinence  of  urine, 
when  due  to  an  alkaline  reaction  of  this  excretion,  is  cured  by  the  ben- 
zoate  of  ammonia.  Phosphatic  calculi  may  be  dissolved  by  the.  long- 
continued  use  of  this  remedy. 

Benzoate  of  sodium  has  lately  occupied  a  large  place  in  profes- 
sional attention.  Having  similar  antiseptic  and  antipyretic  properties 
to  those  of  salicylate  of  sodium,  and  being  without  any  injurious  effect, 
it  came  to  be  largely  used  in  the  septic  maladies.  The  first  important 
observations  were  those  of  Dr.  Klebs,  of  Prague,  who  announced  that 
this  salt  can  be  used  with  good  effects  in  all  infectious  febrile  diseases  ; 
that  while  the  febrile  movement  does  not  cease  as  quickly  as  after  the 
use  of  sulphate  of  quinine  and  salicylate  of  sodium,  the  results  obtained 
from  the  benzoate  are  more  permanent.  Moreover,  absolutely  no  un- 
pleasant after-effects  were  observed  from  this  remedy,  even  when  its 
use  was  much  prolonged,  and  as  much  as  three  hundred  and  eighty 
grains  daily  could  be  taken  without  inconvenience.  The  usual  daily 


BENZOIN.  423 

quantity  required  in  the  treatment  of  diseases  is  ten  to  fifteen  grammes, 
or  one  hundred  and  fifty  to  one  hundred  and  eighty  grains.  Dr.  Klebs 
advised  the  use  of  benzoate  of  soda  in  the  acute  infectious  diseases,  in 
tuberculosis,  and  catarrh  of  the  bronchi.  The  principle  underlying 
these  suggestions  of  Dr.  Klebs  is  the  antiseptic.  He  holds  that  the 
maladies  in  question  are  of  parasitic  origin.  The  appropriate  remedy 
is  an  antiseptic,  destructive  of  germs.  There  are  several  remedies 
having  these  powers,  but  benzoate  of  sodium  is  best,  because,  while 
very  destructive  of  minute  organisms,  it  is  free  from  injurious  effects 
on  the  body.  A  remarkable  and  sudden  extension  was  given  to  the 
use  of  this  salt  by  the  report  from  Innspruck,  that  cases  of  consump- 
tion far  advanced  were  being  quickly  cured  in  the  clinic  of  Prof. 
Propop  Rokitansky.  Subsequent  investigations  proved  the  inaccu- 
racy of  such  observations.  Klebs  held  that  he  had  proved  the  para- 
sitic origin  of  phthisis,  and  Prof.  Schuller,  of  Greifswald,  confirmed 
his  statements  by  additional  experiments.  It  was  discovered  in 
Klebs's  laboratory  that,  if  animals  were  made  to  inhale  the  spray  of 
benzoate  of  sodium,  tubercular  and  diphtheritic  matter  did  not  affect 
them.  Then  followed  the  treatment  of  cases  of  consumption,  by  spray 
of  a  solution  of  the  benzoate.  Although  the  first  claims  put  forth 
were  greatly  exaggerated — not  entirely  unfounded — there  is  reason  to 
believe  that  the  free  use  of  benzoate  spray  is  of  service  in  some  cases 
of  consumption.  According  to  the  estimate  of  Rokitansky  (Propop), 
the  patient  must  inhale  y^Vrr  °f  the  body-weight  daily  of  the  ben- 
zoate in  the  form  of  spray,  to  do  any  good.  .  Among  the  numerous 
observations  in  opposition  to  the  views  of  Klebs  and  his  followers,  may 
be  selected  those  of  Guttmann,  who  found  that  the  treatment  did  not 
relieve  a  single  symptom,  and  that  there  was  no  appearance  in  the 
affected  lungs  of  any  attempt  at  reparation. 

Benzoate  of  sodium  has  been  used  in  other  infectious  diseases. 
Thus  Letzerich  has  employed  it  with  success  in  the  teatment  of  diph- 
theria. Of  twenty-seven  cases  treated  with  this  remedy  in  one  epi- 
demic, only  one  proved  fatal,  and  this  was  an  infant  of  feeble  consti- 
tution. He  gave  from  five  to  twenty  grammes  daily  (seventy-five  to 
three  hundred  grains),  according  to  age,  and  applied  the  powdered 
benzoate  by  insufflation  to  the  diseased  parts.  Other  physicians  have 
not  been  so  largely  successful,  but  many  very  favorable  reports  have 
been  published  (Kien,  Hoffmann).  Thus  Demme  found  it  highly  ser- 
viceable in  diphtheria  and  scarlet  fever.  It  is  well  established  that 
benzoate  of  sodium,  added  to  the  diphtheritic  fungus,  renders  it  harm- 
less, so  that  the  local  use  is  founded  on  sound  reasons.  As  an  anti- 
pyretic in  the  eruptive  fevers,  in  typhoid,  and  in  malarial  fevers,  this 
salt  may  be  preferred  to  the  salicylate,  than  which  it  is  safer,  although 
much  less  effective  as  an  antipyretic.  In  acute  rheumatism  it  has  been 
administered  by  Senator,  McEwan,  and  others,  who  have  found  it  a 


424  ANTISEPTICS. 

good  and  safe  remedy,  but  not  so  active  as  salicylic  acid.  Tordens  has 
treated  whooping-cough  successfully,  using  the  prescription  of  Letze- 
rich  :  r>  Sodii  benzoat.,  3iv;  aquae  destil.,  aquae  menth.  pip.,  aa  3  x  ; 
syrup,  aurantii,  3  ij.  M.  Sig. :  Two  drachms  every  hour  or  two. 

Authorities  referred  to  : 

DEMME,  DR.     Allg.  Wiener  med.  Zeitung,  No.  24,  1880. 

GCTTMANN,  DR.  PAUL.     Berliner  klin.  Wochen.,  December  8,  1879. 

KLEBS,  DR.     Allg.  med.  Centralzeitung,  June  6,  1878. 

KOHLER  UNO  DiTTEL.     Berliner  klinische  Woclien.,  No.  44,  1879. 

LETZERICH,  DR.     Berliner  klinische  Wochen.,  No.  1,  1879. 

McEwAN,  DR.  DAVID.     British  Medical  Journal,  March,  1881,  p.  336. 

SALKOWSKT,  DR.  E.      Virchow's  Archiv,  B.  Ixxviii,  p.  30. 

SENATOR,  DR.     Zeitschrifi  fur  klinische  Med.,  Band  i,  p.  41. 

TORDENS,  DR.  EDOUARD.  Jour,  de  Med.  de  Brux.,  May,  1880.  London  Medical  Record, 
August  15,  1880. 

Acetanilidum. — Acetanilid  (Antifebrin). — An  acetyl  derivative  of 
aniline.  The  term  antifebrin,  by  which  acetanilid  is  best  known, 
is  a  proprietary  designation  ;  acetanilid  is  a  more  scientific  term, 
unrestricted  in  use,  and  hence  should  be  preferred.  Also,  the  name 
antifebrin  expresses  but  one,  and  not  the  most  important,  of  its 
powers. 

PROPERTIES  —  PHYSICAL  AND  PHYSIOLOGICAL.  —  Acetanilid  is  a 
white,  crystallized  powder,  without  odor,  and  having  a  slight,  charac- 
teristic, but  not  disagreeable  taste.  It  is  soluble  to  some  small  extent 
in  cold  water,  1  part  to  194  ;  more  soluble  in  warm  water,  1  part  to 
50  of  water  at  105°  Fahr.  ;  and  dissolving  readily  in  alcohol  (3*5),  in 
ether  (6),  and  in  chloroform  (7).  Chemically,  acetanilid  is  aniline^ 
less  an  atom  of  hydrogen  replaced  by  acetyle.  The  dose  ranges  be- 
tween four  and  eight  grains.  The  latter  quantity  need  rarely  be  ex- 
ceeded in  a  single  dose,  but  a  considerably  larger  amount  can  be  safely 
administered  in  twenty-four  hours.  Drachm-doses  have  been  taken 
by  healthy  persons  without  suffering.  There  are  important  differences 
in  the  action  of  moderate  medicinal  and  of  toxic  doses  (Weill),  for  the 
effect  of  the  latter  on  the  blood-globules  introduces  a  special  pathogenic 
influence  which  must  change  the  character  of  the  symptoms  produced. 

Ordinary  medicinal  doses  do  not  irritate  the  stomach,  and  indeed, 
as  the  author  has  observed,  sometimes  allay  nausea.  Notwithstand- 
ing its  insolubility,  acetanilid  rapidly  diffuses  into  the  blood.  The 
normal  constituents  of  the  blood  are  quickly  changed  in  composition  ; 
the  oxyhaemoglobin  lessens  in  quantity,  and  a  corresponding  formation 
of  methyhaemoglobin  takes  place.  The  effect  of  such  changes  is  to 
seriously  modify  that  function  entitled  the  "  ozonizing  function,"  and 
to  impair  constructive  tissue  metamorphosis,  and  with  it  heat-produc- 
tion. The  effect  of  full  medicinal  doses  in  this  way  is  partly  mani- 
fested in  the  cyanosis  usually  present,  but,  as  no  ill  result  occurs,  it 
is  certain  that  the  change  is  only  temporary.  The  reduction  of  tem- 
perature takes  place  only  when  fever  is  present,  and  no  action  follows- 


ACETANILID.  425 

the  administration  of  the  remedy  during  apyrexia.  It  results  from  this 
fact  that,  to  obtain  the  fullest  effect  from  acetanilid  as  an  antipyretic, 
it  should  be  given  at  the  point  of  maximum  elevation  of  temperature. 

Acetanilid  raises  the  intra-vascular  blood-pressure,  chiefly  by  con- 
tracting the  peripheral  arterioles,  and  thus  increases  the  work  of  the 
heart.  As  the  vascular  tension  rises,  the  heart-beats  lessen  in  number, 
but  gain  in  force  After  a  time,  as  is  the  physiological  law,  the  stimu- 
lation of  the  cardiac  motor  apparatus  is  succeeded  by  diminished  ac- 
tion and  irregularity  of  the  rhythm — consequences  of  a  protracted  and 
powerful  impression  on  the  centers  of  reflex  action,  and  of  the  vaso- 
motor  system.  It  is  a  curious  fact  that,  in  a  considerable  number  of 
persons,  only  the  effects  on  the  nervous  system  are  produced,  and  a 
decline  of  temperature  and  failure  of  respiration  are  not  experienced. 
The  mind  continues  clear,  and  vocal  expression  is  not  impaired,  until 
the  serious  changes  wrought  in  the  blood  bring  about  coma  and  insen- 
sibility. As  the  effects  of  the  medicament  are  developed,  the  reflexes 
lessen,  and  the  irritability  of  motor  and  sensory  nerves  and  of  the 
pneumogastric  progressively  declines.  Analgesia  and  anaesthesia  are 
products  of  its  action,  but  it  is  evident  that  the  interference  in  the 
respiratory  function  of  the  blood  has  much  to  do  with  the  functional 
changes  occurring  in  the  nervous  system. 

In  the  beginning,  acetanilid  excites  increased  action  in  the  central 
nervous  apparatus,  but,  as  the  impression  gains  in  force,  a  quantitative 
decline  takes  place  in  the  functions  of  motility  and  sensibility,  and 
ultimately  they  are  suspended  entirely.  Large  doses  have  so  serious 
an  effect  on  the  red  blood-globules  that  collapse  follows  a  brief  period 
of  excitement.  As  the  antipyretic  power  is  due  to  the  injury  done  to 
the  "ozonizing  function  of  the  blood,"  as  has  been  explained,  it  is 
clear  that  the  therapeutical  applications  for  diminishing  fever-heat  are 
not  without  danger,  and,  although  it  is  an  efficient  remedy  for  this 
purpose,  it  is  probably  not  safer  when  the  proper  dose  is  exceeded  than 
the  other  antipyretics  of  the  same  character.  It  is  true,  to  accomplish 
a  given  result,  so  small,  comparatively,  is  the  dose  required,  that  it  is 
not  necessary  to  exhibit  that  quantity  which  will  produce  dangerous 
symptoms.  In  common  with  the  antipyretics  of  this  class,  but  far  less 
frequently  and  severely,  acetanilid  causes  sweating  at  the  end  of  its 
impression,  and  a  rigor  as  the  temperature  begins  to  rise  again. 

Opinions  differ  somewhat  in  regard  to  the  certainty  and  the  power 
of  acetanilid  as  an  antipyretic.  Eisenhart,  Riese,  Krieger,  and  other 
German  observers,  find  it  to  be  extremely  uniform  in  its  effects  on 
febrile  heat ;  but  Dujardin-Beaumetz  holds  that  small  doses  will  some- 
times have  a  decided  power  to  lessen  the  temperature,  and,  again, 
quite  large  doses  will  fail  of  effect.  He  regards  it,  therefore,  as  a  rather 
capricious  antipyretic,  and  hence  inferior  to  antipyrin  for  this  purpose, 
although  threatening  symptoms  are  but  rarely  induced  by  its  thera- 
peutical administration,  with  the  exception  of  cyanosis,  which  occurs 


426  ANTISEPTICS. 

when  the  larger  doses  are  given,  but  does  not  necessarily  indicate  an 
untoward  action. 

The  amount  required  to  produce  distinct  antipyretic  effects  ranges 
from  four  to  eight  grains,  the  latter  dose  having  proved  to  be  an  effect- 
ive quantity  for  lessening  fever-heat  in  general.  A  much  larger  quan- 
tity can  be  given  with  entire  safety,  if  the  circumstances  demand  the  in- 
crease. Huber  has  administered  from  sixty  to  seventy  grains,  and  from 
ninety  to  a  hundred  grains  in  twenty-four  hours,  without  any  ill  effects. 
The  reduction  of  temperature  begins  in  one  to  two  hours  after  the  dose 
has  been  taken,  and  the  effect  is  maintained  for  four  to  twelve  hours. 

THERAPY. — The  applications  of  acetanilid  to  the  treatment  of  dis- 
eases are  based  on  its  physiological  actions.  There  are  two  directions 
in  especial  that  its  curative  powers  take  :  to  lessen  fever  (antipyretic 
action)  ;  to  diminish  the  functional  activity  of  motor  and  sensory 
nerves,  and  to  inhibit  reflex  actions. 

As  respects  fever,  when  the  high  temperature  must  be  reduced, 
acetanilid  is  effective,  and  although  it  may  exert  less  power  than  an- 
tipyrin,  has  many  advantages,  in  size  of  dose,  ease  of  administration, 
and  freedom  from  untoward  effects.  Its  special  field  of  utility  is  the 
relief  of  inflammatory  conditions  of  nerves.  In  neuritis,  the  author 
has  found  it  so  effective  that  it  has  seemed  to  have  specific  action. 
The  pains  (neuralgia,  myalgia,  etc.)  due  to  inflammation  of  nerves 
are,  as  a  rule,  soon  relieved,  and  the  dose  for  this  purpose  need  not 
exceed  three  to  five  grains  ter  die.  In  optic  neuritis,  with  pain,  Du- 
jardin-Beaumetz  finds  it  exceedingly  effective,  not  only  in  removing 
the  nerve-pain,  but  in  arresting  the  inflammatory  process  on  which 
the  pain  depends.  Very  admirable  results  have  been  had  from  acetan- 
ilid in  the  pains  of  locomotor  ataxia.  As  all  the  world  knows,  these 
pains  have  not  hitherto  been  at  all  readily  relieved  by  the  means  avail- 
able, and  hence  the  importance  of  this  recent  contribution  to  our  re- 
sources. The  pains  of  herpes  zoster,  and  of  sciatica  produced  by  local 
injury,  have  also  been  promptly  arrested  by  this  remedy,  while  no  ap- 
prehension of  a  habit  has  intervened  to  lessen  the  satisfaction  derived 
from  its  curative  power. 

To  Lepine,  of  Lyons,  to  whom  we  owe  the  first  knowledge  of  the 
curative  power  of  acetanilid  in  the  affections  of  the  nervous  system 
mentioned  above,  and  to  Dujardin-Beaumetz,  we  are  also  indebted  for 
the  suggestion  of  its  use  in  epilepsy.  The  experiences  and  observations 
thus  far  accumulated  do  not  warrant  the  statement  of  exact  formula 
to  guide  the  administration.  That  it  lessens  reflex  excitability  and 
opposes  spasm  is  evident,  but  such  an  action  does  not  include  the  whole 
of  its  powers.  The  impression  made  by  acetanilid  on  the  vase-motor 
system  must  be  taken  into  account  as  an  element  in  its  curative  action. 
As  it  causes  contraction  of  the  arterioles,  and  slows  somewhat  the 
heart-beat,  it  must  be  more  useful  in  those  cases  of  epilepsy  character- 
ized by  full  habit,  active  circulation,  redness  of  face,  injection  of  the 


ANTISEPTIC   OILS.  427 

conjunctive,  etc.,  than  in  the  anaemic,  the  pale  and  feeble.  For  similar 
considerations,  it  will  prove  more  useful  in  diurnal  than  in  nocturnal 
epilepsy,  for,  as  in  the  state  of  sleep  there  is  an  anaemic  condition  of 
the  brain,  it  is  probable  that  an  agent  contributing  to  this  will  only 
increase  the  tendency  to  convulsions. 

Exalgine. — By  this  name  a  new  remedy  having  valuable  anodyne 
property  has  been  introduced  by  Dujardin-Beaumetz  and  Bardet.  It 
is  a  derivative  of  acetanilid  with  methyl,  and  hence  the  name,  given  to 
designate,  not  its  composition,  but  its  most  important  curative  power. 
The  chemical  name  is  Orthomethylacetanilid,  which  is  too  difficult 
and  unwieldy  for  general  use.  It  has  proved  to  be  a  highly  effective 
remedy  for  neuralgia,  and  is  free  from  ill  effects.  The  dose  required 
for  internal  exhibition  in  painful  affections  is  determined  by  the  de- 
gree of  pain  and  the  nature  of  the  cause  producing  it.  As  a  hypnotic 
it  has  proved  to  be  one  of  the  most  effective,  and  this  without  any  of 
the  immediate  and  remote  actions  of  a  disagreeable  kind. 

Antiseptic  Oils. —  Oleum  Caryophylli. — Oil  of  cloves. 

COMPOSITION. — Oil  of  cloves  consists  of  two  substances — a  hydro- 
carbon, light  oil  of  cloves,  and  an  oxygenated  oil,  eugenol,  which  has 
acid  properties,  and  is  therefore  called  eugenic  acid.  The  light  oil  of 
cloves  is  isomeric  with  the  oils  of  turpentine,  copaiba,  and  cubebs. 

Salicylic  acid  and  a  camphor  known  as  caryophyllin  are  also  con- 
stituents of  the  oil  of  cloves.  Dose,  gtt.  ij — gtt.  v. 

Oleum  Gaultherive. — Oil  of  gaultheria.  A  volatile  oil,  consisting 
almost  entirely  of  methyl  salicylate,  from  the  leaves  of  Gaultheria 
procumbens  Linne  (Nat.  Ord.  Ericaceae} .  Methyl  salicylate  or  vola- 
tile oil  of  sweet  birch  can  be  substituted  for  oil  of  gaultheria  in  dis- 
pensing. Dose,  Tt[  ij — TIJ,  v.  x. 

Spiritus  Gaultherice. — (Oil  of  gaultheria,  50  c.  c.  ;  alcohol,  950 
c.  c.)  Dose,  3  ss —  3  ij. 

Oil  of  gaultheria  has  been  proposed  and  used  successfully  as  a  sub- 
stitute for  salicylic  acid  in  the  treatment  of  rheumatism,  gout,  and 
affections  dependent  on  these  diatheses  respectively.  It  is  best  given 
in  the  form  of  an  emulsion,  and  it  may  be  combined  with  other  agents 
having  corresponding  powers. 

COMPOSITION. — Oil  of  thyme  contains  a  hydrocarbon  which,  by 
fractional  distillation,  is  resolvable  into  cymene  and  thymene.  Its 
most  important  constituent  is  a  solid  crystalline  substance,  having 
acid  properties  and  homologous  with  carbolic  acid.  This  is  known  as 
thymol,  or  thymic  acid.  Dose,  gr.  ij — gr.  x. 

Oleum  Cajuputi. — Oil  of  cajuput.  The  volatile  oil  distilled  from 
the  leaves  of  Melaleuca  leucadendron  (Nat.  Ord.  Myrtacece).  Dose, 
TTJ.V — TTI  xx. 

COMPOSITION. — The  most  important  constituent  of  the  oil  of  caju- 
put is  cajuputol,  or  the  bihydrate  of  cajuputene. 


428  ANTISEPTICS. 

To  this  list  might  be  added  eucalyptol,  the  camphor  obtained  from 
Eucalyptus  globulus,  and  the  various  balsams,  and  cymene  and  terpene 
volatile  oils ;  but  these  remedies  have  already  been  considered  else- 
where, so  far  as  they  possess  any  practical  importance. 

Thymol.—"  A  phenol  occurring  in  the  volatile  oils  of  Thymus  vul- 
garis,  Linne,  Monarda punctata,  Linne  (Nat.  Ord.  Labiatce)"  etc. 

Large,  colorless,  translucent  crystals  of  the  hexagonal  system,  hav- 
ing an  aromatic,  thyme-like  odor  and  a  pungent  aromatic  taste,  with  a 
very  slight  caustic  effect  upon  the  lips.  Soluble  in  about  1,200  parts 
of  water  at  59°  Fahr.  (15°  C.),  and  in  less  than  its  own  weight  of 
alcohol  ;  also  readily  soluble  in  carbon  disulphide,  glacial  acetic  acid, 
and  in  fixed  and  volatile  oils.  When  triturated  with  about  equal  quan- 
tities of  camphor,  menthol,  or  chloral,  it  liquefies.  (U.  S.  Ph.) 

PHYSIOLOGICAL  ACTIONS. — The  composition  of  this  group  of  oils 
indicates  the  close  correspondence  between  them  and  carbolic,  salicylic, 
and  benzole  acids.  So  intimate  are  the  chemical  relations  of  salicylic 
acid,  benzoic  and  cinnamic  acids,  that  the  balsams  might  with  propriety 
be  grouped  with  the  antiseptics,  for  in  their  physiological  actions  and 
therapeutical  applications  they  are  equally  as  closely  related  as  in  their 
elementary  composition. 

Of  the  members  of  this  group,  thymol  or  thymic  acid  has  been 
most  elaborately  studied.  Lewin  has  shown  that  thymol,  as  respects 
its  influence  on  fermentation  and  putrefaction,  has  a  positive  antiseptic 
property.  Its  actions  are  similar  to  those  acids  of  the  same  class  to 
which  it  is  so  closely  allied  chemically,  viz.,  carbolic,  salicylic,  and 
benzoic.  Locally  applied,  thymol,  just  as  carbolic  acid,  produces  pa- 
ralysis of  the  end-organs  of  the  sensory  nerves  (Lewin). 

The  effects  of  thymol  have  also  been  studied  by  Baltz.  He  has 
ascertained  that  from  twenty  to  thirty  grains  a  day  are  necessary  to 
produce  distinct  effects.  Placed  in  contact  with  the  fauces,  it  causes 
an  acrid  sensation,  which  persists.  It  rarely  excites  vomiting,  but  a 
large  dose  induces  a  sensation  of  heat  about  the  epigastrium,  and 
sometimes  diarrhoea.  In  the  majority  of  cases  thymol  causes,  in  about 
half  an  hour  to  an  hour,  sweating  more  or  less  profuse,  but  distinctly 
less  than  that  produced  by  salicylic  acid  and  jaborandi.  The  urinary 
secretion  is  sometimes  increased.  The  urine  presents  a  dark,  greenish 
hue,  as  if  it  contained  blood.  This  is  due  to  the  presence  of  a  decom- 
position product  of  thymic  acid,  and  in  part  of  thymol  itself,  for  a 
portion  of  that  taken  escapes  unchanged  (Blum).  Singing  in  the  ears, 
deafness,  constriction  of  the  forehead,  are  caused  by  full  medicinal 
doses,  and  a  considerable  decline  of  febrile  temperature  takes  place. 
Decided  sweating  is  coincident  with  the  fall  in  temperatui'e,  and  a 
rigor  usually  succeeds.  It  may  cause  coma,  and  ordinary  apyretic 
dcses  have  induced  great  weakness  and  cardiac  failure.  Toxic  doses 
in  animals  cause  death  by  failure  of  respiration.  It  is  an  antiseptic, 


THYMACETIN.  429 

and  is  destructive  of  pathogenic  organisms.  It  is  also  analgesic,  and 
lessens  the  sensibility  of  the  sensory  nerves. 

Thymol,  therapeutically,  is  employed  as  an  antiseptic  and  antipy- 
retic. It  is  used  as  a  mouth-wash  in  dental  practice  to  allay  the  sen- 
sibility of  the  mucous  membrane,  when  the  gums  are  spongy,  to  arrest 
retraction  of  the  gums,  as  a  gargle  in  faucial  troubles.  For  this  pur- 
pose a  solution  varying  in  strength  from  1  to  10  parts  in  1,000,  or  as 
an  ointment  in  from  1  to  5  per  cent,  may  be  employed. 

In  gastric  and  intestinal  catarrh,  thymol  acts  well  to  arrest  fer- 
mentation and  stimulate  digestion.  As  an  anthelmintic,  it  has  acted 
favorably,  but  large  doses — from  10  to  30  grains — are  necessary  to 
dislodge  ascarides.  It  is  said  to  destroy  anchylostoma,  and  to  pre- 
vent or  remove  the  secondary  troubles  caused  by  this  parasite.  For 
this  purpose  the  dose  should  be  one  or  two  grains  several  times 
a  day. 

As  an  antipyretic,  thymol  has  been  employed  in  fevers,  in  pneu- 
monia, and  in  inflammatory  affections.  The  large  doses — from  10  to 
30  grains — required  to  effect  any  considerable  reduction  of  tempera- 
ture, the  sweats,  chills,  and  depression  of  the  powers  of  life  which  are 
thereby  caused,  render  its  use  doubtful,  even  prohibitory.  As  thymol 
exercises  a  deterrent  influence  over  the  microbes  of  phthisis  and  diph- 
theria, it  has  been  used  topically  with  a  certain  measure  of  success. 
To  this  end  it  is  used  in  the  form  of  spray  and  by  inhalation,  of  the 
strength  of  1  per  cent. 

Externally,  thymol  is  used  in  the  treatment  of  parasitic  skin  dis- 
eases, as  tinea  and  pityriasis  versicolor,  with  success.  An  ointment  of 
5  per  cent  in  lanoline  or  vaseline  is  suitable  for  this  purpose. 

Thymacetin, — Under  this  name  appears  a  derivative  of  thymol,  cor- 
responding to  phenacetin,  a  derivative  of  phenol.  It  occurs  in  the 
form  of  whitish  crystals,  slightly  soluble  in  water. 

Thymacetin  possesses  properties  not  unlike  phenacetin,  its  con- 
gener. It  is  analgesic,  antipyretic,  and  antiseptic.  By  Jolly  it  has  been 
used  successfully  in  the  treatment  of  hemicrania  and  congestion  of  the 
brain.  It  has  been  beneficial  in  other  kinds  of  neuralgia,  and  as  a 
hypnotic  in  wakefulness.  It  will  probably  prove  useful  in  asthma, 
whooping-cough,  and  other  nervous  affections.  The  dose  ranges  from 
2  to  10  grains. 

Myrtol. — This  new  antiseptic  has  the  same  relative  origin  as  thy- 
mol ;  it  is  derived  from  the  myrtle,  and  is  an  oil,  isomeric  with  the  oil 
of  turpentine  (?).  It  is  a  very  active  antiseptic  (Gubler).  It  prevents 
the  decomposition  of  urine  and  other  putrescible  animal  substances, 
and  has  been  used  to  destroy  the  fetor  of  decomposing  pus.  As  an 
active  parasiticide  it  has  been  used  successfully  against  the  round 
worm,  and  the  ascarides  infesting  the  rectum.  By  Laboulbene  it  has 
been  prescribed  for  the  expulsion  of  tcenia,  with  only  partial  success. 


430  ANTISEPTICS. 

The  parasitic  affections  of  the  skin—; favus,  herpes,  and  pityriasis — are 
cured  by  myrtol. 

In  moderate  doses  this  agent  is  rather  grateful  to  the  stomach,  and 
is  a  stomachic  tonic  or  stimulant.  The  most  important  application 
made  of  it  is  in  the  treatment  of  bronchorrhoea,  fetid  bronchitis,  gan- 
grene of  the  lungs,  etc.  Eliminated  by  the  lungs  largely,  it  stimulates 
the  tissues  through  which  it  passes,  and  thus  a  local  action  is  added  to 
the  systemic  effect.  Chronic  bronchitis,  capillary  bronchitis,  whoop- 
ing-cough, humid  asthma,  etc.,  are  maladies  in  which  it  may  be  ex- 
pected to  afford  a  large  measure  of  relief.  In  hcematuria  not  due  to 
acute  congestion,  and  in  passive  haemorrhages  in  general,  it  has  been 
used  with  success. 

It  has  long  been  known  that  oil  of  cloves,  and  indeed  the  essential 
oils  generally,  have  the  power  to  relieve  a  painful  state  of  a  sensory 
nerve.  Inserted  into  the  cavity  of  an  aching  tooth,  they  suspend  the 
pain.  A  solution  of  oil  of  cloves  in  rhigolene  is  a  nostrum  for  the 
cure  of  superficial  neuralgice.  IJ  Ol.  caryophylli,  ol.  gaultheriae,  ol. 
thymii,  aii  3  j  ;  tinct.  benzoini,  tinct.  cinnamomi,  aa  §  iv.  M.  Sig.  : 
Apply  on  lint,  and  cover  with  oiled  silk. 

The  oil  of  cloves  is  the  most  effective  deodorizer  for  sponge-tenta 
hitherto  employed. 

The  essential  oils  dissolved  in  alcohol  (essence  or  tincture)  are 
much  used  to  correct  flatulence. 

Cajuput-oil  has  been  used  successfully  in  cholera,  cholera-morbus, 
and  nervous  vomiting.  $  Ol.  cajuputi,  3  j  ;  spts.  chloroformi,  tinct. 
cinnamomi,  aa  3  j.  M.  Sig.  :  A.  teaspoonful  every  half  hour  in  gly- 
cerin or  sirup  and  water.  As  a  parasiticide,  cajuput-oil  is  an  effective 
local  application  in  parasitic  skin-diseases — scabies,  tinea,  pityriasis, 
etc. — and  in  the  form  of  enema,  in  a  suitable  vehicle,  against  ascarides 
vermicular -es. 

Menthol. — A  stearopten  (having  the  character  of  a  secondary  alco- 
hol) obtained  from  the  official  oil  of  peppermint  (from  Mentha  piper- 
ita,  Smith)  or  from  Japanese  or  Chinese  oil  of  peppermint  (from  Men- 
tha arvensis,  Linne,  var.  piperascens,  Holmes,  and  Mentha  Canadensis, 
Linne,  var.  glabrata,  Holmes  ;  Nat.  Ord.  Labiates,  [U.  S.  P.]). 

"  Colorless,  acicular  or  prismatic  crystals,  having  a  strong  and  pure 
odor  of  peppermint,  and  a  warm,  aromatic  taste,  followed  by  a  sensa- 
tion of  cold  when  air  is  drawn  into  the  mouth. 

"Menthol  is  only  slightly  soluble  in  water,  but  imparts  to  the  lat- 
ter its  odor  and  taste.  It  is  freely  soluble  in  alcohol,  ether,  chloro- 
form, carbon  disulphide,  or  glacial  acetic  acid.  When  triturated  with 
about  an  equal  weight  of  camphor,  thymol,  or  chloral  hydrate,  it  be- 
comes liquid." 

ACTIONS  AND  USES. — The  oil  of  peppermint  has  long  been  known 
to  have  carminative  and  anodyne  properties  in  flatulent  colic  and  gas- 


TEUCKIX.  431 

tralgia,  and  in  gastric  and  intestinal  catarrh.  It  has  been  much  used 
in  domestic  practice  for  these  purposes.  Since  the  discovery  of  men- 
thol, a  much  wider  range  has  been  given  to  its  applications.  To  the 
taste  it  is  pungent,  a  little  bitter,  and  the  local  effect  is  extended  into 
a  cooling  sensation  when  air  is  drawn  in.  The  sense  of  coolness  is  due 
to  an  impression  on  the  sensory  nerves  of  the  part.  Applied  to  the 
skin  it  causes  some  heat,  and  the  superficial  vessels  dilate,  causing 
redness.  It  lowers  the  sensibility  both  of  the  motor  and  sensory 
nerves.  The  circulation  is  first  excited,  then  depressed  by  it,  and  the 
heart  is  finally  paralyzed. 

That  menthol  allays  the  sensibility  of  painful  nerves  a  multitude 
of  facts  show.  For  hemicrania,  neuralgia  of  the  face,  and  toothache^ 
it  is  a  sovereign  remedy.  To  give  relief  in  these  cases,  the  solid  stick 
or  cake  is  rubbed  on  until  the  pain  is  relieved  or  the  skin  becomes  red 
and  sensitive.  An  excellent  combination  for  the  relief  of  local  neural- 
gias is  a  mixture  of  menthol,  thymol,  chloral  hydrate,  rubbed  up  to- 
gether until  liquefied,  and  then  morphine,  atropine,  or  cocaine,  or  all, 
dissolved  in  the  mixture.  $  Menthol,  thymol,  chloral  hydrat.,  aa  3  ij ; 
adde  morphinae  sulph.,  gr.  ij  ;  atropinae  sulph.,  gr.  ^  ;  vel.  cocainse  hy- 
drochlor.,  gr.  j.  M.  Or  a  solution  of  the  three  in  ether  or  chloroform 
may  be  painted  over  a  painful  or  inflamed  part.  There  is  little  doubt 
that  menthol  applied  freely  may  arrest  a  beginning  boil  or  abscess  hi 
accessible  places.  To  an  inflamed  joint  the  combination  above  men 
tioned  is  an  effective  application.  This  is  true  of  rheumatic  or  gon, 
orrhceal  inflammation.  Internally  menthol  is  applicable  to  the  treat- 
ment of  spasmodic  cough,  asthma,  and  singultus.  In  some  instances 
it  has  appeared  to  do  good  in  phthisis. 

Teucrin. — Mosetig-Moorhof  gave  the  name  teucrin  to  a  concen- 
trated, sterilized  extract  of  Teucrium  scordium — Extractum  teucrii 
scordii  depuratum — a  member  of  the  Labiatce.  As  it  has  a  source 
similar  to  that  of  thymol,  and  close  relations  to  the  other  agents  of 
the  group,  it  is  appropriately  considered  here.  Teucrin  is  adminis- 
tered, chiefly  hypodermatically,  in  the  dose  of  3  grammes,  or  46  grains. 
It  is  necessary  in  practicing  the  injection  to  observe  every  antisep- 
tic precaution — the  instrument,  the  fingers  of  the  operator,  and  the 
patient's  skin  about  the  site  of  the  injection  being  autiseptically  pre- 
pared. 

The  concentrated  extract,  or  teucrin,  is  dark  brownish  in  color,  of 
honey-like  consistence,  pungent  in  taste,  cabbage-like  odor,  and  some- 
what acid  in  reaction.  The  effects  are  local  and  systemic.  When  a 
full  dose  is  given  an  immediate  rise  in  temperature  takes  place,  the 
mercury  reaching  to  39°  C.  or  40°  C.  =  104°  Fahr.  in  the  course  of  a  few 
hours.  Slight  chills  are  felt  at  the  onset  of  the  febrile  movement. 
The  return  to  normal  takes  place  in  ten  to  twelve  hours.  The  func- 
tions continue  undisturbed,  the  tongue  remains  clean,  the  skin  moist, 


432  ANTISEPTICS. 

and  the  general  sense  of  well-being  unaffected.  The  local  effects  con- 
sist in  some  pain,  redness,  and  cedematous  swelling  at  the  site  of  the 
injection,  which  last  about  twenty-four  hours. 

Besides  the  fever  movement,  which  occurs  in  the  sick  and  well  alike, 
teucrin  has  a  peculiar  effect  about  the  site  of  chronic  inflammatory 
deposits  :  it  causes  a  congestion  of  the  surrounding  area,  an  increase 
in  the  leucocytes,  and  softening,  disintegration,  and  absorption  of  the 
pathological  material  or  new  formation,  or  exudation.  This  occurs 
usually  within  twenty-four  hours  after  the  injection  is  practiced,  or 
may  extend  to  two  days.  Such  effects,  in  brief,  are  similar  in  char- 
acter to  those  set  up  by  cantharidic  acid  or  the  cantharidates  when 
they  are  employed  by  the  method  of  Liebreich,  or  those  induced  by 
tuberculin  as  this  was  made  use  of  by  Koch.  The  local  action  is 
accompanied  by  fever,  rapid  pulse,  and  other  evidences  of  systemic 
disturbance. 

By  Mosetig-Moorhof  teucrin  has  been  employed  with  "  brilliant " 
results  in  the  treatment  of  cold  abscesses,  fistula,  sinuses,  etc.,  of  tuber- 
cular origin.  Two  injections  at  twenty-four  hours'  interval  usually 
suffice,  the  dose  being  46  grains.  It  proved  useful  in  fungous  adenitis. 
Lymphatic  glands,  suppurating  and  tuberculous,  were  greatly  im- 
proved and  made  to  heal.  Also,  good  results  were  obtained  in  lupus 
and  antinomy  cosis. 

Besides  these  applications  of  the  remedy,  it  has  been  used  success- 
fully in  gastric  catarrh  administered  in  capsules  in  the  dose  of  0'5  grm. 
=  8  grains. 

ANIMAL   EXTRACTS.— PTOMAINES   AND   LEFCOMAINES ;   TOXINS  AND 

ANTITOXINS. 

Ptomaines  and  Leucomaines. — Peculiar  basic  compounds  have  for 
some  time  been  known  to  exist  in  the  tissues  of  animals  corresponding 
to  the  alkaloids  formed  in  the  course  of  the  development  of  plants. 
These  basic  compounds  are  hence  termed  animal  alkaloids.  Those 
are  designated  ptomaines  which  are  produced  in  the  course  of  patho- 
logical processes,  and  are  due  to  the  actions  of  pathogenic  organisms. 
When  the  powers  of  microbes  in  setting  up  morbid  states  was  first 
discovered,  these  results  were  ascribed  to  the  immediate  action  of 
these  bodies,  but  it  has  been  ascertained  that  in  the  course  of  their 
growth  and  development  they  produce  pathogenic  substances.  Among 
the  numerous  ptomaines  may  be  mentioned  indole  and  skatole,  decom- 
position products  to  which  the  odor  of  faeces  is  due  mainly  ;  choline 
and  neurine,  results  of  the  transformation  of  lecithin  ;  tyrotoxicon, 
the  poison  of  milk  and  cheese  ;  tetanotoxine,  derived  from  the  bacillus 
of  tetanus  ;  typhotoxine,  from  the  bacillus  of  typhoid,  etc. 

The  organic  alkaloids  with  which  we  are  here  concerned  are  pro- 
duced by  certain  glands  and  structures  of  the  body  in  the  course  of 


ANIMAL  EXTRACTS.  433 

their  normal  physiological  activity  or  metabolism.  It  was  not  until 
Brown-Sequard's  announcement  of  the  effects  of  testicular  juice  that 
any  efforts  were  made  to  apply  the  new  principle  in  practical  thera- 
peutics. He  ascertained  that  testicular  extract,  injected  subcutane- 
ously,  had  an  extraordinary  power  to  restore  the  muscular  strength 
and  to  increase  the  mental  activity  of  the  aged.  Soon  after,  Paul  and 
Babes  suggested  the  employment  of  other  extracts  supposed  to  con- 
tain leucomaines  possessed  of  certain  special  physiological  powers. 
Some  of  these  have  been  proved  to  possess  distinct  curative  power. 

Orchitic  or  Testicular  Extract. — It  is  unnecessary  to  go  into  de- 
tails regarding  the  effects  of  ablation  of  the  testes.  The  changes  in 
the  hair  and  skin,  the  loss  of  subcutaneous  fat,  the  alteration  of  the 
voice,  and  the  mental  peculiarities  which  develop  in  time  are  so  well 
understood  that  further  details  are  unnecessary.  In  the  present  state 
of  our  knowledge  there  can  be  little  doubt  that  the  effects  of  removal 
of  the  testes  could  be  obviated  by  the  persistent  administration  of  a 
normal  testicular  extract.  There  is  therefore  contained  in  the  testes  a 
leucomaine,  or  organic  principle,  of  great  importance  in  the  growth 
and  development  of  the  body. 

The  testicular  extract  now  employed  is  obtained  from  the  testes  of 
the  bull.  These  bodies  are  carefully  selected,  cut  up  into  small  parti- 
cles, macerated  in  glycerin  with  the  addition  of  salt  solution,  filtered, 
and  sterilized  in  a  suitable  apparatus  in  which  it  is  exposed  to  the  ac- 
tion of  liquid  carbonic  acid.  The  liquefied  carbonic  acid  is  made  use 
of  because  it  is  a  strong  antiseptic  and  does  not  impair  the  virtues  of 
the  albuminoids  and  soluble  ferments.  This  is  the  method  of  D'Arson- 
val,  as  carried  out  under  Brown-Sequard's  direction.  Other  modes  of 
preparing  the  extract  are  followed,  but  it  must  be  aseptic,  and  free 
from  all  foreign  substances.  The  dose  ranges  from  TTI  xv  to  3  j,  injected 
subcutaneously. 

The  composition  of  testicular  fluid  is  complex.  Some  of  its  con- 
stituents are  to  be  found  in  the  body  generally  ;  some  are  peculiar  to 
these  glands.  A  crystalline  principle,  a  phosphate  called  spermine, 
which  is  contained  in  it,  is  held  by  Poehl  to  be  the  active  material ; 
but  this  is  not  generally  admitted.  Whatever  physiological  action  the 
testicular  fluid  has  is  due  to  the  albuminoid  matters,  the  leucomaines, 
and  the  nucleins  which  it  contains.  Brown-Sequard  showed  in  a  series 
of  experiments  on  animals  that  the  fluid  increases  the  power  while  it 
lessens  the  reflex  excitability  of  the  nerve-centers.  It  does  not  modify 
the  circulation  or  respiration,  but  it  notably  increases  the  power  of 
the  heart  when  greatly  enfeebled  by  loss  of  blood.  Ataxic  symptoms, 
and  paralysis  of  muscles  artificially  induced  in  animals,  were  made  to 
disappear  quickly  under  its  influence.  As  regards  the  function  of 
hsematosis  and  the  general  nutrition,  it  exercises  but  little  influence. 

As  the  first  experiences  with  testicular  extract  were  in  respect  to 
30 


434  ANTISEPTICS. 

its  influence  over  senility,  the  condition  of  senile  debility  was  the  first 
malady  in  which  it  was  employed  therapeutically.  Cases  are  reported 
by  Brown-Sequard,  Vogt,  Villeneuve,  J.  J.  Putnam,  and  Loomis,  in 
which  the  physical  and  mental  decline  of  age  were  notably  improved. 
Of  a  group  of  39  cases  of  senile  debility  reported  by  Brown-Sequard 
and  D'Arsonval  only  4  or  5  cases  were  unimproved.  Villeneuve  says 
that  the  fluid  revives  the  organic  energies,  rejuvenates  the  faculties, 
and  so  improves  the  mind  that  mental  activity  long  dormant  becomes 
possible  again.  It  seems  certain  that  decline  in  the  sexual  vigor,  when 
purely  functional,  is  one  of  the  conditions  improved,  even  cured,  by 
this  remedy.  There  is  by  no  means  unanimity  on  this,  the  least  ques- 
tionable point  regarding  the  utility  of  the  testicular  fluid.  Thus  Fiir- 
bringer,  in  his  trials  of  the  various  extracts,  finds  them  devoid  of  thera- 
peutical activity.  In  a  discussion  recently  before  the  Berlin  Medical 
Society  it  seemed  to  be  the  consensus  of  opinion  that  the  animal 
extracts,  including  the  testicular,  were  of  little  or  no  value,  except  the 
thyroid. 

Renal  and  Supra-renal  Glands. — The  most  important  of  the  glandu- 
lar remedies  after  the  thyroid  is  the  supra-renal.  Some  favorable  reports 
have  been  made  regarding  the  utility  of  preparations  of  the  kidney, 
in  affections  of  this  organ  especially,  but  in  respect  to  well-defined  , 
physiological  action  the  suprarenal  is  much  superior.  Pellets  of  the 
gland,  extracts,  and  its  active  principle  adrenalin,  have  been  employed 
with  much  success  in  suitable  cases.  The  gland  substance  is  pre- 
scribed in  the  form  of  pellets  of  three  to  five  grains  ;  the  extract  is 
much  employed  topically  in  affections  of  the  throat  and  nasal  passages 
and  elsewhere,  and  the  adrenalin  hydrochloride  is  also  applied  to 
the  conjunctiva  and  to  accessible  mucous  surfaces  in  the  form  of 
a  solution  having  the  strength  of  1  to  1,000.  Whether  applied  top- 
ically or  taken  internally,  characteristic  effects  follow,  chiefly  on  the 
vasomotor  system,  increasing  the  energy  and  lessening  the  number 
of  the  heart  beats,  raising  the  arterial  tension,  and  thus  diminish- 
ing the  blood  supply  to  a  given  area.  Applied  to  the  mucous  mem- 
brane, it  contracts  the  vessels,  and  the  surface  appears  blanched  and 
bloodless. 

Thyroid  Body. — The  most  conspicuous  example  of  benefit  from 
the  use  of  an  organic  substance  is  that  afforded  by  the  thyroid  body. 
Schiff  was  the  first  to  demonstrate  that  certain  functional  derange- 
ments and  impaired  nutrition  accompanied  by  characteristic  symp- 
tomatology followed  removal  of  the  thyroid  body.  A  correspond- 
ing state  was  next  observed  in  man  by  Reverdin,  of  Geneva,  as  a 
result  of  the  surgical  removal  of  the  gland.  Kocher,  of  Berne,  next 
reported  a  series  of  cases  similar  to  those  of  Reverdin,  in  which  the 
total  extirpation  of  the  thyroid  caused  symptoms  very  similar  to 
those  described  by  Sir  William  Gull,  and  subsequently  by  Dr.  Qrd, 


ANIMAL  EXTRACTS.  435 

under  the  designation  of  myxcedema.  The  effects  observed  after 
removal  of  the  thyroid  consist  in  an  affection  of  the  skin  and  subcu- 
taneous tissue  and  the  mucosa ;  by  changes  in  the  cerebro-spinal  func- 
tions, and  by  a  remarkable  cachectic  state.  By  Kocher  this  complex 
of  symptoms  was  called  strumapriva  cachexia.  Schiff  next  demon- 
strated (1884)  the  important  fact  that  this  pathological  condition  might 
be  removed  and  the  status  in  quo  restored  by  implantation  of  a  fresh 
thyroid  in  the  peritoneal  cavity.  Horsley  was  the  first  to  suggest  to 
substitute  the  thyroid  of  the  sheep  for  relief  of  myxcedema  by  the 
process  of  grafting.  Murray  then  proposed  to  effect  the  same  result 
by  injecting  an  extract  of  the  thyroid  prepared  with  the  proper  anti- 
septic precautions.  Successful  cases  were  soon  reported  by  Fenwick, 
Beatty,  Whipbam,  Corkhill,  and  others,  of  England ;  by  Mendel, 
Wichmann,  and  others,  of  Germany;  by  Robin,  Chopinet  Chantemesse, 
and  others,  of  France.  The  next  most  important  step  was  the  use  of 
the  gland  itself,  proposed  by  Dr.  Howitz,  professor  in  Copenhagen. 
At  first  this  process  consisted  in  feeding  the  raw  gland  in  various  forms 
to  the  subjects  of  myxcedema,  but  at  the  present  time  liquid  extracts, 
the  gland  in  powder,  or  compressed  into  tabloids,  are  employed,  and 
with  much  success. 

Various  disturbances  have  ensued  when  too  large  quantity  of  the 
thyroid  has  been  given.  It  is  rare,  however,  that  the  actions  are  such 
as  to  compel  its  entire  withdrawal.  Among  the  symptoms  caused  by 
too  free  administration  of  the  gland  are  the  following  :  Headache, 
dizziness,  numbness  and  tingling  of  the  extremities,  insomnia,  a  sense 
of  fatigue,  loss  of  appetite,  wasting,  urticaria,  erythema  and  itching 
of  the  skin,  rapid  action  of  the  heart,  and  sudden  feebleness.  By  sim- 
ply suspending  its  use  for  the  time  being,  or  by  giving  a  diminished 
quantity,  the  ill  effects  will  disappear. 

As  regards  the  quantity  of  thyroid  to  be  given,  the  dose  varies  ac- 
cording to  age  and  susceptibility.  From  one  half  to  one  gland  a  day, 
equivalent  to  a  half  to  a  teaspoonful  of  the  extract,  or  one  to  three 
tabloids  made  of  the  desiccated  substance  three  times  a  day,  will  pro- 
cure the  desired  therapeutical  effects. 

The  malady  for  which  the  thyroid  is  administered  with  entire  suc- 
cess is  myxcedema.  The  morbid  complex  constituting  this  peculiar 
disease  is  gradually  removed,  and,  so  long  as  the  gland  is  made  use  of, 
does  not  reappear.  It  is  now  known,  however,  that  occasional  admin- 
istration of  the  remedy  is  necessary  to  maintain  the  health  at  the  nor- 
mal standard.  The  influence  of  the  thyroid  is  essential,  and  if,  in  con- 
sequence of  its  atrophy,  that  influence  is  withdrawn,  obviously  it  must 
be  supplied  from  without.  Sufficient  time  has  not  yet  elapsed  to  de- 
termine how  long  and  to  what  extent  the  supplementary  gland  must 
be  employed. 

Obesity  is  another  malady  in  which  the  thyroid  has  been  used  with 


436  ANTISEPTICS. 

success.  It  is  almost  the  only  remedy  for  this  condition  acting  in  a 
direct  manner.  It  has  the  power  to  reduce  the  body-weight  without 
any  modification  of  diet  or  change  in  the  manner  of  living.  It  must 
be  given  with  caution,  that  the  loss  of  flesh  may  not  proceed  too  rap- 
idly, and  that  cardiac  depression  may  be  avoided. 

In  exophthalmic  goitre  excellent  results  have  been  obtained  by  the 
use  of  the  thyroid.  The  author  has  seen  great  improvement  in  cases 
of  extreme  difficulty.  Some  instances  of  goitre  have  been  apparently 
cured,  as  reported  by  Ingalls  and  Metzgar,  in  this  country. 

lodothyrlne  is  an  extract  from  the  thyroid,  rich  in  iodine,  and  is 
claimed  to  be  an  active  principle,  which  is  permanent  in  form  and 
composition.  Besides  its  utility  in  affections  of  the  thyroid  it  has 
been  successfully  employed  in  the  treatment  of  psoriasis  and  eczema. 
That  it  will  take  the  place  of  the  thyroid  gland  is  more  than  doubtful. 
Indeed,  to  give  iodothyrine  most  efficiently,  it  were  better  to  feed  the 
patient  on  the  fresh  gland  itself.  Undoubtedly,  the  best  results  have 
been  had  in  this  way.  At  the  present  time  the  thyroid  tablet  should 
represent  the  gland  in  its  purity. 

Extract  of  Bone  Marrow. — The  red  marrow  of  bones,  especially 
of  the  ribs,  has  been  utilized  in  medical  practice.  The  marrow  itself, 
finely  subdivided  and  seasoned  suitably,  has  been  eaten  spread  on  but- 
tered bread.  For  the  most  part  the  glycerin  extract  is  used,  and  is  so 
prepared  as  to  be  given  in  the  dose  of  a  teaspoonf  ul  three  times  a  day. 

As  the  red  globules  of  the  blood  are  to  a  great  extent  developed 
from  the  large  cells  of  the  red  marrow,  it  follows  that  the  administra- 
tion of  this  material  should  increase  them  when  deficient.  It  is  espe- 
cially in  anaemia  characterized  by  deficiency  in  the  red  blood-globules 
that  the  use  of  bone  marrow  is  indicated,  and  the  clinical  experience 
coincides  with  theory,  for  a  remarkable  improvement  takes  place  in 
cases  of  this  kind.  The  results  of  its  administration  are  these :  the 
red  globules  and  the  haemoglobin  are  increased,  and  the  white  cells  are 
lessened.  These  good  effects  are  accompanied  by  a  general  improve- 
ment in  body  weight  and  an  increase  of  vital  activity  in  all  directions. 

Toxins  and  Antitoxins. — Besides  those  basic  compounds  known  as 
leucomaines  and  ptomaines,  certain  toxic  albuminous  substances  (tox- 
albumins)  are  found  already  formed,  or  are  artificially  created.  They 
are  now  usually  called  toxins,  because  possessed  of  active  toxic  prop- 
erties. Of  those  formed  in  the  course  of  the  physiological  activity 
of  organs  are  the  various  snake-poisons,  and  abrin,  from  the  abrus 
precatorius,  commonly  known  as  "  jequirety,"  and  ricin,  from  the 
castor-oil  bean  (Ricinus  communis).  Besides  the  toxalbumins,  or  tox- 
ins, there  are  also  formed  principles  that  protect  the  organism  against 
the  effects  of  toxins,  and  are  hence  known  as  antitoxins.  Toxins  are 
the  products  of  bacterial  actions.  Among  the  more  familiar  are  the 
anthrax  protein  produced  by  the  anthrax  bacillus,  toxopeptone  and 


ANIMAL   EXTRACTS.  437 

toxoglobulin  produced  by  the  cholera  bacillus,  and  toxomucin  (tuber- 
culin) produced  by  the  tubercle  bacillus.  Some  organisms  are  pro- 
vided with  an  albuminous  substance  which  has  the  power  to  destroy 
pathogenic  bacilli,  or  to  antagonize  the  toxin  which  they  form.  The 
condition  of  exemption  thus  created  is  known  as  immunity.  It  is  now 
believed  that  pathogenic  bacteria  produce  each  a  poison  peculiar  to 
itself,  and  an  albuminous  substance  which,  if  injected  into  the  tissues 
of  another  animal,  protects  it  against  the  action  of  the  poison.  An 
animal  thus  protected  is  said  to  be  immune,  and  if  the  blood-serum  of 
such  immunized  animal  is  injected  into  the  system  of  another  animal, 
this  also  becomes  immune. 

We  owe  especially  to  Behring,  of  Berlin,  and  Roux,  of  Paris,  the 
demonstration  of  the  methods  by  which  immunization  and  the  forma- 
tion of  antitoxins  are  produced.  Taking  the  diphtheria  toxin  and  anti- 
toxin as  models,  we  find  that  the  first  step  consists  in  the  formation 
of  an  active  toxin  by  cultivation  of  the  germs  in  an  artificial  medium. 
From  a  number  of  such  cultures  a  specially  virulent  one  is  selected. 
The  activity  of  this  toxin  is  ascertained  by  injecting  it  into  guinea 
pigs.  If  it  is  ascertained  to  have  sufficient  virulence  or  toxic  power, 
it  is  then  used  to  secure  the  immunization  of  the  horse,  which  is  found 
to  be  the  most  suitable  animal  for  the  purpose.  As  there  are  great 
differences  among  horses  in  regard  to  their  susceptibility  to  the  effects 
of  the  toxin,  a  small  dose  is  first  employed.  Beginning  with  \  c.  c., 
the  strength  of  the  injection  is  rapidly  increased  until  it  reaches  200 
to  250  c.  c.  The  injection  is  practiced  once  in  eight  days,  and  conse- 
quently three  or  four  months  are  occupied  in  producing  immunization, 
so  that  at  length  as  much  as  250  c.  c.  can  be  injected  without  producing 
any  reaction.  The  result  is,  the  injection  of  toxins  develops  antitoxin 
in  the  blood-serum  of  the  horse.  To  procure  the  antitoxin  in  a  form 
available  for  administration,  the  blood  is  drawn  off  under  suitable  pre- 
cautions, and  the  serum  is  separated  from  it  by  a  process  of  aseptic  fil- 
tration. Patience  in  the  whole  proceeding,  care  at  every  step,  and 
minute  attention  to  the  horse's  health,  are  necessary  to  secure  the  best 
result.  The  physician  should  only  make  use  of  serum  that  has  been 
carefully  tested  and  that  conforms  to  the  highest  standard. 

The  foregoing  remarks  on  the  immunization  of  the  horse  are  based 
on  the  administration  of  the  toxin  by  subcutaneous  injection.  If, 
however,  the  toxin  is  injected  directly  into  the  horse's  veins,  and  the 
process  of  immunization  is  conducted  over  a  longer  period  of  time,  the 
resulting  product  will  have  considerably  greater  power.  The  strength 
of  antitoxin  solutions  must,  it  was  early  seen,  be  expressed  in  terms  of 
a  uniform  standard  that  may  be  universally  conformed  to.  A  unit 
being  agreed  upon,  the  other  terms  of  the  scale  follow — that  is,  an 
immunity  unit  in  which  the  amount  of  antitoxin  serum  sufficient  to 
save  from  fatal  results  a  guinea  pig  weighing  500  grammes,  to  which 


438  ANTISEPTICS. 

the  minimum  fatal  dose  of  diphtheria  toxin  has  been  given.  Ten  times 
more  is  required  for  the  human  subject  than  for  the  guinea  pig,  is  a 
close  estimate. 

The  first  therapeutical  employment  of  antitoxin  in  disease  was  by 
Behring,  soon  followed  by  the  clinical  observations  of  Roux.  Behring 
ascertained  that  active  cultures  of  the  bacillus  of  diphtheria  were  ren^ 
dered  inactive  by  mixing  them  with  the  blood-serum  of  immunized 
animals.  The  serum  was  then  used  as  a  vaccine  to  prevent  the  poison 
of  diphtheria  (toxin)  developing  in  susceptible  subjects,  and  to  neu- 
tralize or  inhibit  it  when  the  disease  was  in  process  of  evolution. 
Roux  carried  out  the  same  method  at  Paris  with  equally  promising 
results,  and  at  the  present  time  this  plan  of  preventing  diphtheria  or 
of  arresting  it  has  been  taken  up  in  all  civilized  countries. 

The  units  of  strength  of  any  preparation  of  serum  should  be  known 
before  making  use  of  it.  The  quantity  injected  varies  from  10*00  to 
j-J-g-  of  the  body  weight,  the  latter  rarely.  About  20  c.  c.  is  probably 
the  average  of  the  various  serums  in  the  market.  The  frequency  of 
the  injection  varies  with  the  severity  of  the  case,  and  is  once  or  twice 
in  the  twenty-four  hours.  Some  redness,  and  not  unfrequently  erythem- 
atous  rashes  and  urticaria,  appear  near  the  site  of  the  injection.  If 
suitable  antiseptic  precautions  are  observed,  nodules  followed  by  sup- 
puration can  hardly  occur.  The  earlier  the  serum  is  injected  the  more 
favorable  the  result.  It  can  hardly  be  expected  that  cases  of  many 
days'  standing,  with  extension  of  the  local  process  to  the  larynx,  and 
with  general  diffusion  of  the  poison,  will  prove  as  amenable  to  the  ac- 
tion of  the  antitoxin  as  recent  examples  of  the  disease;  but  it  has  hap- 
pened. Some  cases  of  the  worst  type  have  been  most  favorably  acted 
on.  The  injection  of  antitoxin  when  it  acts  well  reduces  temperature, 
abates  dyspnoea,  and  favors  detachment  and  expulsion  of  the  false 
membrane. 

Tetanus  is  now  known  to  be  produced  by  a  special  bacillus.  Cul- 
tures of  the  bacillus  by  the  method  of  Behring  develops  in  animals  by 
repeated  injection  a  state  of  immunity,  and  immunized  animals  fur- 
nish a  blood-serum  containing  the  antitoxin.  When  the  serum  is  added 
to  the  poison  the  latter  loses  its  activity  and  is  harmless.  Many  suc- 
cessful cases  of  tetanus  treated  by  the  antitoxin  have  been  published. 
When  a  sufficient  quantity  of  the  serum  of  immunized  animals  has 
been  injected,  the  severity  of  the  disease  is  lessened,  the  spasms  be- 
come less  frequent,  the  temperature  falls,  sleep  occurs,  the  general 
state  improves,  and  the  duration  of  the  disease  is  shortened. 

Pneumonia  is  one  of  the  specific  maladies  which  has  been  subjected  to 
the  action  of  an  antitoxin.  Animals  are  rendered  immune  by  repeated 
injections  of  cultures  of  the  pneumococcus,  and  the  serum  of  immu- 
nized animals  was  found  to  be  effective  against  pneumonia.  These 
experiments  proved  so  successful  that  Neisser  and  Klemperer  then 


AGENTS  ACTING   ON  THE   NERVOUS  SYSTEM.  439 

proceeded  to  make  use  of  the  serum  of  human  subjects  convalescent 
from  pneumonia.  In  accordance  with  the  principles  already  enunci- 
ated, it  was  supposed  that  an  attack  of  pneumonia  developed  the  anti- 
toxin in  the  blood-serum  of  the  individual  affected.  In  the  trials  in 
pneumonia  that  have  been  made,  it  was  found  that  the  antitoxin  serum 
lessened  the  violence  of  the  disease,  the  crisis  occurred  early,  and  with 
the  decline  in  temperature  to  the  normal  there  ensued  a  corresponding 
abatement  in  the  physical  signs.  The  trials  that  have  been  made  in 
this  country,  if  not  altogether  favorable,  have  at  least  given  promise 
of  future  success  when  all  the  conditions  are  properly  complied  with. 

The  treatment  of  hydrophobia  by  antitoxins  is  associated  with  the 
name  of  Pasteur.  Although  his  theory  is  not  accepted  by  all,  and  his 
results  are  questioned,  there  can  be  little  doubt  that  his  method  of 
vaccine  has  greatly  modified  the  usual  course  and  termination  of  that 
disease.  The  real  place  which  this  mode  of  treatment  shall  take  in 
the  therapeutical  processes  of  the  future  can  not  now  be  stated.  It 
must  be  regarded  as  still  subjudice,  with  the  preponderance  of  author- 
ity in  favor  of  the  method.  On  a  candid  survey  of  the  whole  field, 
the  author  is  constrained  to  say,  however,  that  the  practical  outcome 
is  short  of  the  success  which  seemed  to  him  warranted  by  the  pre- 
tensions put  forward  by  its  original  promoters. 

Authorities  referred  to  : 

BRA,  DR.  M.  La  Therapeutique  des  Tissues  ;  Compendium  des  Medications  par  lea 
Extraits  d1  Organs  Animaux.  Paris,  J.  Rothschild,  1895,  pp.  624. 

[To  mention  the  numerous  papers  and  works  on  the  subject  would  occupy  too  much 
space.  The  work  named  is  the  most  recent  and  elaborate  on  the  subject.] 


AGENTS    USED   TO   MODIFY   THE  FUNCTIONS    OF 

ORGANS. 

A.    OF  THE  NERVOUS  SYSTEM. 

IN  this  division,  remedies  are  employed  with  a  view  to  their  influence 
over  the  functions  of  the  nervous  system.  They  do  not  immediately  or 
necessarily  affect  the  function  of  nutrition  ;  they  do  not  enter  into  the 
formation  of  tissues  ;  and,  having  modified  the  functions  of  the  nervous 
system,  they  are  excreted  from  the  organism  in  the  form  in  which  they 
entered  it.  It  is  probable  that  the  selective  action  on  this  system  is 
due  to  the  fact  that  the  nervous  tissue  is  the  most  highly  specialized 
in  function,  and  therefore  most  susceptible  to  such  impressions. 

The  different  parts  of  the  nervous  system  are  so  closely  united  in 
function  that  a  disturbance  at  any  point  is  differentiated  to  other  and 
often  widely-separated  points,  and  the  complexus  of  effects  is  made 
up  of  many  minor  disturbances.  For  this  reason  it  is  quite  impos- 


440  EXCITO-MOTORS. 

sible,  in  the  present  state  of  our  knowledge,  to"  make  a  classification 
which  will  sharply  define  the  limits  of  activity  of  any  particular  rem- 
edy. Nevertheless,  physiological  experiment  and  clinical  experience 
have  furnished  us  sufficiently  accurate  information  with  regard  to  the 
most  important  actions  of  the  remedies  of  this  division,  to  justify  an 
arrangement  based  on  their  most  conspicuous  qualities. 


THOSE  EXCITING    THE  FUNCTIONAL  ACTIVITY  OF   THE  SPINAL 
CORD  AND  SYMPATHETIC. 

Electricity. — Electricity  Fr.  ;  Electricitat,  Ger. 

Forms  of  Electrical  Force  employed  in  Medical  Practice. — Mag- 
netism, static  or  frictional  electricity  (franklinism),  galvanism,  fara- 
dism  (electro-magnetic,  magneto-electric). 

STATIC  OK  FEIOTIONAL  ELECTRICITY. 

This  is  obtained  by  friction  from  glass,  as  in  the  cylinder  or  plate, 
and  by  induction  from  the  Holtz  electrical  machine.  The  last-named 
instrument  is  best  adapted  for  medical  use.  The  prime  conductor  of 
the  electrical  machine  furnishes  positive  or  vitreous  electricity,  and 
the  rubber,  negative  or  resinous.  Various  modes  of  electrization  by 
static  electricity  are  resorted  to  : 

1.  By  sparks.     In  this  mode  the  part  to  be  acted  on  is  made  to  re- 
ceive sparks  from  the  machine  in  action. 

2.  The  electric  bath.     The  patient  is  placed  on  an  insulated  stool, 
and  is  charged  with  positive  or  negative  electricity  from  the  prime 
conductor,  or  rubber,  according   as  he  is  in  connection  with  either. 
Sparks  may  be  drawn  from  the  affected  part  by  presenting  the  knuckles 
or  a  metallic  conductor.     A  sharp,  tingling  sensation,  followed  by  red- 
ness and  wheals,  is  produced  by  sparks,  whether  received  from  the 
machine  or  drawn  from  the  body. 

3.  By  the  Leyden-jar.     In  this  method,  the  electricity  is  condensed 
in  the  Leyden-jar,  and  the  charge  is  transmitted  through  the  part  to 
be  acted  on. 

Owing  chiefly  to  the  physicians  of  Guy's  Hospital,  London,  and 
Dr.  Charcot  and  his  pupils,  Dr.  Arthius  and  Dr.  Vigouroux,  of  Paris, 
the  use  of  static  electricity  as  a  therapeutical  agent  has  been  revived 
and  rendered  entirely  practicable.  Dr.  Morton,  of  New  York,  and  the 
author,  simultaneously  arrived  at  a  method  of  using  the  Holtz  electri- 
cal machine  as  a  means  of  stimulating  muscular  contractions,  and  as 
a  substitute  for  the  faradic  current  in  cases  requiring  such  treatment. 
Before  describing  these  manipulations  it  is  necessary  to  say  something 
regarding  the  structure  of  the  Holtz  machine.  Various  modifications 
of  the  original  pattern  have  been  introduced  ;  but  the  most  successful  is 


ELECTRICITY.  441 

that  of  Toepler.  There  are,  however,  several  excellent  machines 
adapted  from  the  Holtz  model  to  suit  the  views  of  mechanical  theo- 
rists or  practical  electricians,  which  may  be  employed  with  entire  confi- 
dence. The  author  has  used  with  satisfaction  a  machine  the  revolv- 
ing plate  of  which  has  a  diameter  of  fourteen  inches  and  the  fixed  plate 
of  sixteen  inches.  The  power  may  be  furnished  by  an  electric  motor, 
by  a  water  motor  or  more  conveniently  by  an  assistant.  In  the  an- 
nexed figure,  the  arrangement  of  the  Toepler-Holtz  is  shown.  This  is 


FIG.  1. — THB  TOEPLER-!IOLTZ  ELECTRICAL  MACHINE. 

the  model  which  the  author  uses,  and  is  found  to  be  sufficiently  powerful 
for  medical  purposes.  During  the  winter,  when  the  consultation-room 
is  kept  at  or  about  70°  Fahr.  by  artificial  heat,  this  instrument  works 
with  entire  satisfaction.  In  the  late  spring  and  summer,  for  the  most 
part,  the  atmospherical  conditions  are  such  that  some  means  are  neces- 
sary to  preserve  the  instrument  from  moisture.  This  is  accomplished 
by  inclosing  the  machine  in  a  suitable  glass  case  and  keeping  within 
it  some  chloride  of  calcium  to  absorb  the  moisture.  An  arrangement  of 
this  kind  is  preferred  by  Dr.  Morton,  of  New  York,  who  uses  the  origi- 
nal Holtz  machine. 

The  Holtz  machine  may  also  be  employed  to  procure  the  muscular 
effects,  hitherto  obtained  only  from  faradic  appliances.  The  current 
passing  between  the  discharging-rods  can  be  tapped  by  means  of  a  flex- 
ible wire  attached  to  the  outer  coating  of  one  condenser,  and  another 
flexible  wire  connected  with  the  brass  knob  or  bar  which  is  in  communi- 
cation with  the  interior  of  the  other  condenser.  The  strength  of  the 
current  and  the  rapidity  of  the  interruptions  are  regulated  by  the  dis- 
tance between  the  knobs  of  the  discharging-rods.  At  every  passage  of 


EXCITO- MOTORS. 


a  spark  a  muscular  action  takes  place.  If  the  knobs  are  placed  very 
near  each  other,  so  rapidly  do  the  sparks  pass,  that  the  effect  produced 
is  very  like  that  obtained  from  a  mild  faradic  current.  Thus,  by  an 
arrangement  of  the  machine  which  can  be  done  on  the  instant,  the 
actions,  heretofore  only  obtainable  from  the  faradic  machines,  are 
readily  procured  from  the  statical  electrical  instrument.  Besides  the 
effectiveness  of  this  method,  it  has  the  advantage  that  it  is  almost  pain- 
less. In  no  other  way  can  strong  muscular  contractions  be  induced  with 
so  little  pain,  at  least. 

MAGNETISM. 

Magnets  are  natural  or  artificial.  The  former  consist  of  a  native 
iron-ore  possessed  of  the  magnetic  property  ;  the  latter  are  pieces 
of  steel  in  which  the  magnetic  property  has  been  induced.  This 
magnetic  property  consists  in  the  power  to  attract  pieces  of  iron 
and  steel,  in  maintaining  a  certain  fixed  position  when  suspended 
to  move  freely,  and  in  attracting  or  repelling  the  extremities  of  other 
similar  magnets.  A  magnet  suspended,  free  to  move,  always  points 
in  a  certain  direction,  north  and  south.  That  end  pointing  north  is 
the  "marked"  extremity,  because  it  has  a  mark,  notch,  or  groove, 
or  the  letter  JV,  to  indicate  it.  Because  of  this  property,  the  mag- 
net is  said  to  have  "  poles,"  or  polarity.  The  poles  behave  toward 
each  other  in  a  certain  definite  way :  Unlike  poles  attract ;  like  poles 
repel,  is  the  law.  When  a  bar-magnet  is  made  to  approach  a  mag- 
netic  needle  moving  on  a  pivot  or  suspended,  there  ensues  attrac- 
tion or  repulsion,  according  to  the  polarity  of  the 
extremities  approximated.  When  a  certain  prox- 
imity is  attained,  yet  some  distance  short  of  actual 
contact,  the  magnetic  influence  is  exerted,  and  at- 
traction or  repulsion,  according  to  the  pole,  takes 
place.  If  a  bar  of  soft  iron,  not  magnetized,  is  sus- 
pended, on  the  approach  of  a  permanent  magnet,  the 
former  is  seen  to  move  toward  the  latter  when  they 
are  approximated.  The  magnetic  force  is  thus  ex- 
erted through  an  intervening  space  :  inversely  as  the 
square  of  the  distance,  is  the  law,  which  expresses 
this  action  in  mathematical  form.  To  this  property 
is  applied  the  term  magnetic  induction.  When  the 
soft  iron  is  acted  on  by  a  sufficiently  powerful  mag- 
net, it  ceases  to  be  in  a  neutral  or  unexcited  state, 
the  magnetic  property  is  induced  in  it,  and  for  the 
time  being  it  assumes  the  polar  condition  ;  but  not 
possessing  the  coercitive  property — i.  e.,  the  prop- 
erty to  retain  the  magnetism  induced  in  it — soon  returns  to  its  former 
neutral  condition.  Steel,  having  the  coercitive  property,  is  the  ma- 
terial out  of  which  permanent  magnets  are  made.  The  magnetic  prop- 


FIG.  2. — COMPOUND 

MAGNET. 


ELECTRICITY. 


443 


erty  is  induced  in  such  pieces  of  steel  by  the  contact  of  other  permanent 
magnets.  When  once  induced,  the  magnetic  property  may  be  readily 
destroyed  by  a  powerful  blow,  by  repeated  scratching,  and  by  heating. 
When  a  magnet  is  broken  into  several  fragments,  each  piece  has 
the  same  polarity.  The  forms  of  magnets  are  the  bar  and  horseshoe, 
chiefly — the  latter  being  more  convenient,  and  also  better  retaining  its 
power,  because  an  armature  can  be  kept  in  position.  A  compound 
horseshoe  magnet  is  usually  preferred  for  medical  use,  because  of  the 
proximity  of  the  poles,  but  the  straight  form  (Fig.  2)  is  also  used. 

GALVANISM. 

All  chemical  action  is  accompanied  by  electrical  phenomena.     The 
electricity  furnished  by  the  galvanic  combinations  in  use  is  derived 


FIG.  3.— GALVANIC  BATTERY. 

from  a  chemical  action  which  takes  place  in  the  elements.  These 
are  of  various  forms.  Reduced  to  its  simplest  condition,  a  galvanic 
combination  consists  of  two  substances,  one  of  which  can  be  acted  on 
chemically,  while  the  other  has  merely  the  conducting  property  ;  and 

also  of  a  material — a  fluid,  usually — 
which  can  excite  the  chemical  action. 
There  is,  then,  a  generating  plate  or 
element,  usually  of  zinc,  a  conducting 
plate  or  element  of  copper  or  car- 
bon, usually,  and  a  fluid  or  semi-solid 
which  acts  on  the  zinc,  setting  up 
the  chemical  action.  When  such  ele- 
ments with  the  exciting  fluid  are 
placed  in  a  glass  or  earthen  vessel, 
the  whole  combination  is  called  a 
galvanic  cell  or  couplet,  and  when 
several  of  these  are  united  they  form 
a  battery  (Fig.  3). 
Galvanic  cells  may  have  a  single  or  two  fluids  :  the  single  fluid  is 
not  constant ;  in  the  two-fluid,  there  are  arrangements,  partly  mechan- 
ical, chiefly  chemical,  for  securing  constancy  in  the  current.  In  Fig.  4 


Fia.  4.— A  CELL. 


444 


EXCITO-MOTORS. 


we  have  two  metals — zinc,  z,  and  copper,  c — united  by  the  wire,  Jf, 
placed  in  a  glass  vessel  containing  dilute  sulphuric  acid.  The  chem- 
ical action  in  such  a  cell  consists  in  the  formation  of  the  sulphate  of 
zinc,  the  water  being  decomposed,  and  hydrogen  appearing  at  the 
surface  of  the  copper.  Such  an  arrangement  may  be  defined  to  be  a 
means  of  making  a  difference  in  potential  between  two  points.  Elec- 
tricity flows  from  the  higher  to  the  lower  potential.  The.  point  where 
the  chemical  action  is  taking  place — the  surface  of  the  zinc — is  the 
higher  potential,  and  hence  "the  current"  passes  from  this  through 
the  liquid  to  the  lower  potential,  the  copper,  which  is  the  conducting 
plate.  Now,  as  the  current  always  flows  from  the  higher  to  the  lower 
potential,  it  follows  that,  outside  of  the  element,  the  copper  becomes 
positive  and  the  zinc  negative,  for  the  current  passes  through  the 
"  conjunctive  wrire  "  from  the  former  element  to  the  latter.  It  follows 
that  such  an  "  element,"  or  "  cup,"  can  not  furnish  a  constant  current. 
The  chemical  action  soon  rises  to  the  maximum,  the  sulphuric  acid 
combines  with  the  zinc,  and  hence  the  exciting  fluid  is  soon  nothing 
more  than  a  saturated  solution  of  zinc  sulphate,  while  the  hydrogen 
accumulates  on  the  copper  plate.  The  chemical  action,  therefore, 
quickly  subsides,  and  the  hydrogen-bubbles  hinder  the  passage  of  the 
current  by  the  conducting  plate.  Elements  of  this  kind  are  usually 
employed  to  run  faradic  machines,  but  they  are  not  suited  for  gal- 


FIG.  5.— DANIELL'S  ELEMENT. 


vanic  batteries,  since  the  tension  of  the  current  varies  so  much  in  a 
short  time,  and  the  action  soon  ceases. 

The  two-fluid  cells,  in  which  the  chemical  action  is  less  violent, 
and  mechanical  devices  prevent  the  polarization  of  the  hydrogen,  are 


ELECTRICITY. 


445 


alone  suited  to  medical  uses.  Only  those  ascertained  by  experience  to 
be  adapted  to  medical  purposes  can  be  referred  to.  One  of  the  ear- 
liest two-fluid  cell  batteries  constructed  was  that  of  Daniell  (Fig.  5). 
The  arrangement  of  the  parts  in  this  cell  will  illustrate  the  principles 
concerned  in  such  galvanic  combinations.  The  zinc  and  copper  ele- 
ments and  the  two  liquids  are  separated  by  a  porous  cup  of  unglazed 
earthenware.  The  zinc,  z,  is  outside,  and  is  a  cylinder  having  a  cleft ; 
about  it  is  diluted  sulphuric  acid  (1  part  to  16  of  water).  The  copper, 
c,  is  contained  in  the  porous  cup,  and  is  surrounded  by  a  saturated  so- 
lution of  copper  sulphate,  which  is  kept  at  the  point  of  saturation  by 
a  quantity  of  the  crystals  packed  around  the  copper  element.  The 
polarization  of  the  hydrogen  is  prevented  by  chemical  means,  for  in 
the  decomposition  of  copper  sulphate  the  hydrogen  combines  with 
oxygen  to  form  water,  while  metallic  copper  is  deposited  on  the  copper 
element.  The  Daniell,  as  modified  by  the  celebrated  Dr.  Remak,  of 
Berlin,  has  been  more  widely  used  for  medical  purposes  than  any  other 
cell,  and  still  maintains  its  superiority.  In  this  arrangement  made  by 
Siemens  and  Halske,  of  Berlin,  and  known  under  their  name,  besides 
the  porous  cup,  a  quantity  of  papier-mache,  or  paper-pulp,  is  packed 


FIG.  6.— BUNSEN  CELL. 

in  between  the  elements,  and,  while  the  copper  is  surrounded  by  cop- 
per sulphate  in  solution,  only  water  is  used  with  the  zinc.  In  the  de- 
composition, copper  is  deposited  on  the  copper  element  and  sulphuric 
acid  diffuses  through  into  the  zinc  compartment.  This  cup  is  remark- 
able for  the  uniform  tension  of  the  current,  for  constancy,  and  for 
economy.  A  "  gravity  battery,"  composed  of  zinc  and  copper  elements, 


440  EXCITO-MOTORS. 

zinc  sulphate  solution  about  the  zinc,  and  copper  sulphate  solution 
about  the  copper,  and  separated  merely  by  the  specific  gravity  of  the 
respective  solutions,  is  now  much  employed  in  telegraphy,  and  to  a 
considerable  extent  in  medical  practice.  Zinc  and  carbon  are  now 
utilized  in  two-fluid  as  in  one-fluid  cells.  The  Bunsen  combination 
is  a  most  efficient  one  (Figs.  6  and  7).  The  outer  zinc  plate  has  a 


FIG.  7.— BCXSEN  BATTERY. 

cleft,  and  is  immersed  in  dilute  sulphuric  acid,  while  the  carbon,  of  the 
variety  known  as  gas-carbon,  is  contained  in  a  porous  cup  with  strong 
nitric  acid.  Here  the  hydrogen  is  intercepted  by  the  nitric  acid,  ni- 
trous-acid fumes  are  given  off,  and  sulphate  of  zinc  is  formed.  It  is 
a  very  powerful  combination,  but  the  fumes  of  nitrous  acid  make  it 
very  objectionable.  Although  it  is  not  suited  for  medical  use  in  gen- 
eral, it  is  well  adapted  for  galvano-caustic  purposes.  Mr.  De  la  Rue's 
chloride-of-silver  battery  is  admirably  well  arranged  for  forming  a 
portable  or  permanent  combination  for  the  medical  electrician.  It 
may  be  made  of  test-tubes,  closed  with  a  rubber  stopper  containing 
two  orifices  for  the  elements,  which  consist  of  a  zinc  rod  and  flat- 
tened silver  wire.  At  the  bottom  of  the  tube  is  placed  some  chlo- 
ride of  silver,  and  above  this  a  solution  of  common  salt.  The  silver 
element  dips  down  into  the  chloride  of  silver,  and  above  this  is  in- 
sulated by  sheet  gutta-percha.  This  cell  has  an  electro-motive  force 
a  little  more  than  the  Daniell,  and  it  is  remarkably  constant,  portable, 
and  unchangeable.  A  very  efficient  and  at  the  same  time  economical 
cell  can  be  constructed  of  a  tin  can,  iron  filings,  a  porous  cup,  and  a 
rod  of  zinc.  In  the  porous  cup,  about  the  rod  of  zinc,  is  put  some 
common  potash,  and  the  iron  fillings  which  form  the  positive  element 
are  packed  around  the  porous  cup. 

Besides  the  above,  mention  should  be  made  of  the  two-fluid  bichro- 
mate of  potash  cell.  A  solution  of  the  bichromate  in  dilute  sulphuric 
acid  is  now  chiefly  used  as  the  exciting  fluid  in  single-fluid  cells  ;  but, 
in  the  two-fluid  arrangement,  the  carbon  element  is  placed  in  a  porous 
cell  containing  a  saturated  solution  of  bichromate  of  potash  in  water 


ELECTRICITY.  447 

only,  and  the  zinc  element  is  acted  on  by  very  dilute  sulphuric  acid 
(1  to  20).  The  performance  of  this  cell  is  in  a  high  degree  satisfactory. 
The  carbon  in  this,  as  in  the  other  galvanic  cells,  is  gas-carbon,  which 
is  remarkable  for  its  density  and  for  conducting  power.  The  zinc  is 
ordinary  commercial  zinc,  amalgamated.  The  process  of  amalgama- 
tion consists  in  first  immersing  the  zinc  plate  or  rod  in  dilute  sulphuric 
acid  to  make  a  clean  surface,  and  then  rubbing  it  with  a  little  mercury 
until  it  presents  a  silvery  whiteness.  A  homogeneous  surface  is  thus 
made,  and  the  loss  of  power  due  to  the  formation  of  innumerable 
couplets  of  zinc  with  the  impurities  contained  in  it  is  thereby  pre- 
vented. 

The  force  generated  in  the  cup  by  the  chemical  action  is  termed 
electro-motive  force,  and  it  is  the  difference  in  potential  between  the 
two  elements.  The  power  of  any  combination  of  cups  is  the  sum  of 
the  electro-motive  force  of  each  one  less  the  difference  caused  by  re- 
sistance in  the  circuit.  The  current  from  a  battery  has  strength,  ten- 
sion, and  quantity.  The  strength  is  the  amount  transmitted  in  the 
unit  of  time,  along  a  given  conductor  ;  tension  is  the  power  to  over- 
come resistance  ;  and  volume  is  the  net  quantity  available.  There 
are  various  objects  which  offer  resistance  to  the  passage  of  the  current. 
The  circuit  of  a  galvanic  battery  consists  of  the  space  between  the 
elements  in  the  cup,  the  conducting  element,  and  the  wire  which  unites 
the  poles — the  conjunctive  wire.  The  current  passing  over  this  circuit 
has  to  overcome  the  resistance  opposed  by  these  several  parts.  The 
conjunctive  wire  offers  a  degree  of  resistance  determined  by  its  length 
and  section.  A  single  large  cup,  having  zinc  and  carbon  elements  of 
corresponding  size,  excited  by  bichromate  solution,  will  heat  to  red- 
ness, even  volatilize  a  platinum  wire,  while  twenty  small  medical-bat- 
tery cups  connected  in  series  will  scarcely  warm  such  a  wire.  Inten- 
sity, resistance,  and  quantity,  are  now  given  a  mathematical  mode  of 
expression.  The  unit  of  electro-motive  force  is  the  volt,  in  honor  of 
Volta,  and  is  very  nearly  the  power  of  a  Daniell  cell,  which  is,  hencei 
convenient  as  a  standard  of  comparison.  The  unit  of  resistance  is  the 
ohm,  so  named  from  the  discoverer  of  the  celebrated  law.  The  unit 
of  intensity  is  the  ampere,  formerly  the  weber,  both  the  names  of 
physicists,  distinguished  in  electrical  science.  An  ampere,  represents 
the  quantity  of  electricity  produced  by  the  unit  of  electro-motive  force 
— the  volt — circulating  in  a  conductor  having  the  unit  of  resistance — 
the  ohm — during  the  unit  of  time — the  second.  It  has  been  practically 
ascertained  that  this  is  the  quantity  of  electricity  furnished  by  a  Daniell 
cell,  and  made  to  pass  through  a  hundred  metres  of  telegraph-wire. 
The  unit  of  capacity  is  the  farad,  from  Faraday  ;  but,  as  this  amount 
is  much  too  large  for  medical  purposes,  it  is  the  usual  practice  to  em- 
ploy the  term  microfarad,  which  is  equal  to  one  millionth  part  of  a 
farad. 


448 


EXCITO-MOTORS. 


There  are  several  modes  of  ascertaining  the  current  strength.  The 
voltameter  (Fig.  8)  is  an  instrument  for  collecting  the  oxygen  and 
hydrogen  produced  by  the  decomposition  of  water.  The  quantity  of 
gas  per  minute  evolved  by  the  gal- 
vanic action  is  an  absolute  measure 
of  the  strength  of  the  current  dur- 
\\\fr  that  time.  This  instrument, 

O  * 

although  not  so  much  used  as  the 
galvanometer  for  determining  cur- 
rent strength,  is  not  without  prac- 
tical utility,  and  it  is  employed  by 
Ciniselli  and  others  to  ascertain  the 
power  of  any  given  combination  be- 
fore proceeding  in  the  operation  of 
electrolysis  in  the  treatment  of  aneu- 
rism. Galvanometers  are  more  frequently  used.  A  galvanic  current 
made  to  traverse  a  wire,  in  the  vicinity  of  a  magnetic  needle,  deflection 
takes  place  according  to  the  strength  and  direction  of  the  current. 
This  constitutes  the  simplest  form  of  the  galvanometer.  It  is  really  a 
galvanoscope,  indicating  the  existence  of  a  current  and  its  direction, 
but  not  affording  an  exact  measure  of  its  strength.  The  astatic  com- 
bination is  much  more  sensitive  :  it  consists  of  two  needles  of  about 
the  same  strength,  but  placed  in  opposite  positions  as  to  polarity,  so 
that  the  directive  force  of  the  earth's  magnetism  is  neutralized  (Fig.  9). 
The  arrangement  of  an  astatic  galvanometer  is  shown  in  Fig.  10.  To 


Pis.  8.— VOLTAMETER. 


FIG.  9.— GALVANOMETER. 


Fro.  10.— GALVANOMETER. 


render  such  a  galvanometer  of  use  as  a  means  of  exactly  representing 
the  strength  of  the  current,  the  scale  must  be  graduated  in  mille-am- 
peres  of  absolute  measurement,  or  millewebers.  Such  instruments,  as 
now  made,  enable  the  operator  to  express  in  exact  terms  the  current 


ELECTRICITY.  449 

strength  ;  instead  of  the  number  of  cups,  which  affords  so  inexact  a 
measure,  the  absolute  galvanometer  interpolated  in  the  circuit,  indi- 
cates in  mille-amperes,  or  millewebers,  the  actual  strength.  In  the 
present  condition  of  this  subject,  it  has  become  necessary  to  express 
in  an  exact  way  the  current  strength,  just  as  medicines  are  carefully 
weighed. 

The  mode  of  combining  the  cells  of  a  galvanic  battery  is  determined 
by  the  purpose  to  which  it  is  to  be  applied.  The  circuit  may  be  "  sim- 
ple "  or  "  compound."  In  the  former,  the  elements  are  united  zinc  to  zinc 
and  copper  to  copper,  so  that  in  a  battery  of  twenty  cells  so  united  there 
is  one  large  zinc  and  one  large  copper  element,  and  the  resistance  is  at 
the  minimum,  the  chemical  action  yielding  a  very  considerable  quantity 
of  electricity,  the  most  of  which  is  available.  In  the  compound  circuit 
the  battery  elements  are  arranged  in  series,  the  zinc  of  one  connected 
with  the  copper  or  carbon  of  the  next,  and  so  on  throughout  the  whole 
number.  As  every  conductor  opposes  some  resistance  to  the  passage 
of  the  current — in  other  words,  there  is  no  perfect  conductor — there 
must  be  considerable  loss  of  electricity.  It  is  sometimes  said  that  the 
quantity  of  electricity  is  determined  by  the  size  of  the  zinc  plates  acted 
on,  and  that  intensity  is  the  result  of  combining  numbers  of  elements. 
It  must  be  understood  that  intensity  is  the  power  to  overcome  resist- 
ance, and  as  the  resistance  offered  by  the  human  body  is  enormous,  it 
follows  that  a  battery  for  the  medical  application  of  galvanism  must 
have  numbers  rather  than  size.  Those  battery-cells  furnish  the  smooth- 
est current  in  which  the  internal  resistance  is  about  equal  to  the  resist- 
ance of  the  human  body.  The  zinc-carbon  elements  of  Stohrer  cause 
considerable  irritation  and  burning,  while  those  of  Siemens  and  Halske 
are  smooth  and  bland.  The  most  experienced  electricians  use  the 
latter  for  this  reason.  It  follows,  therefore,  that  all  those  devices  in- 
tended to  diminish  internal  resistance  are  not  to  be  commended  in  gal- 
vanic batteries  for  medical  use,  how  desirable  soever  they  may  be  in 
batteries  for  economic  purposes.  In  galvanic  batteries  intended  for 
transportation,  every  consideration,  except  efficiency,  must  be  sacrificed 
to  portability,  and  various  mechanical  arrangements  have  been  made 
to  combine  these  qualities.  In  the  Stohrer,  Gaiffe,  and  chloride-of- 
silver  batteries,  the  safe  transportation  of  the  cells  is  insured,  but  the 
current  of  such  combinations  is  wanting  in  the  uniformity  and  smooth- 
ness which  are  such  important  qualities  in  the  permanent  batteries. 

The  performance  of  any  galvanic  combination  may  be  readily  as- 
certained by  the  law  of  Ohm.  The  intensity  is  directly  proportional 
to  the  electro-motive  force,  and  inversely  proportional  to  the  resist- 
ance encountered  within  the  cell  and  on  the  circuit.  This  law  is  rep- 
resented in  the  following  formula  : 

T-        E 

"  R  +  r 

31 


450  EXCITO-ilOTORS. 

I  is  the  symbol  for  intensity,  E  for  electro-motive  force,  R  for  internal 
resistance  (in  the  cup),  and  r  for  external  resistance  (on  the  circuit). 

V 

Or  it  may  be  stated  that  R  =  -p- ;  that  is  to  say,  the  resistance  eqiials 

the  electro-motive  force  divided  by  the  current.  The  term  electro* 
motive  force  merely  means  the  difference  in  potential  between  the  two 
poles. 

A  battery,  whether  portable  or  permanent,  requires  a  "  pole-board  " 
for  its  working.  An  ordinary  battery  of  a  few  elements  may  be  manip- 
ulated by  a  simple  sliding  selector  and  polarity  changer,  such  as  that 
now  attached  to  the  Stohrer  portable  arrangement ;  but  the  permanent 
batteries  of  large  size,  such  as  are  now  employed  for  the  office  and  con- 
sultation rooms  of  medical  electricians,  require  more  efficient  arrange- 
ments. The  battery  of  60  to  100  elements  placed  in  the  cellar  or  some 
distant  closet,  is  connected,  in  groups  of  cells,  with  the  pole-board. 
By  means  of  the  selector,  any  desired  number  of  cells  can  be  put  in 
the  circuit.  The  pole-board  should  also  be  supplied  with  a  current- 
changer,  a  rheostat,  an  interrupter,  and  resistance-coils.  A  water  rhe- 
ostat suffices  for  ordinary  purposes.  As  water  is  an  indifferent  con- 
ductor, it  follows  that  the  galvanic  current  has  a  degree  of  difficulty 
in  passing  through  it ;  hence,  any  amount  of  resistance  can  be  interpo- 
lated in  the  circuit.  The  most  accurate  mode  of  introducing  a  meas- 
urable resistance  is  the  resistance-coil.  This  is  made  of  German-silver 
wire  of  a  certain  length  and  cross-section.  The  resistance  offered  by 
such  a  wire  to  the  passage  of  the  current  is  directly  as  its  length,  and 
inversely  as  its  sectional  area  ;  that  is,  the  longer  the  wire,  and  the  less 
its  size,  the  more  the  resistance  to  the  transmission  of  the  current. 
The  unit  of  resistance,  the  ohm,  is  the  resistance  made  to  one  volt  by 
a  wire  two  hundred  metres  in  length.  It  is  obvious  that  any  number 
of  ohms  in  resistance  can  be  interpolated  in  the  circuit.  Resistance- 
coils  of  definite  measures  of  resistance  are  now  added  to  each  properly 
equipped  pole-board.  They  are  especially  necessary  in  applications  of 
galvanism  by  the  polar  method. 

FAKADISM,  OB  ELECTRO-MAGNETISM  AND  MAGNETO-ELECTRICITY. 

Faradism,  so  named  in  honor  of  Faraday,  is  induced  electricity. 
When  the  galvanic  current  passes  through  the  conjunctive  wire  of  the 
elements  of  a  cup,  especially  of  a  battery,  it  acquires  new  properties — 
acts  on  a  magnetic  needle,  and  exhibits  the  other  properties  of  a  mag- 
net. When  the  conjunctive  wire  is  extended  into  a  coil,  coated  with 
insulating  material,  it  will  act  on  another  coil  in  its  neighborhood,  as  it 
does  on  a  magnet.  The  former  is  called  the  primary  or  inducing  coil, 
and  the  latter  the  secondary  or  induction  coil.  If  the  latter  is  con- 
nected with  a  galvanometer,  it  will  be  found  that  when  a  current  trav- 
erses the  primary  coil,  the  needle  of  the  galvanometer  is  at  once 


ELECTRICITY. 


451 


deflected  ;  but  if  the  current  continue  to  pass  without  any  variations 
in  the  tension,  the  needle  presently  comes  to  rest.  When  the  current 
is  broken  or  interrupted,  the  needle  is  again  deflected,  but  this  time 
in  the  opposite  direction.  It  follows,  therefore,  that  the  induced  cur- 
rent only  occurs  at  the  opening  and  closing  of  the  primary  circuit :  at 
the  making  or  closing  the  circuit,  in  the  opposite  direction  ;  and  at  the 
opening  or  breaking  of  the  circuit,  in  the  same  direction.  The  induced 
or  f aradic  current  is  therefore  a  to-and-fro  current,  instantaneous  in 
duration.  It  is  obvious  from  these  considerations  that  in  the  construc- 
tion of  a  faradic  battery  there  must  be  a  mechanical  arrangement  for 
interrupting  the  current  in  the  primary  circuit.  The  usual  automatic 
interrupter  is  Neef's  hammer,  a  vibratile  steel  spring  worked  by  the 
magnetism  of  the  soft-iron  core.  The  best  instruments  are  now  pro- 
vided with  a  simple  mechanism  to  give  slow  interruptions,  an  impor- 
tant matter  when  muscles  are  to  be  exercised.  In  the  purchase  of  a 
faradic  instrument  for  medical  purposes  the  device  to  effect  the  slow 
interruptions  should  not  be  overlooked. 

The  galvanic  couplet  for  the  primary  coil  is  now  almost  always  the 
zinc-carbon  combination  excited  by  bichromate  solution.*  The  pri- 
mary or  inducing  coil  is  made  of  thick  wire  and  is  much  shorter  than 
the  secondary  coil.  In  the  interior  of  the  primary  coil  is  placed  a 
bundle  of  wires,  each  one  insulated  and  becoming  a  magnet  when  the 
current  passes.  This  temporary  magnet  attracts  the  hammer  of  the 


FIG.  11. — KUHMKORFF  Coru 

vibrator,  and  on  the  instant  the  current  is  closed  and  opened  again. 
The  so-called  primary  current  of  the  faradic  battery  is  therefore  some- 

*  The  bichromate  solution  is  prepared  as  follows :  Dissolve  one  ounce  of  bichro- 
mate of  potassium  in  eighteen  ounces  of  hot  water  in  an  earthenware  vessel.  Let 
it  cool,  and  when  cold  add  two  fluid  ounces  of  sulphuric  acid,  and  two  drachms  of 
nitric  acid.  It  should  not  be  used  until  cold,  and  it  is,  therefore,  preferable  to  keep  it 
on  hand. 


452 


EXCITO-MOTORS. 


thing  more  than  that  coming  from  the  galvanic  couplet  ;  it  is  re- 
enforced  by  the  induction  between  the  turns  of  the  coil  and  by  the 
magnetism  of  the  soft-iron  core. 

The  coil  of  induction,  or  the  secondary  coil,  is  made  of  long  and 
fine  wire  ;  the  longer  and  finer,  the  more  intense  the  current.  The 
Ruhmkorff  coil,  which  is  composed  of  miles  of  very  fine  wire,  fur- 
nishes a  brilliant  spark  sometimes  several  inches  in  length  (Fig.  11). 

Electro-magnetism  is  the  title  of  that  mode  of  the  force  induced 


Fio.  12. 

by  the  action  of  a  galvanic  current  on  a  bundle  of  wires  within  an 
insulated  coil  ;  in  other  words,  it  is  the  ordinary  faradic  battery,  ex- 
cited by  a  galvanic  couplet  (Fig.  12).  Magneto-electricity,  on  the 
other  hand,  is  that  mode  of  the  force  induced  by  the  action  of  a  per- 
manent magnet.  If  we  substitute  for  the  cell 
a  strong  permanent  magnet,  we  learn  that, 
on  the  approach  or  withdrawal  of  the  magnet 
from  a  coil  of  insulated  wire,  a  current  of  elec- 
tricity is  induced  in  the  coil :  on  the  approach 
of  the  magnet,  in  one  direction  ;  on  its  with- 
drawal, in  the  opposite  direction  (Fig.  13).  Thus 
an  instantaneous  to -and -fro  current  may  be 
caused  by  the  action  of  a  magnet,  just  as  by 
the  action  of  a  galvanic  current.  Out  of  this 
principle  has  developed  the  magneto-electric  *«  :  'WUr 
machine,  which  consists  of  the  permanent  mag- 
nets, insulated  coils  made  to  revolve  about  the 
poles,  and  a  mechanical  arrangement  for  ob- 
taining regular  revolutions,  and  making  and  breaking  the  circuit. 
Thus,  by  mechanical  power,  the  same  results  are  produced  as  by 
ohemicai  action  (Fig.  14). 

The  discovery  of  a  simple  commutator,  by  which  the  currents  can 


ELECTRICITY.  453 

be  collected  and  sent  in  one  direction,  has  quite  revolutionized  the 
utility  of  this  form  of  battery.  It  is  now  applicable  to  electric  de- 
composition (electrolysis),  to  electric  heating  (galvano-causty),  and 


FIG.  14.— MAGNETO-ELECTRIC  MACHINE. 

electric  lighting.  Indeed,  with  the  general  use  of  electricity  fur- 
nished by  the  "  dynamo-machines "  as  a  motive  power,  it  is  prob- 
able that  the  force  in  this  form  will  be  successfully  applied  to  medi- 
cal purposes. 

Storage  Cells,  Accumulators,  etc. — The  Plante1  cell  was  the  first  ap- 
plication of  the  principle  of  polarization  to  the  storage  of  electrical 
energy.  This  consisted  at  first  of  plates  of  lead  rolled  into  a  spiral, 
separated  by  strips  of  vulcanite,  and  acted  on  by  dilute  sulphuric  acid. 
Such  a  cell  connected  with  a  battery  was  found  to  become  energized 
and  to  give  off  a  considerable  current  for  several  hours.  The  electro- 
motive force  of  such  a  cell  was  determined  by  the  extent  of  the  sur- 
face, the  seat  of  the  chemical  action.  The  original  cell  of  Plante  was 
made  of  practical  utility  by  Faure,  who  improved  the  amount  of  chem- 
ical energy  to  be  transformed  into  electrical  power  by  coating  the  sur- 
face of  the  plates  with  lead  peroxide  and  by  enlarging  the  surface  by 
mechanical  devices.  Improvements  on  the  methods  of  Faure  have 
been  made  by  Brush  and  many  others,  so  that  now  a  storage  cell  or 


454  EXCITO-MOTORS. 

an  accumulator  can  be  so  charged  by  a  battery  or  dynamo  as  to  give 
out  an  amount  of  electro-motive  force  only  limited  by  the  chemical 
action  occurring  at  the  surface  of  the  plates.  Such  an  accumula- 
tor will  furnish  sufficient  power  for  lighting,  heating,  or  mechanical 
work. 

The  storage  cell  is  now  employed  to  furnish  light  for  illuminating 
the  eye,  the  ear,  the  throat,  and  other  cavities  for  cautery  purposes  in 
all  the  varied  operations  in  which  the  electric  knife  is  used,  and,  with 
suitable  controllers  and  rheostats,  for  the  numerous  applications  of 
galvanism  in  medical  practice.  By  means  of  a  storage  cell,  therefore, 
the  electrical  work  of  an  office,  including  faradic,  galvanic,  illuminat- 
ing, and  caustic,  can  be  carried  on  without  the  agency  of  the  ordinary 
batteries.  "When  a  storage  cell  is  exhausted  or  has  run  down,  it  can  be 
recharged  again  at  the  central  office,  or  it  can  be  recharged  from  the 
street  main  by  suitable  adapter  and  controller. 

The  Public  Supply  of  Electricity. — Arrangements  are  now  available 
for  utilizing  the  public  sources  of  electric  lighting  and  power.  There 
are  two  forms  of  the  force  which  can  be  diverted  from  the  street  mains 
to  the  office  instruments — the  arc  and  the  incandescent — and  both 
forms  are  now  in  operation  in  a  great  many  cities  and  towns.  By 
means  of  a  "  current  adapter,"  the  current  from  a  sixteen-candle  lamp 
can  be  fitted  to  a  suitable  resistance  coil's  box  and  a  proper  milliam- 
peremeter,  whereby  the  strength  can  be  regulated  according  to  the 
purposes  of  the  operator  ;  or,  by  means  of  a  current  adapter,  the  cur- 
rent can  be  utilized  to  energize  the  coils  of  a  faradic  battery,  whereby 
the  faradic  current  with  all  its  modifications  can  be  produced.  Simi- 
larly, the  street  supply  may  be  brought  into  service  to  perform  the 
part  of  a  caustic  battery,  or  it  may  be  used  to  energize  the  storage 
cell,  and  this  in  turn  be  made  to  do  duty  as  a  galvanic  or  faradic  cur- 
rent, or  for  heating  and  lighting. 

Galvano-Faradization. — The  pole-board  of  a  finished  electrical  ap- 
paratus should  have  an  arrangement  for  combining  the  galvanic  and 
faradic  currents,  so  that  a  simultaneous  application  of  the  two  can  be 
made.  Proposed  not  long  since  by  De  Watteville,  this  form  of  elec- 
trical application  has  already  been  largely  employed.  When  the  gal- 
vanic current  is  flowing  through  the  electrode  wire,  the  faradic  is 
turned  on,  thus  bringing  into  action,  on  a  part,  the  effects  of  both. 
To  impart  a  higher  tonicity  to  the  organic  muscular  fiber,  to  increase 
absorption  of  exudates,  are  the  chief  purposes  to  be  subserved  by  this 
method.  To  any  one  familiar  with  the  physiological  action  of  fara- 
dism,  it  will  not  seem  strange  that  this  process  can  be  really  useful 
only  when  the  electrode  can  be  brought  into  contact  with  the  affected 
tissue.  The  application  of  galvano-faradism  has  proved  of  remark- 


ELECTRICITY.  455 

able  utility  in  cases  of  pelvic  inflammation,  uterine  diseases  (subinvo- 
lution),  and  consequent  displacements,  and  excessive  proliferation  of 
the  connective  tissue  of  the  pelvis.  The  combined  currents  act  more 
efficiently  in  these  maladies  than  does  galvanism  alone. 

Electric  Baths. — Until  two  or  three  years  ago  electric  baths  were 
only  used  by  charlatans,  but  of  late  they  have  been  studied  from  the 
scientific  standpoint,  and  their  real  value  determined.  Water  is  a 
conductor,  but  still  an  inferior  conductor,  of  electricity.  When  both 
poles  are  placed  in  the  water — a  little  saline,  or  slightly  acidulated — 
and  the  patient  immersed,  the  current  passes  through  the  water  inter- 
posed, and  hence  the  resistance  to  be  overcome  will  be  directly  as  the 
thickness  of  the  stratum.  Such  an  application,  the  water  being  the 
medium  of  communication,  has  the  same  character  as  general  fara- 
dization, or  galvanization.  It  is  a  dipolar  electric  bath.  When  one 
electrode  enters  the  water,  and  the  other  is  in  contact  with  the 
patient,  the  bath  is  monopolar.  In  the  practice  of  charlatans  it  is 
usual,  if  the  patient  complains  that  he  feels  nothing,  to  place  a 
metallic  electrode  on  the  skin,  when,  of  course,  a  lively  sense  of 
burning  is  experienced. 

The  objections  to  electric  baths  are — the  necessary  trouble  to  apply 
them  ;  the  enormous  resistance  of  the  water  ;  the  inequality  in  ten- 
sion, and  the  lack  of  precision  in  every  case  as  to  the  point  at  which 
the  application  is  to  be  made,  as  to  the  sudden  and  considerable  varia- 
tions in  the  quantity  of  the  electricity  furnished,  and  the  unscientific 
character  of  the  method  in  every  aspect.  To  these  objections  may  be 
added  the  association  of  electric  baths  with  the  most  baleful  charlatan- 
ry. If,  indeed,  the  method  possessed  such  conspicuous  advantages 
that  considerations  of  that  character  could  be  disregarded,  then  it  could 
be  placed  among  our  therapeutical  resources  without  compunctions. 

Electro-Physiology. — Much  of  the  supposed  knowledge  of  this  sub- 
ject is  in  a  transition  state,  and  will  ultimately  require  very  different 
statement.  Into  this  doubtful  region  the  author  will  not  enter  ;  but 
there  are  facts  of  great  value  which  should  not  be  overlooked. 

Action  of  Galvanism  on  Motor  Nerves  and  Muscles. — Whether  a 
muscle  be  acted  on  directly  by  a  galvanic  current,  or  indirectly  through 
a  motor  nerve  which  supplies  it,  the  muscle  is  thrown  into  action  ;  but 
the  action  is  limited  to  the  opening  and  closing  of  the  circuit  if  the 
tension  of  the  current  continues  the  same  throughout.  If  the  "de- 
scending "  or  "  direct "  current  has  the  minimum  strength  to  cause  a 
muscular  contraction,  this  will  take  place  at  the  closing  of  the  circuit 
only,  and  there  will  be  no  action  at  the  "  opening,"  or  "  interruption," 
or  "  breaking  "  of  the  circuit.  A  descending,  closing-current  muscu- 
lar contraction  is  always  greater  than  the  opening.  The  rule  is  differ- 


456  EXCITO-MOTORS. 

ent  in  the  case  of  the  "  ascending  "  or  "  indirect "  current.  The  feeblest 
strength  of  current,  passing  in  the  inverse  direction,  which  will  cause 
a  muscular  contraction,  induces  it  only  at  the  opening  of  the  circuit, 
but,  if  a  strong  current  is  used,  both  at  the  opening  and  closing.  Di- 
rect excitation  of  a  muscle  by  galvanism  causes  more  powerful  mus- 
cular contractions  than  indirect.  Such  are  the  results  of  galvanic 
stimulation  when  the  motor  nerves  are  uncovered  by  tissues,  and  are 
directly  acted  on  by  the  electrodes.  If,  however,  motor  nerves  and 
the  muscles  are  acted  on  through  the  tissues  covering  them,  the  most 
energetic  contractions  are  induced  by  inverse  or  ascending  currents, 
and  at  the  closing  of  the  circuit.  When  a  motor  nerve  supplies  by 
separate  filaments  two  muscles,  stimulation  of  one  filament  causes  con- 
traction of  the  muscle  to  which  it  goes,  but  contraction  of  the  other 
muscles  also  takes  place.  To  the  latter  is  applied  the  term  induced 
contraction.  If  a  motor  nerve  is  stimulated  again  and  again  by  a 
direct  current,  finally  its  excitability — that  is,  its  power  to  contract  on 
irritation — is  exhausted  ;  then  the  excitability  may  be  restored  by  the 
action  of  an  inverse  current.  By  thus  alternating  in  the  direction  of 
the  current,  the  muscular  irritability  may  be  alternately  destroyed  and 
restored  for  a  long  time,  if  not  indefinitely.  To  these  phenomena 
has  been  applied  the  term  voltaic  alternatives. 

Action  of  Faradism  on  Motor  Nerves  and  Muscles. — A  faradic 
current,  whatever  its  direction,  stimulating  a  motor  nerve,  causes  con- 
traction of  the  muscles  innervated  by  this  nerve.  If  the  interruptions 
in  the  primary  circuit  are  slow,  the  muscles  have  time  to  contract  and 
relax  ;  but  when  the  interruptions  are  rapid,  the  muscles  are  kept  in 
a  condition  of  tonic  contraction,  or  are  tetanized.  Long-continued, 
powerful  faradic  stimulation  of  a  motor  nerve  exhausts  its  irritability. 
Muscles  directly  acted  on  by  a  faradic  current  contract  energetically, 
but  repeated  over-stimulation  will  fatigue  and  ultimately  destroy  their 
contractility.  When,  however,  muscles  are  in  this  condition  of  fatigue 
and  exhaustion,  from  faradic  stimulation,  their  proper  functional  state 
may  be  restored  by  passing  a  continuous  galvanic  current  through 
them.  If  not  too  long  applied  or  too  powerful  in  action,  faradic  ap- 
plications improve  the  nutrition  of  muscles,  and  through  this  increased 
activity  of  the  circulation  there  occurs  a  rise  of  temperature,  generally. 

The  Polar  Method  as  applied  to  the  Reactions  of  Motor  Nerves  and 
Muscles. — This  important  method  of  examining  the  condition  of  motor 
nerves  and  muscles  must  be  understood,  to  rightly  appreciate  the 
modern  mode  of  electro-diagnosis.  As  certain  terms,  having  technical 
meanings,  are  much  used  in  this  connection,  it  is  necessary  to  define 
them  before  proceeding  to  describe  the  phenomena.  Anode  is  the 
term  applied  to  the  positive  pole,  cathode  to  the  negative  pole,  and 
the  adjectives,  anodal,  relating  to  the  anode,  and  cathodal,  relating  to 
the  cathode.  As  the  polar  method  had  its  origin  in  Germany,  the 


ELECTRICITY.  457 

symbols  now  used  to  indicate  electrical  reactions  are  taken  from  Ger- 
man words.  Charcot  in  France,  Buzzard  in  England,  and  the  Ameri- 
can writers  in  general,  have  adopted  the  German  formulae,  so  now 
their  use  is  universal. 

The  polar  method  consists  in  exciting  nerve  or  muscle  with  one 
pole,  while  the  other  rests  on  some  indifferent  spot,  as  the  sternum,  as 
advised  by  Erb.  We  are  here  concerned  with  the  normal  or  physio- 
logical state  ;  hereafter,  the  pathological  conditions  will  be  given. 
The  normal  formulae,  consist  in  the  reactions  which  ensue  on  polar 
stimulation,  nerves  and  muscles  being  healthy.  When  the  current  is 
closed  by  applying  the  cathode  to  the  nerve  or  muscle  to  be  excited, 
the  symbols  are  Ka  S  (Ka,  Kathode  ;  S,  Schliessung,  closing).  When  the 
current  is  opened  or  broken  by  removing  or  disconnecting  the  cathode, 
the  symbols  are  Ka  O  (Oeffhung,  opening).  Corresponding  symbols 
are  used  in  respect  to  the  anode.  Thus,  the  words  anodal  closing  are 
An  S,  and  anodal  opening,  An  O.  To  express  muscular  contraction 
the  symbol  is  Z  (Zuckung)  ;  a  strong  contraction  is  Z' ;  for  a  weak 
contraction,  z,  and  for  a  tetanic  contraction,  Te.  In  the  physiological 
state,  the  muscular  contractions  as  induced  by  the  polar  method  are 
characteristic,  and  can  be  expressed  in  the  symbolic  language  now 
employed  for  the  purpose.  It  is  to  be  observed,  in  the  first  place,  that 
the  cathode  or  negative  pole  has  more  power  to  induce  muscular  action 
than  the  anode  or  positive  pole. 

The  cathode  has  more  effect  on  closing  the  circuit ;  whereas  the 
anode  acts  more  powerfully  on  opening  or  breaking  the  circuit. 

The  normal  formulae  of  muscular  contractions  induced  by  the  polar 
method  may  be  arranged  in  three  grades  : 

In  the  first  grade,  the  weakest  current  having  power  to  induce  any 
contraction  causes  it  on  cathodal  closing  —  whence  the  formula  Ka 
S  Z  ;  and  no  action  takes  place  from  the  anode. 

In  the  second  or  intermediate  grade,  the  strength  of  current  is 
sufficient  to  cause  strong  cathodal  closing  contraction  (Ka  S  Z'),  but  no 
opening  contraction  ;  whereas,  on  anodal  opening  and  closing  there 
are  feeble  contractions — whence  An  S  z,  and  An  O  z. 

In  the  third  grade,  which  is  the  highest,  the  current  causes  on 
cathodal  closing  a  tetanic  contraction,  Ka  S  Te,  and  a  feeble  contrac- 
tion on  cathodal  opening  Ka  O  z  ;  whereas,  there  occur  decided  con- 
tractions on  anodal  opening,  An  O  Z,  and  on  anodal  closing,  An  S  Z. 

Such  are  the  normal  formulae — such  is  the  normal  behavior  of 
muscles  ;  but  in  disease,  as  we  shall  subsequently  learn,  these  formulae 
may  be  much  changed,  may  be  even  entirely  reversed. 

Action  of  Galvanism  on  Non-striated  Muscles. — The  physiologi- 
cal differences  in  the  action  of  voluntary  and  organic  muscular  fibers 
are  well  exhibited  in  the  results  of  galvanic  stimulation.  Instead  of  a 
prompt,  almost  instantaneous  muscular  contraction,  characteristic  of 
the  voluntary  fiber,  a  slow  vermicular  motion  is  set  up  in  the  involun 


458  EXCITO-MOTORS. 

tary,  and  this  movement  is  propagated  from  the  point  of  stimulation 
by  a  rhythmical  action. 

Action  of  the  Galvanic  Current  on  the  Brain  and  Spinal  Cord. — 
Until  the  experiments  of  Fritsche  and  Hitzig,  Ferrier,  Nothnagel, 
and  others,  within  a  few  years  past,  the  electric  excitability  of  the 
brain  had  not  been  admitted.  It  seems  now  to  be  established  that 
certain  areas  of  the  cortex  cerebri  are  anatomically  associated  with 
certain  muscular  groups.  These  facts  have  been  ascertained  by  direct 
stimulation  of  these  areas  of  the  cortex  by  galvanic  (Fritsche  and 
Hitzig)  and  faradic  (Ferrier)  applications.  Can  the  intra-cranial  or- 
gans be  reached  through  their  investing  tissues  ?  This  is  the  most  im- 
portant question,  and  to  this,  fortunately,  we  are  able  to  reply  in  the 
affirmative.  Erb  was  the  first  to  prove  the  transmission  of  a  galvanic 
current  through  the  brain,  and  now  the  fact  is  universally  admitted. 

On  electric  stimulation  of  the  cord,  results  are  produced  accord- 
ing to  the  functional  powers  of  the  part — pain  when  the  sensory  tract 
is  irritated,  and  muscular  movements  when  the  motor  is  acted  on. 
Hence,  the  statement  of  Erb,  that  these  effects  may  be  due  to  stimula- 
tion of  the  nerve-roots,  has  a  high  degree  of  probability.  In  the  spi- 
nal cord,  as  in  the  nerves,  the  inverse  or  ascending  current  causes  more 
decided  effects.  , 

Electric  excitation  of  that  part  of  the  cord  between  the  fifth  cervi- 
cal and  tenth  dorsal  vertebras  causes  dilatation  of  the  pupil,  whence 
this  region  is  known  as  the  cilio-spinal  region.  The  explanation  of 
this  fact  is,  that  in  this  part  of  the  cord  originate  filaments  of  the 
sympathetic,  connected  with  the  cervical  ganglia.  In  the  lumbar  part 
of  the  cord  is  a  similar  center,  related  to  the  genital  apparatus,  and 
hence  called  the  genito-spinal  region. 

Action  of  the  Galvanic  and  faradic  Currents  on  the  Pneumogas- 
tric. — A  weak  galvanic  current  sent  through  the  pneumogastric,  in- 
creases the  force  and  rapidity  of  the  heart's  movements  ;  but  a  strong 
current  arrests  the  heart  in  the  diastole.  After  division  of  the  nerve, 
stimulation  of  its  upper  or  central  portion  arrests  respiration  in  the 
movement  of  inspiration,  but  does  not  influence  the  heart ;  but  a 
strong  current  acting  on  the  lower  or  distal  portion  of  the  nerve  stops 
the  heart  in  diastole.  A  descending  galvanic  current,  passed  through 
the  pneumogastric  nerve,  suspends  the  contractions  of  the  stomach. 
A  faradic  current  directly  applied  to  the  pneumogastric,  before  and 
after  division  of  the  nerve,  produces  the  same  results,  but  more  decid- 
edly ;  applied  through  the  tissues,  it  has  no  apparent  effect. 

Action  of  Galvanism  and  Faradism  on  the  Sympathetic  System. — 
Covered  by  the  tissues,  the  ganglia  and  fibers  of  the  cervical  sympa- 
thetic are  not  acted  on  by  faradic  and  static  electricity,  but  even  a 
weak  galvanic  current  does  affect  them.  Applied  directly  to  the  sym- 
pathetic nerves,  the  effect  of  faradism  is  tetanizing,  and  the  ves- 
sels receiving  their  innervation  from  this  source  contract  very 


ELECTRICITY.  459 

strongly.  Applied  through  the  tissues,  the  faradic  current  has  little 
or  no  effect. 

The  kind  of  action  set  up  by  galvanism,  and  the  differences  due  to 
the  direction  in  which  the  current  is  passing,  have  been  much  disputed. 
The  author  believes  that  the  experiments  and  the  deductions  of  Onimus 
and  Legros  correctly  represent  the  actual  condition.  They  hold  that 
the  direct  or  descending  current,  by  increasing  the  normal  wave-like 
or  vermicular  motion  of  the  muscular  layer  of  the  vessels,  increases  the 
amount  of  blood  passing  through  them  ;  but  a  very  strong  galvanic  cur- 
rent— forty  to  sixty  milliampere-metres — will  tetanize  the  organic  mus- 
cular fiber,  as  we  have  ascertained  by  actual  investigation,  and  in  this 
way  lessen  the  quantity  of  blood  passing. 

ELECTRO-DIAGNOSIS. — For  diagnostic  purposes  both  galvanic  and 
faradic  currents  are  necessary.  The  polar  method  has  been  applied  with 
great  success  for  determining  the  condition  of  nerve  and  muscle.  As 
has  been  stated,  the  pole  intended  for  excitation  must  be  placed  over 
the  nerve  or  muscle  to  be  acted  on,  while  the  other  rests  on  some  in- 
different point — for  the  upper  extremity  and  trunk,  the  sternum  is 
convenient.  If  the  operator  has  no  assistant,  an  interrupting  handle 
of  the  electrode  is  useful,  or  an  automatic  interrupter  may  be  attached 
to  the  pole-board,  or  the  interruptions  may  be  effected  by  simply  ap- 
plying or  removing  the  electrode. 

The  normal  formulae  of  nerve  and  muscle  actions  have  been  set 
forth  ;  in  disease  these  formulae  are  altered — may  be,  even  entirely 
reversed.  It  suffices  now  to  state  that  when  a  faradic — an  induced — 
current  is  applied  to  a  muscle,  or  to  the  motor  nerve  supplying  it,  con- 
traction of  the  muscle  takes  place.  This  is  called  faradic  excitation, 
and  it  is  direct  when  the  contraction  is  caused  by  application  of  the 
electrodes  to  the  muscle  itself,  and  indirect  when  the  motor  nerve  is 
acted  on.  "When  galvanism  is  used  to  produce  these  effects,  the  term 
applied  is  galvanic  excitation,  and  this  is  direct  or  indirect. 

The  Diagnosis  of  Paralysis. — When  the  paralysis  is  limited  to  a 
group  of  muscles,  to  one  member,  or  to  one  side,  the  behavior  of  the 
paralyzed  muscles  is  compared  with  the  normal.  If,  however,  as  is 
comparatively  infrequent,  symmetrical  muscles  are  paralyzed,  their 
condition  must  be  contrasted  with  that  of  another  healthy  subject. 

The  paralysis  of  muscles  may  be  complete,  and  yet  they  react  in  a 
normal  manner.  In  other  cases,  there  may  be  merely  quantitative 
changes  ;  that  is,  there  is  a  mere  increase  or  diminution  of  electric 
excitability,  the  polar  reactions  conforming  to  the  normal,  in  order. 
In  the  third  group,  the  paralyzed  muscles  are  found  to  be  changed, 
not  only  quantitatively  but  qualitatively,  in  respect  to  their  responses 
to  the  electrical  excitation.  If  the  muscles  respond  in  a  normal  man- 
ner to  both  forms  of  current,  it  may  be  concluded  that  the  spinal  cord 
connected  by  nerve-fibers  to  the  paralyzed  part  is  free  from  disease. 


460  EXCITO-MOTORS. 

The  changes  in  respect  to  the  electric  excitability,  in  some  cases  of 
paralysis,  consist  merely  in  a  quantitative  increase  to  both  currents  : 
the  muscles  react  to  a  less  strength  of  current,  or  more  energetically 
to  the  same  strength.  In  the  latter,  while  the  normal  formula  is  de- 
veloped by  acting  on  the  healthy  muscles,  on  the  paralyzed  side  the 
reaction  is  more  decided,  as  indicated  by  a  cathodal  closing  contrac- 
tion (Ka  S  Z)  occurring  with  a  very  weak  current,  or  Ka  S  Z  becoming, 
on  the  application  of  the  same  current,  a  tetanus  (Ka  S  Te)  ;  also  indi- 
cated by  the  early  appearance  of  an  anodal  opening  contraction  (An  O  Z) 
and  the  prompt  appearance  of  a  cathodal  opening  contraction  (Ka  O  Z). 
A  hemiplegia  of  recent  occurrence,  some  cases  of  spinal  paralysis  at 
a  very  early  stage,  and  very  rarely  the  earliest  manifestations  of  pa- 
ralysis from  nerve-lesions,  are  illustrative  of  this  state. 

The  usual  condition  for  which  the  electrical  currents  are  employed 
in  diagnosis  is  diminution  or  loss  of  electric  excitability.  Spinal, 
motor-nerve,  and  muscular  lesions  are  the  most  important.  "  Reac- 
tions of  degeneration  "  is  the  happy  term  employed  by  Erb  to  signify 
the  changes  in  the  electrical  reactions.  Owing  to  disease  of  the  cord, 
or  of  the  motor-nerve  trunks,  degenerations  of  tissue  ensue,  and  hence 
the  term.  For  a  very  brief  period,  in  some  cases,  there  is  an  increase 
of  electrical  excitability,  but  a  decline  then  quickly  ensues.  As  re-" 
gards  faradism,  the  strength  of  current  necessary  to  cause  a  contrac- 
tion of  the  affected  muscles  must  be  constantly  increased,  and  in  a 
short  time  no  strength  of  current  will  cause  the  least  movement.  The 
normal  formula  for  the  galvanic  current  is  changed,  pari  passu,  with 
the  decline  of  faradic  excitability.  First,  the  cathodal  closing  tetanus 
ceases  (Ka  S  Te),  then  anodal  closing  contraction  (An  S  Z),  and  finally 
cathodal  closing  (Ka  S  Z)  can  be  excited  only  by  the  strongest  cur- 
rent. These  changes  represent  a  gradually  increasing  atrophy  of  the 
muscles,  and  the  final  cessation  of  the  cathodal  closing  contraction 
signifies  an  extreme  degree  of  atrophy,  and  the  disappearance  of  the 
muscular  elements. 

In  the  condition  known  as  the  reactions  of  degeneration,  it  is  im- 
portant to  distinguish  between  the  reactions  of  the  motor  nerve  and  of 
the  muscles.  It  has  been  already  pointed  out  that,  whether  the  mo- 
tor nerve  supplying  it,  or  the  muscle  itself  is  acted  on,  muscular  con- 
tractions take  place.  In  the  changes  which  ensue  in  cases  of  paralysis, 
the  state  of  the  nerve  is  separable  from  that  of  muscle.  If  the  paral- 
ysis is  due  to  a  lesion  of  the  nerve-trunk — to  an  inflammation  of  the 
nerve,  for  example — there  may  be  a  brief  period  when,  as  above  stated, 
the  electric  excitability  is  heightened  ;  but,  as  the  nerve  undergoes  de- 
generative atrophy,  there  ensues  a  quantitative  decline  in  the  response 
to  electrical  excitation,  to  both  faradic  and  galvanic,  and  by  the  twelfth 
day,  sometimes  earlier,  it  has  usually  entirely  disappeared,  if  the  le- 
sions have  proved  destructive  and  irremediable.  On  the  other  hand, 


ELECTRICITY.  461 

if  the  injury  done  is  less,  and  is  remediable,  the  electric  excitability  is 
modified  only,  and  not  lost.  When  recovery  from  the  injury,  or  in- 
flammation of  the  affected  motor  nerves  takes  place,  the  muscles  inner- 
vated will  respond  to  the  impulses  of  the  will,  long  before  they  react 
to  faradic  or  galvanic  stimulation. 

When  the  spinal  cord  is  the  seat  of  disease,  as  in  infantile  paralysis, 
glossolabiolaryngeal  paralysis,  progressive  muscular  atrophy,  etc.,  the 
paralyzed  nerves  and  muscles  exhibit  most  characteristic  electrical  re- 
actions. As  regards  the  motor,  nerves,  in  two  or  three  days,  usually, 
after  the  paralysis  has  manifested  itself,  a  regular  and  steady  quanti- 
tative decline  in  excitability  to  both  forms  of  current  takes  place,  and 
by  the  end  of  the  second  week,  usually,  and  sometimes  by  the  end  of 
the  first  week,  no  strength  of  current  applied  to  the  nerve  will  cause 
muscular  contractions.  At  first,  cathodal  closing  ceases,  then  anodal 
closing,  and  finally  anodal  opening. 

The  muscular  reactions  are  much  changed  from  the  normal.  The 
muscles,  in  about  a  week  after  the  paralysis  appears,  begin  to  decline 
in  their  excitability  to  the  faradic  current,  and,  at  the  end  of  two 
weeks,  it  is  totally  lost,  and  they  cease  to  respond  to  any  strength 
of  application.  If  regeneration  of  the  diseased  nerve-tissue  can  be 
effected,  restoration  of  the  faradic  excitability  may  be  accomplished, 
but  to  a  less  extent  than  before. 

The  phenomena  connected  with  the  galvanic  excitability  are  very 
different.  For  the  first  week  of  the  paralysis  the  response  of  the  mus- 
cles to  the  galvanic  current  declines,  as  it  does  to  the  faradic  ;  but, 
after  the  second  week,  a  remarkable  change  ensues  :  then  the  galvanic 
excitability  begins  to  increase,  and  with  this  there  occur  qualitative 
changes  in  the  order  and  mode  of  muscular  contractions.  These  con- 
sist in  a  gradual  increase  of  the  anodal  closing  contraction,  which  soon 
equals  if  it  does  not  surpass  the  cathodal  closing,  and  the  cathodal 
opening  contraction  declines  in  the  same  measure.  In  other  words,  an 
actual  reversal  takes  place  of  the  normal  formulae.  If  the  degenera- 
tions continue,  and  the  muscular  elements  are  finally  destroyed,  the 
reactions  ultimately  cease,  the  last  to  disappear  being  a  very  feeble 
anodal  closing  contraction.  Such  are  the  reactions  of  degeneration. 
They  occur  in  cases  of  spinal  paralysis,  when  the  disease  in  the  cord 
is  in  direct  anatomical  association  with  the  paralyzed  parts,  and  in 
cases  of  peripheral  paralysis  when  due  to  injury  or  disease  of  nerve- 
trunks.  The  so-called  infantile  paralysis  is  an  illustration  of  the  for- 
mer, and  facial  paralysis  of  the  latter.  When  the  disease  is  situated 
in  the  cord  above  the  point  from  which  nerves  are  given  off  to  the 
paralyzed  members,  there  is  no  change  in  the  law  of  muscular  contrac- 
tion. When,  for  example,  a  transverse  myelitis  exists  entirely  above 
the  dorso-lumbar  enlargement  of  the  cord,  the  muscles  of  the  lower 
extremities,  although  paralyzed,  react  normally  to  the  faradic  and 


4G2  EXCITO-MOTORS. 

galvanic  currents.  Again,  in  disseminated  myelitis  there  are  groups 
of  muscles  that  react  in  accordance  with  the  law  of  normal  contrac- 
tion, and  other  groups  that  manifest  the  reactions  of  degeneration — 
the  former  being  in  anatomical  connection  with  a  healthy  part  of  the 
cord  ;  the  latter  with  a  diseased  area.  It  follows,  therefore,  that  a 
proper  electrical  examination  should  be  made  as  a  means  of  diagnosis 
in  the  diseases  of  the  nerve-centers. 

Diagnosis  of  Sensibility. — By  means  of  the  faradic  brush,  and 
pointed  electrodes  closely  approximated,  the  state  of  sensibility  of  the 
skin  may  be  readily  marked  out.  The  skin  must  be  carefully  dried 
to  prevent  diffusion  of  the  current,  and  then  the  brush  or  electrodes 
conveying  the  induced  current  must  be  carefully  passed  over  the  sup- 
posed anaesthetic  and  analgesic  area,  and  the  outlines  of  the  affected 
surface  thus  ascertained. 

The  galvanic  current  by  the  polar  method  has  been  very  success- 
fully applied  to  determine  the  state  of  the  auditory  nerve.  The  pole 
intended  for  excitation  is  introduced  through  a  suitable  non-conduct- 
ing speculum  into  the  ear,  previously  filled  with  warm  water,  and  the 
other  pole  is  placed  on  the  mastoid  process,  nape  of  the  neck,  or  any 
indifferent  point.  Brenner,  of  St.  Petersburg,  who  has  contributed 
the  most  of  the  exact  knowledge  now  in  our  possession  regarding  these 
auditory  reactions,  has  invented  resistance-coils  to  be  utilized  in  these 
researches.  A  strong  current,  reduced  to  the  necessary  point  for  act- 
ing on  the  auditory  nerve  by  the  introduction  of  sufficient  resistances, 
is  passed  through  the  organ,  and  the  resulting  sounds,  subjective,  and 
audible,  of  course,  only  to  the  patient,  indicate  the  condition  of  the 
nerve.  These  sounds,  whistling,  singing,  roaring,  etc.,  have  been  re- 
duced to  formulated  expressions.  Although  there  are  differences  of 
opinion  in  regard  to  the  real  value  of  these  auditory  reactions,  it  seems 
to  be  now  well  established  that  Brenner's  method  and  formulas  are 
correct  in  the  essential  details. 

The  state  of  gustatory  sensibility  is  most  correctly  ascertained  by 
galvanic  stimulation  of  the  end-organs  of  the  nerve.  For  this  purpose 
a  pointed  electrode,  the  positive  and  negative  as  closely  approximated 
as  possible,  is  carefully  passed  over  the  area  of  distribution  of  the  sense 
of  taste,  and  its  condition  noted. 

Feigned  paralysis  may  sometimes  be  detected  by  faradic  stimula- 
tion of  the  muscles,  and  feigned  insensibility  by  a  strong  current. 
Hysterical  paralysis  is  remarkable  for  the  absence  of  electro-sensibility 
and  the  presence  of  electro-contractility. 

THERAPY. — Manipulation. — Electrodes  for  the  application  of  gal- 
vanism or  faradism  are  of  various  shapes  and  materials.  The  best, 
probably,  is  a  disk  of  carbon  covered  with  wash-leather.  A  metal 
disk  covered  with  soft  sponge  is  also  much  used.  The  size  depends 
on  the  purpose  to  which  applied.  When  large  volume  and  high  in- 


ELECTRICITY.  463 

tensity  are  the  qualities  of  the  current,  the  electrode  should  be  of  large 
size,  of  soft  sponge,  well  moistened.  For  application  to  small  muscles, 
Duchenne's  olive-shaped,  curved  electrodes  are  most  suitable  ;  and  to 
individual  nerves,  metal  buttons  of  various  shapes  covered  with  wash- 
leather.  The  instrument-makers  are  now  supplied  with  all  forms  and 
kinds  of  electrodes,  so  that  the  operator  can  always  obtain  what  form 
of  electrode  soever  he  may  desire. 

When  it  is  intended  to  act  on  parts  beneath  the  skin,  the  electrodes 
and  skin  should  be  well  moistened,  for  the  conductivity  of  the  tissues 
is  in  direct  ratio  with  the  amount  of  water  they  contain.  On  the  other 
hand,  if  the  skin  alone  is  to  be  acted  on,  it  should  be  well  dried  to  pre- 
vent diffusion  of  the  current.  When  weak  galvanic  applications  are 
made,  but  little  tingling  is  felt  by  the  patient,  and  hence  he  may  sup- 
pose that  no  curative  effect  is  produced.  Under  such  circumstances, 
it  were  better  to  add  a  little  salt  to  the  water  with  which  the  electrodes 
are  moistened. 

Electrical  applications  should  always  be  made  to  the  affected  part, 
and  also  to  those  parts  in  which  decided  symptoms  are  felt.  The 
principle  of  localized  electrization,  as  established  by  Duchenne,  was  a 
most  important  advance.  Next,  the  polar  method  did  much  to  give 
exactness  to  methodical  applications.  When  the  poles  have  a  fixed 
position,  and  are  not  moved,  the  application  is  said  to  be  stabile,  and, 
when  moved  over  the  part  operated  on,  labile.  If  the  direction  the 
galvanic  current  is  taking  is  parallel  to  the  nerve-current,  or  from  the 
center  toward  the  periphery,  the  application  is  said  to  be  direct,  or 
descending  ;  if  in  the  opposite  direction,  indirect,  or  ascending. 

General  electrization  is  a  term  used  to  indicate  the  application  of 
either  current  to  the  whole  surface  of  the  body — one  pole  placed  on 
the  nape  of  the  neck,  or  to  the  feet,  and  the  other  passed  over  the 
whole  surface  of  the  body.  Central  galvanization  is  a  term  invented 
by  Beard  and  Rockwell  to  signify  applications  to  the  cervical  sym- 
pathetic, to  the  pneumogastric,  to  the  cervical  and  dorsal  parts  of  the 
spinal  cord,  and  to  the  solar  plexus.  If  one  pole  be  placed  on  the 
seventh  cervical  vertebra,  and  the  other  in  the  fossa  behind  the  angle 
of  the  jaw  ;  if  the  former  be  kept  in  this  position,  and  the  latter  put 
on  the  epigastrium  ;  and,  lastly,  if  the  first  be  moved  down  the  spine 
to  a  point  opposite  the  second — there  will  be  brought  into  the  circuit, 
successively,  the  ganglia  of  the  cervical  sympathetic  and  their  cardiac 
branches,  the  pneumogastric,  spinal  accessory,  phrenic,  the  semilunar 
ganglion  and  solar  plexus,  and  the  spinal  cord. 

In  what  mode  soever  applied,  and  at  what  point,  more  or  less  dif- 
fusion of  the  current  takes  place.  Although  the  current  flows  from 
the  higher  to  the  lower  potential  by  the  most  direct  route,  a  greater 
or  less  deflection  is  caused  (diffusion)  by  the  resistance  encountered  on 
the  circuit. 


464  EXCITO-MOTORS. 

Magneto-Therapy.  —  The  force  furnished  by  the  magnet  —  mag- 
netic polarity — produces  distinct  effects  when  applied  to  plants  and  to 
animals,  and  it  has  been  utilized  in  the  treatment  of  diseases.  It  has 
been  shown  by  Dr.  Vansant  that  the  south  pole  of  the  magnet  ap- 
plied to  a  sensitive  surface  causes  pain,  while  the  north  pole  is  free 
from  this  action,  and  indeed  relieves  the  pain  caused  by  the  former. 
Small  animals  are  similarly  affected,  the  south  pole  causing  excite- 
ment, and  the  north  pole  sedation.  Sometimes  remarkable  curative 
results  are  obtained  by  the  application  of  magnets  in  neuralgia  and 
in  chorea  /  but  they  often  fail  utterly.  In  hysterical  affections,  hemi- 
ancesthesia,  contractures,  etc.,  the  results  are  more  constant,  and,  in- 
deed, are  often  very  striking.  It  is  quite  impossible  to  separate  the 
influences  due  to  the  imagination  from  the  direct  action  of  the  magnet. 

The  form  of  magnet  used  in  medical  practice  is  chiefly  the  horse- 
shoe, and,  to  obtain  sufficient  power,  several  permanent  magnets  are 
clamped  together.  The  magnetic  pole  with  which  the  effect  is  in- 
tended to  be  produced  may  be  gently  stroked  along  the  course  of  the 
nerve  in  cases  of  neuralgia,  or  the  magnet  may  be  fastened  on  the  part 
by  suitable  straps.  The  duration  of  the  application  will  be  determined 
by  the  effects.  In  some  cases  the  result  is  little  short  of  magical ;  in 
others,  apparently  of  the  same  character,  no  effect  follows. 

Galvano  -  Therapy.  —  The  most  important  curative  results  are 
wrought  by  galvanism.  As  a  rule,  the  large,  two-fluid  elements  of 
the  permanent  battery  are  much  more  effective  therapeutically  than 
the  small  portable  combinations.  In  the  Siemens  and  Halske  modifica- 
tion of  the  Daniell  cup,  which  is  so  much  employed  by  German  electro- 
therapeutists,  and  which  the  author  also  uses,  the  resistance  within 
the  battery  is  very  great,  nearly  equal,  indeed,  to  the  resistance  of  the 
body.  Hence,  the  current  is  smooth  and  uniform,  and  hence,  also,  the 
good  results  obtained  from  it. 

Allbutt  made  a  number  of  experimental  observations  at  the  West 
Riding  Lunatic  Asylum  on  the  therapeutical  effects  of  electricity  (gal- 
vanism) in  psychical  disorders,  and  he  sums  up  his  results  as  follows  : 
Marked  improvement  in  acute  primary  dementia  ;  distinct  improve- 
ment in  mania,  atonic  melancholia,  and  perhaps  recent  secondary  de- 
mentia ;  no  change  observed  in  chronic  dementia  and  some  cases  of 
melancholia,  and  an  unfavorable  effect  in  hypochondriacal  melancholia, 
and  perhaps  brain-wasting.  In  the  cases  reported  by  Allbutt,  the  cur- 
rent was  sent  through  the  head  and  through  the  cervical  sympathetics. 
Benedict  (page  222)  reports  three  cases  of  mental  disorder  improved 
by  galvanism. 

I  have  observed  excellent  results  in  the  mental  and  other  symp- 
toms— confusion  of  mind,  impaired  memory,  hypochondriasis,  vertigo, 
etc. — which  result  from  imperfect  nutrition  of  the  brain,  caused  by 
atheromatous  degeneration  of  the  cerebral  vessels.  My  method  of 


ELECTRICITY.  465 

application  has  consisted  in  transverse  transmission  of  galvanism 
through  the  brain,  using  a  current  of  sufficient  intensity  merely  to 
cause  slight  giddiness,  a  faint  metallic  taste,  and  barely  perceptible 
flashes  of  light. 

Galvanization  of  the  brain  and  of  the  cervical  sympathetics  is  one 
of  the  measures  to  be  resorted  to  in  acute  active  or  passive  congestion 
of  the  brain.  Wakefulness,  when  not  reflex  in  origin,  and  when  de- 
pendent simply  on  the  state  of  the  vascular  supply,  is  often  relieved 
by  galvanization  of  the  brain.  Insomnia  may  be  dependent  on  either 
active  or  passive  congestion.  In  the  first  case  a  continuous  current  of 
moderate  intensity  should  be  passed  through  the  superior  ganglion  of 
the  sympathetic — the  positive  pole  being  placed  in  the  auriculo-max- 
illary  fossa,  the  negative  on  the  seventh  cervical  vertebra  ;  in  the 
second  case  a  mild  current  should  be  transmitted  transversely  through 
the  brain,  and  be  slowly  interrupted. 

To  promote  absorption  of  the  clot  in  cases  of  cerebral  haemorrhage, 
and  to  relieve  the  collateral  oedema  in  embolism  of  the  cerebral  arte- 
ries, very  mild  galvanic  currents  may  be  employed.  Caution  is  neces- 
sary, however,  in  employing  galvanism  in  such  cases.  Strong  currents 
and  lengthened  applications  may  do  serious  mischief  ;  but  the  author 
believes,  with  Remak,  that  judicious  application  of  galvanism  will  be 
useful.  The  immediate  effects  of  the  embolism,  or  of  the  hemorrhage, 
should  be  allowed  to  subside  before  commencing  the  use  of  electricity, 
and,  if  there  be  much  headache  and  vertigo,  the  greatest  circumspec- 
tion will  be  necessary. 

In  hemiplegia  the  constant  current  may  be  applied  to  the  brain, 
for  the  purpose  of  improving  its  nutrition,  and  the  faradic  or  induced 
current  to  the  muscles,  to  prevent  wasting  and  loss  of  function  from 
disuse.  If  the  temperature  of  the  paralyzed  parts  is  lowered,  the  skin 
discolored  and  roughened,  the  muscles  weak  and  flabby,  much  im- 
provement in  all  these  particulars  will  follow  faradization.  Large  elec- 
trodes, well  moistened,  should  be  used,  and  all  the  muscles  should 
in  turn  be  made  to  contract — one  pole  being  placed  over  the  motor 
nerve,  the  other  over  the  bellies  of  the  affected  muscles.  In  cases  of 
hemiplegia,  when  the  nutrition  of  the  skin  and  muscles  has  been  im- 
proved to  the  extent  which  faradization  can  accomplish,  no  advantage 
can  accrue  from  further  persistence  in  the  applications.  In  faradizing 
the  muscles  in  a  case  of  hemiplegia,  a  current  of  just  sufficient  inten- 
sity to  cause  contractions  should  be  used.  Tetanic  cramps  fatigue  the 
muscles,  and  are  harmful.  The  so-called  "  late  rigidity  " — the  muscu- 
lar contractions  which  ensue  after  a  time  in  hemiplegia,  and  which 
occur  chiefly  in  the  forearm  and  hands — is  best  treated  by  a  contin- 
uous current  to  the  contracted  flexors,  and  an  interrupted  or  faradic 
current  to  the  relatively  weaker  extensors. 

In  recent  affections  of  the  spinal  cord,  as  a  rule,  electricity  is  not 
32 


466  EXCITO-MOTORS. 

indicated.  In  chronic  myelitis,  syphilitic  diseases  of  the  meninges, 
after  a  course  of  suitable  specific  treatment,  and  in  some  of  the  sequelae 
of  acute  meningitis,  much  good  may  be  accomplished  by  the  galvani- 
zation of  the  spine  and  the  paralyzed  muscles.  The  wasting  of  the  af- 
fected muscles  may  be  arrested  and  their  nutrition  raised  to  the  nor- 
mal, and  the  paralysis  of  the  sphincters  may,  in  many  cases,  be  relieved. 
When  the  electro-contractility  of  the  muscles  is  not  impaired,  and 
when  they  have  not  wasted,  no  good  is  to  be  accomplished  by  stimu- 
lating them  with  the  electrical  current. 

That  very  troublesome  disorder,  spinal  irritation,  with  its  extensive 
irradiations  of  nerve-pain,  is  much  benefited  by  an  inverse  galvanic  cur- 
rent, according  to  Hammond,  and  this  observation  I  have  been  enabled 
to  confirm  by  my  own  experience.  Hysterical  paralysis  of  the  extremi- 
ties, accompanied  or  not  with  anaesthesia  or  hyperaesthesia,  should  be 
treated  by  galvanization  of  the  spine  and  faradization  of  the  muscles. 

In  paralysis  from  lead  (dropped  wrist),  the  muscles  may  be  so  far 
atrophied  as  not  to  respond  to  faradization,  but  may  react  when  stimu- 
lated by  a  slowly-interrupted  galvanic  current.  When  this  condition 
exists,  the  interrupted  galvanic  current  must  be  first  employed,  and  the 
cure  be  completed  by  the  faradic  current  when  the  muscles  are  so  far 
improved  as  to  react  to  the  latter. 

The  best  example  of  a  peripheral  paralysis  is  that  of  the  muscles 
of  the  face,  from  disease  or  injury  of  the  facial  nerve.  From  exposure 
to  cold,  or  disease  of  the  ear,  or  traumatic  injury,  the  nerve  is  damaged, 
and  the  muscles  to  which  it  is  distributed  are  paralyzed.  In  accordance 
with  the  law  already  given,  such  muscles  do  not  respond  to  the  faradic 
current,  but  do  react  to  galvanism.  The  positive  pole  is  placed  over 
the  pes  anserinus,  or  on  the  mastoid  process,  and  the  negative  is  made 
to  pass  over  the  peripheral  expansion  of  the  nerve,  so  that  all  the  mus- 
cles innervated  by  the  nerve  are  brought  into  action.  A  current  of 
sufficient  intensity  to  induce  muscular  contraction  must  be  employed. 
As  in  the  case  of  other  peripheral  paralyses,  after  a  time  the  af- 
fected muscles  recover  their  power  of  response  to  faradism,  when  this 
form  of  current  may  be  used  to  complete  the  cure.  If  the  nerve  has 
not  been  irremediably  damaged,  and  if  the  paralysis  has  not  existed 
so  long  that  the  electro-contractility  is  lost  in  consequence  of  atrophic 
degeneration  of  the  muscles,  a  cure  of  facial  paralysis  may  be  effected 
by  a  persistent  use  of  electricity. 

Certain  of  the  ocular  paralyses,  as  of  the  third,  fourth,  and  sixth 
nerves,  are  often  cured  by  electricity  (interrupted  galvanic  current).  It 
is  necessary,  in  order  to  obtain  a  successful  result,  that  the  remedy  be 
employed  in  suitable  cases.  Wben  these  paralyses  are  dependent  on 
cerebral  tumors,  syphilitic  gummata,  exostoses,  etc.,  electricity  can  not 
be  expected  to  cure  ;  but  the  paretic  state  of  the  muscles,  left  after 
the  removal  of  the  gummata,  may  be  promptly  relieved  by  galvaniza- 


ELECTRICITY.  467 

tion.  The  functional  states  of  the  above-mentioned  nerves,  of  which 
paralysis  may  be  a  symptom,  will  certainly  be  cured  by  electricity. 
Faradism  may  sometimes  succeed  when  galvanism  fails  in  these  cases 
(Althaus). 

Cases  of  aphonia^  when  dependent  on  paralysis  of  the  vocal  cords, 
are  sometimes  cured  by  a  single  application,  and  few,  indeed,  resist  the 
proper  use  of  galvanism.  The  larynx  may  be  faradized  externally  ; 
the  recurrent  laryngeal  may  be  galvanized  by  placing  one  rheophore 
over  its  trunk  and  the  other  over  the  larynx,  or,  what  is  better,  an  in- 
tra-laryngeal  electrode  (Mackenzie's)  may  be  used. 

Paralysis  of  the  bladder  and  of  the  sphincter  ani,  even  when 
symptomatic  of  spinal  affections,  may  be  greatly  benefited,  and  the 
condition  of  the  patient  rendered  much  more  comfortable,  by  an  inter- 
rupted galvanic  or  faradic  current  applied  by  suitable  insulated  elec- 
trodes. Idiopathic  cases  of  these  affections  may  be  cured  in  this  way. 
Constipation,  due  to  atony  of  the  muscular  layer  of  the  large  intestine, 
can  be  overcome  by  the  same  means.  An  insulated  electrode  is  intro- 
duced into  the  rectum,  and  a  large  sponge-covered  rheophore,  well 
moistened,  is  passed  over  the  abdomen  so  as  to  bring  every  part  of  the 
large  intestine  within  the  circuit. 

The  failure  of  respiration  in  opium  narcosis  can  be  most  success- 
fully obviated  by  faradization  of  the  muscles  of  respiration.  A  strong 
faradic  current  is  one  of  the  most  effective  means  of  causing  uterine 
contractions  in  cases  of  post-partum  haemorrhage. 

In  certain  of  the  "  myopathies  of  spinal  origin"  but  not  in  all  of 
them,  electricity  gives  excellent  results.  The  most  decidedly  curative 
results  are  obtained  in  infantile  paralysis.  The  electrical  treatment 
should  be  begun  early,  but  after  the  subsidence  of  all  inflammatory 
symptoms.  Good  results  may  be  looked  for  if  the  electro-contractility 
of  the  muscles  is  not  lost,  and  if  important  changes  have  not  occurred 
in  the  joints.  In  many  cases  the  affected  muscles,  although  not  atro- 
phied, do  not  respond  to  the  faradic  current,  but  will  to  the  interrupted 
galvanic.  The  latter  should  therefore  be  used  until  the  muscles  are 
put  into  a  condition  to  respond  to  the  former.  Besides  galvanization 
and  faradization  of  the  paralyzed  muscles,  the  electrical  treatment 
should  include  galvanic  spinal-nerve  and  plexus-nerve  currents.  Thus 
far  but  little  benefit  has  accrued  from  the  electrical  treatment  of  pro- 
gressive muscular  atrophy.  If  the  initial  change  in  this  malady  were 
myopathic  (as  asserted  by  Friedreich),  good  results  from  localized 
faradization  might  be  obtained.  The  author's  most  recent  experience 
as  to  the  curability  of  this  disease  by  electricity  is  not  in  accord  with 
Onimus  and  Legros's,  who  declare  that  it  is  without  avail  in  this  dis- 
order, for  it  does  appear  to  have  the  power,  in  some  instances,  of 
arresting  its  progress.  Posterior  spinal  sclerosis  is  sometimes  retarded 
in  its  course  and  progress  by  electricity,  and  galvanization  of  the  spine 


468  EXCITO-MOTORS. 

lessens  somewhat  the  severity  of  the  neuralgic  pains  which  belong  to 
this  malady.  Recently  it  has  been  shown  that  persistent  use  of  the 
faradic  brush  to  the  spine,  body,  and  extremities,  is  in  suitable  cases 
remarkably  effective.  Of  all  the  remedial  means  now  employed,  this 
is  the  most  promising,  for  Strumpf,  of  Diisseldorf,  who  has  revived 
this  treatment,  reports  not  only  amelioration  but  apparent  cures  of 
this  before  intractable  disease. 

Nothing  is  more  certain  in  therapeutics  than  the  relief  to  pain  by 
galvanization  of  the  affected  nerve  or  nerves.  In  tic-douloureux  de- 
cided relief  to  the  pain  is  obtained  by  electrical  applications  to  the 
fifth,  and  a  permanent  cure  not  unfrequently  results  in  those  cases 
belonging  to  the  category  of  the  essential  neuralgias,  so  called.  The 
best  method  of  application  is  that  advised  by  Onimus  and  Legros, 
which  consists  in  placing  the  positive  pole  on  the  point  of  emergence 
of  the  affected  nerve,  and  the  negative  over  the  superior  ganglion  of 
the  cervical  sympathetic.  About  ten  elements  of  Siemens  and  Hal- 
ske  is  the  proper  strength,  and  five  to  eight  minutes  the  proper  time, 
for  these  applications.  This  method  of  treatment  is,  according  to 
Frommhold,  the  most  effective  remedy  for  migraine  or  hemicrania. 

In  cerv  ico-brachial  neuralgia,  and  in  sciatica,  excellent  results  are 
obtained  by  galvanization  of  the  affected  nerves.  The  positive  pole 
should  be  placed  over  the  point  of  emergence  of  the  nerves  from  the 
cord,  and  the  negative  over  the  main  divisions  of  the  peripheral  expan- 
sion. Both  labile  and  stabile  currents  may  be  employed.  A  current 
from  thirty  elements  will  usually  be  required.  The  electrodes  should 
be  large  sponges  well  moistened.  In  old  cases  of  neuralgia,  a  needle 
such  as  is  used  for  acupuncture,  but  insulated  to  near  its  point,  may  be 
introduced  down  to  the  neighborhood  of  the  nerve-trunk  and  attached 
to  the  positive  pole,  while  the  negative  sponge-electrode  may  be  passed 
over  the  course  of  the  nerve.  This  mode  of  galvanization  is  especially 
to  be  recommended  in  old  cases  of  sciatica.  A  daily  seance  of  from 
five  to  fifteen  minutes  is  required  usually  in  cases  of  neuralgia.  The 
cure  is  much  more  difficult,  and  the  applications  must  be  continued 
over  a  much  longer  period  of  time,  in  those  cases  of  neuralgia  depend- 
ent on  neuritis.  Decided  amelioration  and  even  cure  may  be  hoped 
for  by  sufficiently  prolonged  applications,  when  the  nerves  are  so  far 
altered  that  induced  currents  do  not  cause  any  muscular  contractions. 
Some  of  the  most  satisfactory  results  have  been  obtained  from  galvan- 
ization of  the  uterus  in  uterine  and  ovarian  nerve-pain. 

In  certain  kinds  of  muscular  spasm  the  galvanic  current  has  un- 
questioned utility.  Cases  of  spasmodic  wry-neck  (torticollis)  of  recent 
origin,  due  to  "  rheumatism,"  are  quickly  relieved  by  galvanization  by 
stabile  currents  of  the  affected  muscles,  and  faradization  of  the  opposed 
muscles.  Old  cases  of  wry-neck  and  convulsive  tic  of  the  face,  and 
writer's  cramp,  are  not  benefited  by  this  treatment.  Cases  of  chorea 


ELECTRICITY.  469 

have  been  cured  by  static  electricity,  but  little  benefit  has  been  derived, 
according  to  the  author's  observation,  from  galvanism  or  faradism. 

Galvanism  is  sometimes  of  great  service  in  epilepsy,  but  no  exact 
indications  for  its  use  can  be  laid  down.  Obviously  it  can  only  be  ser- 
viceable in  idiopathic  epilepsy.  The  applications  should  include  the 
brain  (transverse  current  from  mastoid  process),  the  cervical  sympa- 
thetic, and  those  nerve-trunks  along  which  an  aura  is  transmitted. 

The  author  has  witnessed  some  remarkable  results  from  the  galvan- 
ization of  the  pneumogastric  nerves,  and  as  conspicuous  failures  from 
the  same  practice,  in  spasmodic  asthma.  Even  in  those  cases  not  per- 
manently improved,  great  relief  to  the  difficult  breathing  is  experienced 
when  the  current  is  passing.  The  positive  pole  is  placed  over  the  pneu- 
mogastric, beneath  the  mastoid  process,  and  the  negative  pole  is  applied 
to  the  epigastrium.  Faradism  is  not  serviceable  in  this  disease. 

Exophthalmic  goitre,  a  disease  of  the  sympathetic  system  and 
manifested  objectively  by  proptosis,  goitre,  and  palpitation  of  the  heart, 
is  cured  by  galvanization  of  the  cervical  sympathetic  and  of  the  pneu- 
mogastric, and  by  applications  to  the  eyes  and  thyroid  gland,  when  it 
is  merely  functional  in  character. 

There  can  be  no  reasonable  doubt  of  the  influence  of  electricity 
over  the  nutritive  functions.  Beard  and  Rockwell  employ  the  method 
termed  by  them  "  general  electrization,"  which  consists  in  f aradic  ap- 
plications to  the  surface  of  the  body,  "one  pole,  usually  the  negative, 
being  placed  at  the  feet  or  the  coccyx,  while  the  other  is  applied  all 
over  the  surface  of  the  body."  They  formulate  their  principles  in 
these  applications  as  follows  :  "  Constitutional  diseases  are  better 
treated  by  general,  and  local  diseases  by  localized  electrization."  Ac- 
cording to  Benedikt — and  in  this  view  electricians  are  generally  in 
accord — the  true  method  of  using  electricity  consists  in  making  appli- 
cations to  the  affected  part  or  organs,  and,  to  this  rule  may  be  added, 
to  those  parts  or  organs  also  in  which  symptoms  are  felt. 

General  electrization  is  useful  "  in  those  diseases  that  are  dependent 
on,  or  associated  with,  impairment  of  nutrition  and  general  debility  of 
the  vital  functions,  such  as  nervous  dyspepsia,  neurasthenia,  anaemia, 
chlorosis,  hysteria,  hypochondriasis,  paralysis,  and  neuralgia  of  a  con- 
stitutional origin,  rheumatism  and  other  toxic  diseases,  some  forms  of 
chorea,  and  oftentimes  in  functional  disorders  of  the  genital,  digestive, 
and  other  special  organs." 

In  anaemia  and  chlorosis  the  usual  remedies  for  these  states  may  be 
much  assisted  by  central  galvanization,  and  localized  applications  to 
the  vegetative  organs.  Regurgitation  of  food,  gastralgia,  and  feeble- 
ness of  digestion,  are  often  signally  benefited  by  galvanization  of  the 
pneumogastrics,  and  by  localized  applications  to  the  abdominal  organs. 
Strong  currents  are  needed  when  internal  organs  are  to  be  affected  by 
electrodes  applied  to  the  integument  of  the  abdomen.  A  more  effec- 


470  EXCITO-MOTORS. 

tive  application  in  these  cases  consists  in  the  use  of  an  insulated  rectal 
electrode,  while  a  sponge  electrode  of  large  size,  and  well  moistened, 
is  passed  over  the  various  organs  of  the  abdomen.  The  relief  of  con- 
stipation by  this  means  has  already  been  alluded  to. 

Various  diseases  of  the  pelvic  organs,  both  in  the  male  and  female, 
are  successfully  treated  by  electricity.  Amenorrhoea,  when  dependent 
on  atony  of  the  ovaries  and  uterus,  is  cured  by  static  electricity,  by 
faradism,  or  by  an  interrupted  galvanic  current.  A  shock  from  a 
Leyden-jar  may  be  transmitted  through  the  pelvis,  or  a  strong  faradic 
or  galvanic  current  may  be  applied  by  means  of  one  pole  on  the  spine, 
the  other  on  the  hypogastric  region.  In  the  case  of  married  women 
an  insulated  vaginal  electrode  may  be  introduced  and  placed  in  con- 
tact with  the  os  uteri.  This  is  a  more  effective  way  of  making  the 
applications  than  by  the  electrodes  placed  externally.  In  neuralgic 
dysmenorrhcea  the  galvanic  current  will  afford  relief  in  a  large  propor- 
tion of  cases  ;  and,  in  congestive  dysmenorrhcea,  an  inverse  current 
will  diminish  the  blood-supply,  and  thus  lessen  suffering.  The  treat- 
ment of  these  affections  should  be  conducted  during  the  interval.  The 
chronic  congestive  enlargement  of  the  uterus  is  sometimes  remarkably 
benefited  by  a  galvanic  current  of  moderate  intensity  slowly  inter- 
rupted, but  it  is  doubtful  if  any  case  of  chronic  interstitial  metritis  is 
ever  cured,  or  even  ameliorated,  by  this  means. 

Although  the  changes  in  the  joints,  induced  by  gout  and  rheu- 
matism, may  not  be  cured  by  galvanization  of  the  central  nervous 
system,  as  claimed  by  Meyer,  yet  there  is  no  doubt  that  myalgia,  lum- 
bago, and  other  so-called  rheumatic  diseases  of  the  muscular  system, 
may  be  promptly  relieved  and  cured  by  the  constant  current.  The  stiff- 
ness of  the  joints  and  the  muscular  soreness  which  remain  after  an  at- 
tack of  acute  rheumatism  are  best  relieved  by  passing  a  mild  galvanic 
current  through  the  affected  parts. 

Herpes,  especially  herpes  zoster,  and  prurigo,  when  they  are  refer- 
able to  an  alteration  of  the  cutaneous  nerves,  are  curable  by  electricity. 
The  author  has  seen  excellent  results  in  cases  of  shingles,  from  gal- 
vanization of  the  affected  intercostal  nerves — the  positive  pole  being 
placed  over  the  point  of  emergence  of  the  nerves,  and  the  negative 
brushed  over  the  terminal  filaments  in  the  skin.  Beard  reports  the 
cure  of  obstinate  cases  of  chronic  eczema  by  central  galvanization,  and 
his  results  have  been  confirmed  by  others.  The  author  has  seen  a 
number  of  cases  of  acne  get  well  under  the  influence  of  galvanization 
of  the  cervical  sympathetic,  and  local  galvanization  of  the  skin  of  the 
face — the  positive  pole  on  the  neck,  the  negative  passed  over  the  af- 
fected parts.  It  need  hardly  be  stated  that  strong  currents  are  not  to 
be  used  when  the  poles  are  applied  in  these  situations.  Among  the 
other  skin-affections  treated  by  galvanism  with  success  are  prurigo, 
psoriasis,  and  even  scleroderma  ;  but,  as  Dr.  Piffard,  of  New  York, 


ELECTRICITY.  471 

has  remarked,  this  method  is  "  by  no  means  uniformly  successful."  It 
is  applicable  to  the  treatment  of  the  neuroses  of  the  skin. 

ELECTEOLYSIS. — When  the  electrical  current  is  made  to  traverse 
insulated  needles  introduced  into  the  tissues  of  the  body,  electrolytic 
effects  are  produced,  decomposition  of  the  tissues  ensues,  hydrogen 
and  the  alkalies  appear  at  the  negative  pole,  and  acids  and  chlorine  at 
the  positive.  Remak,  in  his  various  publications,  much  insisted  on 
the  catalytic  action  of  the  constant  current.  Effusions  into  and  about 
inflamed  parts,  and  into  the  substance  of  tumors,  may  be  made  to  dis- 
appear by  the  external  application  of  galvanism,  through  moistened 
sponge-electrodes.  It  is  doubtful,  however,  whether  neoplastic  forma- 
tions can  be  thus  made  to  undergo  absorption.  The  disappearance  of 
effusions  induces  such  an  appearance  of  shrinking  of  tumors  and  in- 
flammatory products,  that  actual  absorption  of  the  neoplastic  material 
may  be  supposed  to  have  occurred. 

Galvano-puncture  is  used  to  remove  malignant  and  other  new  for- 
mations. The  sanguine  expectations  once  entertained  that  cancer  can 
be  thus  removed,  although  justified  by  the  results  in  a  few  apparently 
successful  cases,  have  not  been  realized.  Beard  proposed  and  has 
executed  a  new  method,  entitled  "  working  up  the  base,"  which  con- 
sists in  electrolytic  decomposition  of  the  subjacent  parts  of  a  can- 
cer. A  number  of  needles,  insulated  to  near  their  points,  are  intro- 
duced into  the  healthy  tissues  beneath  the  morbid  growth,  and  a  cur- 
rent from  twenty  to  sixty  elements  is  passed  through  them.  Decom- 
position ensues,  and  there  takes  place  a  separation  of  the  morbid 
mass.  As  the  pain  of  this  method  is  great,  etherization  should  be 
resorted  to. 

Aneurisms,  so  situated  as  to  be  beyond  the  reach  of  surgical  inter- 
ference, have  been  treated  by  galvano-puncture,  but  the  success,  al- 
though brilliant  in  a  few  instances,  has  not  been  such  as  to  justify 
very  sanguine  expectations  of  its  future  utility.  Erectile  tumors  are 
curable  by  electrolysis.  Goitre  is  sometimes  made  to  disappear  by 
the  same  means.  The  cysts  connected  with  glandular  tumors  in  the 
neck  may  be  permanently  occluded  by  galvano-puncture.  The  most 
useful  applications  of  this  method  have  been  in  hydrocele,  which  may 
be  often  cured  in  my  experience  by  introducing  two  needle-electrodes, 
insulated  to  near  their  points,  and  passing  a  current  from  twenty  to 
forty  elements.  Not  less  effective  is  the  same  method  in  the  treat- 
ment of  hydatid  disease  of  the  liver.  One  needle  connected  with  the 
negative  pole  is  introduced,  and  the  sponge-electrode  is  placed  at  some 
indifferent  point  on  the  abdomen. 

Spasmodic  and  permanent  stricture  of  the  urethra  are  treated  by 
electrolysis,  an  insulated  sound  with  a  metallic  tip,  connected  with  the 
negative  pole,  being  passed  into  the  stricture,  and  the  positive  pole 
placed  at  some  indifferent  point.  The  most  successful  results  have 


472  EXCITO-MOTORS. 

been  obtained  by  Mallez  and  Tripier,  and  Dr.  Robert  Newman,  of 
New  York  ;  but  it  is  the  author's  observation,  as  also  the  expe- 
rience of  Dr.  Keyes,  of  New  York,  that  this  method  has  little  real 
utility. 

Wounds  and  ulcers  of  an  indolent  character,  and  bed-sores,  may  be 
made  to  heal  by  attaching  to  them  a  galvanic  couplet  (zinc  and  silver), 
one  of  the  elements  remaining  in  contact  with  the  sore,  and  the  other 
on  the  skin  in  the  neighborhood.  They  should  be  connected  by  a 
copper  wire,  and  be  confined  to  the  parts  by  strips  of  adhesive  plas- 
ter. This  method  has  been  especially  serviceable  in  the  treatment  of 
bed-sores. 

CATAPHORESIS. — Du  Bois-Reymond  applied  this  term  to  signify  the 
transference  of  certain  medicaments  by  the  galvanic  current  through 
the  skin  or  mucous  membrane  from  one  point  to  another.  The  move- 
ment is  a  kind  of  osmosis  or  diffusion,  and  takes  place  from  the  positive 
pole — the  anode — to  the  negative  pole — the  cathode.  The  action  is 
mechanical,  and  not  chemical  or  electrolytic.  The  medicaments  thus 
transferred  through  the  tissues  have  been  chiefly  anodynes  and  prepa- 
rations of  iodine,  although  experimentally,  in  the  way  of  proof  of  the 
fact,  many  different  kinds  of  substances  have  been  employed  for  this 
purpose.  It  is  necessary  to  the  process  of  cataphoresis  that  the  medi- 
cine to  be  thus  transferred  be  in  solution,  and  one  capable  of  diffusion. 
The  skin  offers  the  greatest  opposition  to  the  transfer.  Dr.  Corning, 
of  New  York,  sought  to  overcome  the  resistance  of  the  skin  by  per- 
forating it  by  means  of  a  Baunscheidt-needle  instrument  at  the  point 
of  application  of  the  anode. 

The  apparatus  required  for  the  process  of  cataphoresis  consists  of 
a  galvanic  battery  of  the  strength  of  five  milliamperes  up,  of  a  suit- 
able electrode  for  containing  the  medicament,  and  the  substance  to  be 
transferred  in  proper  form  for  the  purpose.  An  ordinary  sponge  elec- 
trode moistened  with  a  solution  has  been  used  successfully,  but  greater 
precision  than  such  a  method  admits  of  should  be  employed.  The  best 
electrode  for  the  purpose  probably  is  one  of  carbon  having  an  outer 
rim  of  leather  or  other  soft  material  to  adapt  itself  to  the  skin.  A 
nickel-plated  disk  may  be  used  also.  A  bit  of  paper  or  linen  cloth  of 
the  proper  size  is  laid  on  the  electrode,  and  the  solution  is  dropped 
on.  Such  disks  of  paper  or  linen  may  be  impregnated  with  a  defined 
amount  of  the  solution,  dried,  and  when  required  for  use  can  be  moist- 
ened. Dr.  Morton  has  substituted  for  Dr.  Peterson's  paper  soluble 
gelatinous  disks  duly  impregnated  with  the  drug  to  be  used  in  this 
way. 

The  method  of  cataphoresis  is  employed  in  neuralgia  chiefly,  and 
by  means  of  cocaine,  morphine,  aconite,  chloroform,  and  other  ano- 
dynes. Vesication  quickly  follows  the  application  of  chloroform — so 
easily  and  quickly  as  to  make  this  a  nice  method  of  raising  a  blister. 


ELECTRICITY.  473 

The  lithium  salts  are  used  in  cases  of  rheumatic  or  gouty  affections  of 
joints.  SimiJarly,  the  iodides  are  employed  in  the  treatment  of  stru- 
mous  and  syphilitic  affections,  and  in  deformities  arising  from  mus- 
cular lesions. 

As  the  skin  offers  the  greatest  obstacle  to  the  passage  of  the  cur- 
rent and  also  of  the  anodyne  solution,  punctures  with  a  Baunscheidt 
instrument  may  be  usefully  made  in  advance  of  the  application  of  the 
electrodes.  By  such  an  expedient  we  have  the  effects  of  a  counter- 
irritant  superadded  to  the  action  of  cataphoresis,  as  well  as  facili- 
tating the  anodyne  treatment.  A  mixture  corresponding  to  that  in 
Schleich's  method  may  be  utilized  under  these  circumstances. 

GALVANO-CAUTERY. — This  method  consists  in  cauterization  by  a 
platinum  wire  heated  by  the  galvanic  current.  The  battery  used  for 
this  purpose  furnishes  a  large  quantity  of  electricity  of  low  tension  ; 
hence  the  elements  are  few  in  number  but  have  extensive  surface. 
When  a  quantity  of  electricity  is  made  to  traverse  a  platinum  wire 
which  offers  great  resistance,  the  wire  is  heated  and  may  be  melted. 
The  platinum  in  the  form  of  wire-loop,  or  dome  cautery,  or  knife, 
heated  by  the  electrical  current,  is  the  cauterizing  agent.  If  the  wire 
be  not  so  highly  heated  as  to  cut  through  the  tissues  too  rapidly,  but 
little  bleeding  results,  and  a  clean  surface  is  left  which  promptly  gran- 
ulates and  heals. 

Cities  of  any  considerable  size  are  now  usually  provided  with  a 
public  electrical  supply,  by  means  of  which  all  forms  of  electrical  appli- 
cation can  be  made  by  the  interpellation  of  a  suitable  "controller,"  or 
other  means  of  modifying  the  current ;  or  storage-cells,  dry  or  with 
liquid  elements,  may  be  used  as  the  means  of  force  if  suitably  charged. 
A  storage  system  consists  of  an  element  or  combination  of  elements 
which  may  be  charged  by  another  battery.  The  form  of  "storage- 
cell"  or  "accumulator"  now  chiefly  used  consists  of  plates  of  lead 
immersed  in  dilute  sulphuric  acid.  These  are  charged  by  some  Daniell 
or  Bunsen  cells,  communicating  with  them,  and  in  action  for  sev- 
eral hours.  Bubbles  of  hydrogen  gas  form  on  one  lead  plate,  and 
of  oxygen  on  the  other  ;  whence  they  are  said  to  be  "  polarized," 
and  the  current  produced  by  the  recombination  of  the  gases  is  called 
a  "current  of  polarization."  By  such  an  arrangement  the  quan- 
tity of  electricity  furnished  by  some  Bunsen  or  other  cells,  acting  for 
many  hours  or  days,  can  be  given  out  in  a  short  time  and  in  immense 
quantity.  The  accumulators  of  Faure,  charged  in  Paris,  have  been 
transported  across  the  ocean  to  give  out  their  force  in  New  York. 
Trouve  has  utilized  this  principle  in  constructing  his  "polyscope." 
A  storage-cell  of  Plante  is  charged  by  the  action  of  two  Bunsen 
elements,  and  subsequently  the  stored-up  electricity  can  be  employed 
in  heating  a  platinum  wire  or  knife  for  cautery  purposes,  or  for 
illumination. 


474  EXCITO-MOTORS. 

STATIC  ELECTRICITY. — The  modified  Holtz  or  Toepler-Holtz  elec- 
trical machine  is  now  used  to  procure  all  of  the  nerve  and  muscular 
effects  hitherto  obtained  by  faradic  electricity,  and  also  therapeutical 
results  of  a  very  striking  kind.  It  has  long  been  known  that  chorea 
and  other  nervous  affections  may  be  readily  cured  by  static  electricity, 
but  a  remarkable  extension  has  been  given  to  the  subject  by  late 
discoveries.  Chorea  is  now  treated  by  the  "electric  bath,"  sparks 
being  drawn  from  the  spine.  If  the  Holtz  machine  is  used,  sparks 
can  readily  be  drawn  through  the  clothing  by  presenting  the  brass 
knob  along  the  spine.  The  results,  which  have  been  so  long  ob- 
tained at  Guy's  Hospital  by  this  mode  of  electrical  applications,  are 
now  generally  conceded.  It  seems  to  be  the  most  successful  method 
of  treating  this  disease.  Neuralgia  is  now  promptly  relieved  in 
most  instances  by  insulating  the  patient  and  drawing  sparks  from 
along  the  trajectory  of  the  nerve  affected.  The  pains  of  progress- 
ive locomotor  ataxia  are  much  benefited  in  the  same  way,  and  it 
is  said  the  disease  itself  is  arrested.  Amenorrhoea,  other  conditions 
favorable,  is  quickly  cured  by  sparks,  or  a  shock  sent  through  the 
pelvis.  The  general  nutrition  is  greatly  promoted  by  electrization 
by  sparks. 

The  Toepler-Holtz  machine  may,  by  connecting  the  interior  of  one 
condenser  with  the  exterior  of  the  other,  be  utilized  to  procure  the 
muscle  and  nerve  reactions  of  the  faradic  current. 

Trouve's  Polyscope,  referred  to  above,  will  probably  be  largely 
employed  in  the  future,  for  the  purposes  of  illumination.  Suitable 
throat  and  other  mirrors,  platinum  knives,  and  loops,  are  furnished 
with  the  instrument  for  illumination  of  the  cavities,  and  for  the  various 
caustic  operations.  It  is  very  powerful,  occupies  but  little  space,  and 
promises,  when  certain  mechanical  defects  are  overcome,  to  fulfill  more 
perfectly  than  any  other  apparatus  the  requirements  of  a  surgical  gal- 
vano-caustic  and  a  medical  illuminating  apparatus. 

THE  ROENTGEN  OB  X-RAYS. 

It  has  long  been  known  that  ordinary  white  light  is  a  combinatioa 
of  light,  heat,  and  chemical  rays,  the  red  end  of  the  solar  spectrum 
being  the  least,  and  the  violet  the  most  refrangible.  In  the  violet  end 
of  the  spectrum,  and  beyond,  are  contained  the  chemical  rays.  The 
ethereal  vibrations,  or  impulses,  occurring  in  this  position,  are  not  the 
regular,  successive  movements  that  produce  light,  but  a  less  orderly 
disturbance  of  the  ether.  These  so-called  X-rays  have  the  power  to 
penetrate  many  bodies  opaque  to  ordinary  light — as  flesh,  wood,  paper, 
and  other  fibrous  materials.  It  has  been  found  that  substances  and 
structures  of  considerable  thickness  and  high  atomic  weight  are  less 
permeable  to  these  rays.  For  example,  when  the  rays  are  passed 
through  the  extended  hand,  the  muscles,  connective  tissue,  and  fat  are 


NUX   VOMICA.  475 

transparent  to  them,  while  the  bones  are  opaque,  and  hence  appear  in 
distinct  outlines  on  the  photographic  plate. 

The  Equipment  for  an  X-Ray  Apparatus. — The  several  parts 
required  for  the  production  of  these  rays  are — 1,  a  static  machine,  or 
a  supply  from  the  street  mains  ;  an  induction-coil ;  2,  a  vacuum-tube 
in  which  the  rays  are  excited  ;  3,  the  fluorescent  screen,  or  fluoroscope  ; 
and  4,  the  photographic  plate,  on  which  the  image  of  the  part  is  taken. 

The  static  machine  employed  for  this  purpose  is  usually  of  the 
Holtz  form,  or  some  modification  of  this  instrument.  There  must  be  a 
sufficient  number  and  size  of  the  revolving  plates  to  furnish  a  spark  of 
proper  volume. 

The  current  may  also  be  obtained  from  a  coil  charged  by  the  street 
mains,  or  by  a  dynamo,  or  by  a  storage  or  gravity  battery. 

The  most  important  part  of  the  apparatus  for  producing  the  X-rays 
is  the  vacuum-tube,  originally  a  Crookes  tube.  This  is  a  glass  bulb 
10  centimetres  in  diameter,  with  metal  terminals — cathode,  anode,  and 
the  anticathode  or  target.  The  cathode  and  anode  are  made  of  alu- 
minum, and  the  target  for  the  reception  of  the  cathode  stream  is  com- 
posed of  platinum  alloyed  with  iridium.  In  the  single  focus-tube  the 
anode  and  target  are  combined,  and  is  then  made  of  the  alloy  of  plati- 
num and  iridium. 

Next  in  importance  to  the  vacuum-tube  is  the  fluorescent  screen 
for  the  separation  of  the  X-rays.  This  is  a  piece  of  cardboard  coated 
uniformly  on  one  side  with  tungstate  of  calcium  or  platino-chloride  of 
barium.  The  size  of  the  screen  varies  with  the  size  and  position  of 
the  part  to  be  examined. 

The  photographic  plate  for  receiving  an  impression  of  the  part 
under  examination  is  the  final  part  of  an  equipment  for  X-ray  work. 

The  use  of  the  X-ray  for  diagnostic  and  therapeutic  purposes  has 
become  an  indispensable  adjunct  in  surgical  and  medical  practice. 

Nux-Vomica. — The  seeds  of  Strychnos  nux-vomica  Linn6  (Nat.  Ord. 
Loganiacece).  (U.  S.  P.)  Noix  vomique,  Fr. ;  Krahenaugen,  Ger. 

Extractum  Nucis  Vbmicce. — Extract  of  nux-vomica.    Dose,  £ — gr.  J. 

Extractum  Nucis  Vbmicce  Fluidum. — Fluid  extract  of  nux-vomica. 
Dose,  TTIJ — ttlv- 

Tinctura  Nucis  Vbmicce. — Tincture  of  nux-vomica.  Dose,  ni  j — TH.XV. 

COMPOSITION. — Nux-vomica  contains  two  alkaloids  and  a  peculiar 
acid.  The  alkaloids  are  strychnine  and  brucine,  and  the  acid  strychnic 
or  igasuric  acid.  The  proportion  of  strychnine  ranges  from  one  fourth 
to  one  half  of  one  per  cent,  and  of  brucine  from  one  eighth  to  one  per 
cent.  These  wide  differences  are  in  great  part  due  to  the  varying  skill 
of  the  chemists  who  have  made  analyses.  Besides  these,  another  crys- 
tallizable  base  has  been  discovered  in  the  mother-liquor  from  which 
strychnine  and  brucine  have  been  precipitated.  This  has  been  named 


476  EXCITO-MOTORS. 

igasitrine.  The  alkaloids  exist  in  nux-vomica  in  combination  with 
igasuric  acid. 

Strychnina. — Strychnine.  Occurs  in  colorless,  transparent,  octa- 
hedral or  prismatic  crystals,  or  as  a  white  crystalline  powder,  odorless 
and  having  an  intensely  bitter  taste.  Soluble  at  59°  Fahr.  (15°  C.)  in 
6,700  parts  of  water  and  in  110  parts  of  alcohol.  Also  soluble  in  7 
parts  of  chloroform. 

Strychnines  Sulphas. — Strychnine  sulphate.  A  white  salt,  in  col- 
orless, prismatic  crystals,  odorless,  exceedingly  bitter,  soluble  at  59° 
Fabr.  in  50  parts  of  water,  sparingly  soluble  in  alcohol,  and  insoluble 
in  ether.  Effloresces  on  exposure  to  the  air,  and  melts  when  heated, 
losing  nearly  fourteen  per  cent  of  its  weight  of  water  of  crystalliza- 
tion. By  a  strong  heat  it  is  wholly  volatilized.  Dose,  gr.  -fa — gr.  -fa. 

JBrucinwn. — Brucine.  Is  not  official,  but  is  a  constituent  of  nux- 
vomica,  possessed  of  distinct  physiological  actions,  similar  to,  but  by 
no  means  identical  with,  strychnine.  It  is  alleged  to  have  analgesic 
effects  when  applied  locally  to  the  mucous  membrane,  but  this  prop- 
erty has  not  been  utilized  to  any  extent  in  practice. 

ANTAGONISTS  AND  IXCOMPATIBLES. — The  paralyzers,  such  as  woo- 
rara,  conium,  tobacco,  opium,  belladonna,  and  physostigma,  antagonize 
the  actions  of  strychnine  in  a  part  of  the  sphere  of  its  influence. 
They  do  not  antagonize  its  toxic  action.  Chloral,  tobacco,  bromide  of 
potassium,  ether,  and  chloroform  (inhaled),  are  its  true  physiological 
antagonists. 

In  cases  of  poisoning,  tannin  and  the  vegetables  containing  it 
should  be  freely  administered,  for  the  tannate  of  strychnine  is  very 
insoluble.  Emetics,  or  the  stomach-pump,  must  be  used  promptly. 
The  tetanic  spasms  are  best  controlled  by  chloral  and  the  inhalation 
of  ether,  or  by  tobacco,  or  by  the  bromide  of  potassium  in  very  large 
doses  (  3  ij —  1  ss).  The  maintenance  of  artificial  respiration  has  a 
decided  effect  in  postponing  in  animals  as  in  man  the  lethal  action  of 
strychnine. 

Strychnine  should  not  be  combined  with  bromides,  chlorides,  and 
iodides,  in  the  same  solution.  Accidents  have  happened  by  taking  the 
last  portion,  which  will  contain  all  of  the  strychnine,  precipitated  as 
hydrobromate,  hydriodate,  etc. 

SYNERGISTS. — Brucine,  picrotoxine,  thebaine,  ergot,  and,  according 
to  my  own  experimental  investigations,  belladonna,  electricity,  cold, 
etc.,  promote  the  activity  of  nux-vomica  and  its  alkaloids. 

PHYSIOLOGICAL  EFFECTS. — The  preparations  of  nux-vomica  are  ex- 
tremely and  persistently  bitter.  Like  all  bitters,  they  promote  the 
flow  of  the  stomach  and  intestinal  juices,  increase  the  digestive  power, 
and  thus  favorably  affect  the  appetite.  They  also  hasten  the  intestinal 
movements,  and  the  stools  voided  are  somewhat  relaxed. 

The  alkaloids  of  nux-vomica  are  very  diffusible  substances,  and 


NUX  VOMICA.  477 

enter  the  blood  very  quickly.  They  lessen  somewhat  the  oxidizing 
power  of  the  blood,  but  this  effect  is  quite  insufficient  to  account  for 
the  physiological  reactions  produced  in  the  nervous  system.  Small 
medicinal  doses  of  nux-vomica  and  its  alkaloid  accomplish  no  more 
than  other  bitters,  as  respects  the  circulation.  More  or  less  plethora, 
slightly  increased  action  of  the  heart,  and,  as  a  consequence  of  this 
condition  of  the  vascular  system,  a  greater  energy  in  the  performance 
of  the  various  functions,  result  from  their  administration. 

When  a  lethal  dose  of  nux-vomica,  or  of  its  alkaloid,  has  been 
taken,  characteristic  symptoms  follow  in  a  few  minutes.  The  state 
of  the  stomach  as  to  food,  the  presence  of  tannic  acid  in  the  food,  and 
of  fat,  probably  ;  also  the  condition  of  the  blood-vessels,  influence  the 
rate  of  absorption,  and  symptoms  may  begin  in  a  few  minutes  or  be 
delayed  an  hour  or  even  longer.  When  a  full  medicinal  dose  has 
been  taken,  some  slight  shuddering,  a  sense  of  constriction  of  the 
fauces  and  jaws,  sudden  pains  like  electric  shocks  passing  through  the 
limbs,  startings  of  some  of  the  voluntary  muscles,  dilated  pupils,  "  a 
meaningless  smile,"  paleness  of  the  face,  followed  by  flushing  and 
increased  warmth  of  the  surface  and  perspiration,  are  symptoms  which 
may  be  produced  without  further  development  of  a  toxic  action.  If 
the  dose  be  large  enough  to  cause  death,  the  above-described  symptoms 
are  quickly  followed  by  tetanic  convulsions,  in  which  nearly  all  the 
voluntary  muscles  are  engaged.  When  the  paroxysm  occurs,  a  shud- 
der passes  through  the  whole  frame  ;  the  head  and  extremities  jerk 
and  twitch,  and  then  suddenly  a  general  tonic  convulsion  takes  place 
— the  limbs  are  extended,  the  hands  clinched,  the  toes  and  feet  incur- 
vated,  the  head  bent  backward,  the  body  arched  and  rigid,  the 
abdominal  muscles  hard  and  tense,  the  respiratory  muscles  fixed  so 
that  the  body,  curved  in  the  form  of  a  bow,  rests  on  the  occiput  and 
heels.  The  countenance  assumes  a  ghastly  grin — the  risus  sardonicus  / 
the  arrest  of  the  respiratory  movements  suspends  oxidation  of  the 
blood,  and  the  skin  becomes  cyanosed  ;  strong  erections  of  the  penis 
occur,  and  frequently  involuntary  evacuations  of  semen,  urine,  and 
faeces  take  place.  Rarely  does  death  ensue  in  the  first  paroxysm  ; 
the  spasm  relaxes,  and  nothing  remains  of  the  attack  but  the  muscular 
soreness  and  fatigue,  and  the  sense  of  impending  dissolution.  Ab- 
solute quiet  retards  the  paroxysms.  At  first  the  senses  are  preternat- 
urally  acute,  and,  as  the  reflex  function  is  abnormally  excitable,  the 
slightest  peripheral  irritation  suffices  to  bring  on  the  spasms.  Gener- 
ally patients  experience  comfort  when  the  limbs  are  strongly  held,  or 
even  rubbed,  during  the  paroxysms  ;  but,  in  the  interval,  absolute 
quiet  is  most  grateful.  The  mind  remains  unaffected  until  the  close, 
or,  at  least,  until  carbonic-acid  poisoning  sets  in.  The  paroxysms 
rapidly  succeed  each  other,  and  increase  in  duration  and  severity, 
death  occurring  usually  by  fixation  of  the  muscles  of  respiration,  or 


478  EXCITO-MOTORS. 

by  exhaustion,  and  within  two  hours,  as  a  rule,  from  the  beginning  of 
symptoms. 

The  remarkable  similarity  in  the  symptomatology  of  traumatic 
tetanus  and  strychnine  tetanus  requires  that  the  points  of  difference 
between  them  be  clearly  set  forth.  In  strychnine  tetanus  the  jaw- 
muscles  are  not  first  thrown  into  spasm,  and  are  not  always  rigid  dur- 
ing the  paroxysm  ;  in  traumatic  tetanus,  trismus  is  one  of  the  first 
symptoms.  In  strychnine  tetanus,  after  the  convulsion,  lasting  from  a 
half  to  one  or  two  minutes,  there  is  usually  complete  relaxation  ;  in 
traumatic  tetanus  rigidity  of  the  affected  muscles  continues.  A  case 
of  strychnine  tetanus  goes  on  rapidly  increasing  in  severity,  and  lasts 
from  a  few  minutes  to  two  hours  ;  a  case  of  traumatic  tetanus  proceeds 
more  slowly,  and  lasts  always  a  number  of  hours,  and  may  extend  over 
days  and  even  weeks.  And,  lastly,  in  traumatic  tetanus,  the  capital 
symptom  of  a  wound  or  injury  exists. 

No  very  characteristic  post-mortem  appearances  result  from  strych- 
nine-poisoning. The  muscles,  at  first  relaxed,  become  rigid,  the  feet 
turned  in,  the  fingers  clinched,  or  the  body  may  maintain  the  position 
of  opisthotonos,  in  which  it  was  at  the  moment  of  death.  Conges- 
tion of  the  cerebral  and  spinal  meninges  is  usually  observed,  and 
Schroeder  Van  der  Kolk  first  ascertained  that  dilatation  of  the  vessels 
and  sanguineous  extravasations  are  found  in  the  gray  matter  of  the 
cord  (medulla  oblongata),  and  this  observation  has  since  been  repeat- 
edly confirmed. 

The  smallest  quantity  of  strychnine  which  has  produced  a  fatal  re- 
sult in  an  adult  was  a  half -grain.  Rarely  can  one  twelfth  of  a  grain 
be  given  without  causing  muscular  twitchings,  and  one  sixteenth  of 
a  grain  has  caused  death  in  a  child  of  between  two  and  three  years. 

The  effects  of  strychnine  are  exerted  on  the  spinal  cord,  on  the 
seat  of  the  motor  functions.  It  does  not  affect  the  functions  of  the 
motor  nerves  directly — the  irritability  of  the  motor  nerves  is  not  de- 
stroyed by  strychnine,  it  is  exhausted  by  over-stimulation.  The  sen- 
sory nerves  are  either  unaffected,  or  their  irritability  is  exhausted. 
The  reflex  functions  of  the  spinal  cord  are  exalted.  The  afferent 
nerves,  while  preserving  their  irritability,  communicate  impressions  to 
the  reflex  centers,  motor  impulses  are  quickly  originated,  and  the  mus- 
cles through  the  motor  nerves  are  fixed  in  a  state  of  tonic  contraction. 
The  over-stimulation  of  the  cord  and  the  motor  nerves  exhausts  the 
irritability  of  the  latter.  The  muscles  preserve  their  contractility. 

The  effects  of  strychnine  are  not  limited  to  the  nervous  system  of 
animal  life  :  the  organic  nervous  system  participates  in  the  perturba- 
tion. The  dilatation  of  the  pupil,  the  erection  of  the  hair-follicles,  the 
tinnitus,  the  increased  heat  in  the  limbs,  and  the  perspiration  which 
are  produced  when  strychnine  is  injected  subcutaneously,  indicate  an 
influence  on  the  sympathetic  system  similar  in  kind  to  tnat  exerted 


NUX  VOMICA.  479 

on  the  voluntary.  Experimental  investigations  have  confirmed  these 
clinical  observations.  A  very  considerable  rise  in  the  arterial  pressure, 
contraction  of  the  vessels  in  the  frog's  web,  and  increased  action  of 
the  heart,  have  been  experimentally  demonstrated  to  be  caused  by 
strychnine  (Sigmund  Mayer). 

Magendie,  who  made  the  first  study  of  the  actions  of  strychnine, 
found  that,  by  previously  destroying  the  spinal  cord,  no  convulsions 
followed  the  administration  of  a  poisonous  dose.  The  precise  agency 
of  the  cord  is  disputed,  but  it  is  in  a  high  degree  probable  that  the 
condition  is  one  of  exaggerated  reflex  excitability,  so  that  the  smallest 
possible  peripheric  irritation  induces  a  response  in  the  reflex  motor 
center.  When  Setschenow's  inhibiting  center  of  reflex  movements  is 
withdrawn  as  in  the  decapitated  frog,  the  spasms  are  induced  as  before. 
The  passage  over  the  face  of  the  faintest  current  of  air,  even  the  men- 
tal conception  of  such  an  impression,  will  excite  the  spasms.  Abso- 
lute repose,  as  by  placing  the  poisoned  frog  under  a  bell-glass,  the 
table  firm  so  that  no  jar  can  reach  the  animal,  and  light  excluded,  has 
a  decided  effect  in  preventing  attacks.  If  a  poisoned  human  subject 
is  similarly  protected,  the  convulsions  are  diminished  in  violence. 
Again,  if,  when  the  convulsions  are  impending,  the  limbs  are  firmly 
grasped  and  held,  the  force  of  the  spasm  is  lessened  thereby.  The 
medicines  most  effective  in  affording  relief  are  those  which  lower  the 
activity  of  the  reflex  function — notably  chloral,  bromide  of  potassium, 
etc.  These  facts  indicate  that  an  exaltation  of  the  reflex  function  of 
the  spinal  cord  is  caused  by  strychnine.  But  this  is  probably  not 
alone  sufficient :  irritation  of  the  motor  cells  is  also  a  factor  (Spitzka). 
In  opposition  to  the  commonly  accepted  view,  Falck  maintains  that 
strychnine  acts  primarily  on  the  brain,  or  rather  on  the  vaso-motor 
center  of  the  brain,  then  on  the  inhibitory  center  for  the  heart,  and  the 
respiratory  center,  and  lastly  on  the  reflex  apparatus  of  the  cord.  The 
spasms  are  the  combined  results  of  these  actions. 

Bernard  held  that  the  sensibility  of  the  sensory  nerves  is  destroyed 
by  strychnine,  but  after  the  motor  functions  have  ceased.  Martin- 
Magron,  and  subsequently  Vulpian,  ascertained  that  the  sensibility 
persists  after  motility  has  ceased.  This  contradiction  of  supposed 
facts  has  been  examined  more  recently  by  Busch,  whose  observations, 
if  entitled  to  belief,  support  the  statement  of  Bernard.  Busch  has 
found  that  the  toe  of  the  poisoned  frog  may  be  crushed,  and  the  cen- 
tral portion  of  the  divided  sciatic  may  be  burned,  without  inducing 
spasms  or  reflex  movements,  when  the  slightest  jar  of  the  animal  will 
cause  strong  convulsions.  Kolliker  and  Vulpian,  with  many  others, 
hold  that  the  excitability  of  the  motor  nerves  is  so  far  impaired  by 
strychnine  that  irritation  of  the  nerve-trunk  produces  very  feeble  or 
no  muscular  contractions,  The  American  observers  Klapp  and  Spitzka 
both  maintain  that  the  peripheral  nerves  are  unaffected  in  strychnine- 


480  EXCITO-MOTOR3. 

poisoning.  Martin -Magron  et  Buisson  and  Yulpian  find  that  the  action 
of  strychnine  is  local  on  the  nerves,  and  is  therefore  greatly  influenced 
by  the  quantity  of  the  poison  reaching  them.  If  the  dose  of  strych- 
nine is  small,  the  motor  and  sensory  nerves  remain  unimpaired  ;  but  if 
the  dose  be  large,  their  irritability  is  destroyed.  The  influence  of  the 
quantity  administered  is  consequently  very  great,  and  is  exhibited  in 
other  respects.  Thus,  while  a  merely  lethal  dose  causes  strong  con- 
vulsions, a  very  large  toxic  dose  will  kill  at  once  without  any  reflex 
disturbances.  It  is  impossible,  then,  to  make  the  distinction  between 
motor  and  sensory  nerves  as  respects  the  action  of  strychnine:  it  either 
destroys  or  spares  the  excitability  of  both. 

While  strychnine  exalts  the  irritability  of  the  reflex  motor  center, 
it  stimulates  the  vaso-motor  center  or  centers  in  the  cord,  with  the  re- 
sult of  greatly  increasing  the  blood-pressure.  This  rise  in  blood-press- 
ure is  prevented  by  dividing  the  cord,  according  to  Mayer,  Klapp, 
and  others,  but,  according  to  Schlesinger,  not.  Now,  as  it  has  been 
found  by  Richter,  who  has  studied  the  circulation  in  transparent  parts, 
by  Mayer,  and  by  Spitzka,  that  the  arterioles  strongly  contract  under 
the  influence  of  strychnine,  the  blood-pressure  must  rise  from  this 
cause  ;  hence,  the  observation  of  Schlesinger  is  probably  correct,  that 
the  blood-pressure  rises  in  strychnine-poisoning,  notwithstanding  di-' 
vision  of  the  cord.  As  has  been  tersely  expressed  by  Spitzka,  "  its 
vaso-motor  effect  is  to  increase  the  blood-pressure  and  the  rapidity  of 
the  blood-current  by  contracting  the  arterioles.  This  effect  is  inde- 
pendent of  the  central  nervous  system."  The  effects  of  strychnine  on 
the  heart  differ  in  cold-  and  warm-blooded  animals,  according  to  most 
authorities,  and  decidedly,  also,  according  to  the  size  of  the  dose.  On 
frogs,  the  diastolic  pause  is  prolonged,  and  the  force  of  the  systole 
augmented,  so  that  arrest  of  the  heart's  action  may  take  place  in  te- 
tanic rigidity.  These  results,  Spitzka  holds,  are  due  to  an  action  on 
the  cardiac  ganglia  and  on  the  pneumogastric.  The  previous  obser- 
vations of  Heinemann,  however,  do  not  correspond,  for  he  finds  that 
these  phenomena  are  produced  after  the  vagi  are  divided.  In  warm- 
blooded animals  the  heart's  action  is  accelerated,  while  the  tension  is 
raised.  Klapp,  however,  finds  that  strychnine  slows  the  pulse  in  the 
cat  and  rabbit,  and  that  the  retardation  is  due  to  an  impression  on  the 
cardiac  motor  ganglia,  and  not  to  stimulation  of  the  inhibition.  He 
finds  that  the  action  is  the  same  on  both  classes  of  animals.  These 
contradictions  are  probably  due  to  the  difference  in  the  dose  employed. 
A  large  toxic  dose  of  strychnine  will  paralyze,  instead  of  stimulate, 
the  vaso-motor  center  in  the  medulla,  and  thus  prevent  any  rise  of 
blood-pressure.  A  small,  merely  lethal  dose  will  stimulate  the  cardiac 
ganglia,  the  pneumogastric,  and  the  vaso-motor  ganglia  ;  but  a  large 
toxic  dose  will  slow  the  heart,  paralyze  the  vagi  and  the  accelerator 
apparatus,  and  depress  the  vaso-motor  functions  generally.  In  the 


NUX   VOMICA.  481 

course  of  annual  experiments  for  class  instruction,  the  author  has  con- 
stantly observed  the  difference  in  results  due  to  the  quantity  adminis- 
tered. 

From  clinical  observation,  in  the  absence  of  any  experimental  evi- 
dence, strychnine  has  been  ascertained  to  have  a  stimulating  effect  on 
the  respiration.  If  the  dose  is  less  than  sufficient  to  tetanize,  the  func- 
tion of  respiration  is  increased  in  energy  and  in  depth.  Hence,  this 
agent  antagonizes  the  respiratory  poisons,  as  well  as  those  morbid 
states  which  depress  the  respiratory  function. 

On  the  blood,  the  experiments  of  Harley  show,  strychnine  has  some 
action.  Agitation  of  blood  with  the  air,  in  the  presence  of  strychnine, 
is  followed  by  a  less  production  of  carbonic  acid  than  if  strychnine  be 
not  present,  but  such  experiments  are  entitled  to  small  consideration. 
Strychnine,  as  Hippel  and  Cohn  have  shown,  stimulates  the  retina  and 
increases  the  sharpness  of  definition  and  the  area  of  the  visual  field. 
These  facts  explain  the  curative  effects  of  strychnine  in  certain  dis- 
eases of  the  retina. 

Very  peculiar  phenomena  have  been  observed  by  Spitzka  as  a  re- 
sult of  chronic  poisoning — an  entirely  new  subject.  It  appears  to  be 
exceedingly  difficult  to  keep  animals  alive,  but  Spitzka  succeeded  in 
maintaining  five  frogs  in  tetanus  for  over  forty  days.  Symptoms  oc- 
cur under  these  circumstances  quite  distinct  from  those  produced  in 
acute  poisoning  by  strychnine.  Disease  in  the  cord  is  set  up,  "  partly 
as  an  insular  sclerosis,  partly  as  an  hsemorrhagic  or  non-ha3morrhagic 
myelitis."  These  experiments  demonstrate  that,  to  maintain  a  con- 
stant effect  by  strychnine  in  the  beginning,  the  dose  must  be  increased, 
but  later  the  quantity  given  may  be  decreased  and  administered  at 
longer  intervals.  The  importance  of  these  observations  from  the  ther- 
apeutical point  of  view  is,  indeed,  great.  The  symptoms  occurring 
from  chronic  poisoning  are,  as  respects  the  spasms,  a  diminution  of 
their  energy,  the  development  of  an  ataxic  state,  with  tremors  and 
pupillary  myosis.  These  phenomena  approach  those  produced  by  pi- 
crotoxin,  and  are  intermediate  between  the  effects  of  strychnine  proper 
and  of  curara  or  methyl  strychnium. 

THERAPY. — The  tincture  of  nux-vomica  is  one  of  the  numerous 
remedies  proposed  for  the  vomiting  of  pregnancy.  It  is  best  adapted, 
according  to  the  author's  observation,  to  those  women  who  have  a  sea- 
sick feeling  and  who  do  not  vomit  much.  Half  a  drop  to  a  drop, 
in  cherry-laurel  water,  or  in  simple  water,  every  hour  or  two,  is  a 
suitable  dose.  Like  all  other  remedies,  nux-vomica  often  fails  in  this 
malady.  Owing  partly  to  its  intense  bitterness,  and  partly  to  its  in- 
fluence on  the  nervous  system,  the  tincture  of  nux-vomica  is  an  excel- 
lent stomachic  tonic,  adapted  more  especially  to  the  treatment  of  those 
cases  in  which  there  is  a  neurotic  element,  as,  for  example,  atonic  dys- 
pepsia and  gastralgia.  From  five  to  ten  drops  three  times  a  day  be- 
33 


482  EXCITO-MOTORS. 

fore  meals  is  a  suitable  dose  in  these  cases.  In  chronic  gastric  catarrh, 
whether  occurring  as  an  independent  affection,  or  as  an  accompani- 
ment of  other  maladies,  the  tincture  of  nux-vomica  is  one  of  the  most 
effective  bitters.  In  the  gastric  catarrh  and  morning  vomiting  of 
drunkards,  this  remedy  is  next  in  value  to  arsenic.  It  may  be  given, 
advantageously,  with  mineral  acids.  The  poor  appetite,  the  feeble 
digestion,  and  the  nervousness  and  trembling,  which  follow  the  sudden 
withdrawal  of  alcoholic  stimulants,  may  be  removed  by  frequent  small 
doses  of  the  tincture.  To  diminish  the  craving  for  stimulants  when 
they  are  withdrawn,  and  to  sustain  the  nervous  system,  the  following 
combination  is  exceedingly  effective  :  IJ  Tinct.  capsici,  3  vj  ;  tinct. 
nucis  vom.,  3  ij.  M.  Sig. :  Twenty  drops  in  water  every  four  hours. 
Intestinal  indigestion  and  flatulence  are  also  removed  by  tincture  of 
nux-vomica. 

In  atonic  diarrhoea,  nux-vomica  is  a  serviceable  addition  to  other 
remedies,  when  a  paretic  condition  of  the  muscular  layer  of  the  bowel 
may  be  presumed  to  exist.  It  is,  however,  more  especially  in  consti- 
pation that  nux-vomica  is  useful.  It  is  indicated  in  those  cases  in 
which  there  are  inaction  of  the  muscular  layer  and,  consequently,  great 
fecal  accumulations.  It  may  be  most  advantageously  given  with  pur- 
gatives in  such  cases :  fy  Tinct.  aloes  et  myrrhse,  3  vj  ;  tinct.  nucis 
vomicse,  3  ij.  M.  Sig.:  fifteen  to  thirty  drops  two  or  three  times  a 
day. 

Nux-vomica  has  been  signally  useful  in  some  forms  of  epidemic 
dysentery.  It  is  indicated  when  there  is  depression  of  the  vital  forces, 
the  intestines  distended  with  gas,  the  stools  like  prune-juice.  In  some 
epidemics  of  cholera,  strychnine,  combined  with  mineral  acids  and 
opium,  has  appeared  to  be  effective  when  the  patient  was  about  to  pass 
into  the  state  of  collapse  ;  and  it  has  also  been  used  as  a  prophylactic 
during  the  preliminary  diarrhoea  :  I£  Strychnines  sulphat.,  gr.  J  ;  acid, 
sulphuric,  dil.,  §  ss  ;  morphinse  sulphat.,  gr.  ij  ;  aquas  camphorse,  §  iijss. 
M.  Sig.  :  A  teaspoonful  every  hour  or  two,  well  diluted.  This  combi- 
nation is  also  effective  in  summer  diarrhoea,  when  the  evacuations  are 
very  watery,  and  in  colliquative  diarrhoea.  When  there  is  much  pain, 
the  quantity  of  morphine  may  be  increased,  or  the  first  dose  may  be 
doubled.  When  the  character  of  the  case  is  such  as  to  require  con- 
tinued use  of  the  prescription,  of  course,  the  quantum  of  strychnine 
must  be  lessened. 

Nux-vomica  and  its  alkaloid  strychnine  are  much  used  in  combi- 
nation with  restorative  remedies,  in  cases  of  impoverished  blood — in 
ancemia,  chlorosis,  hosmorrhagic  diathesis,  purpura,  etc.  In  anaemia 
and  chlorosis  strychnine  is  used  with  reference  to  its  power  to  stimu- 
late the  blood-making  organs,  which  functionate  under  some  special 
influence  proceeding  from  the  nervous  system.  I£  Ferri  sulph.  exsic., 
3ij  ;  quininae  sulph.,  £>  j ;  strychnin*  sulph.,  gr.  ss.  M.  Ft.  pil.  no. 


NTTX  VOMICA.  483 

xx.  Sig.  :  One  pill  three  times  a  day.  No  prescription  is  more  gen- 
erally useful  in  these  states  than  the  sirup  or  elixir  of  iron,  quinine,  and 
strychnine,  a  formula  originally  proposed  by  Aitken. 

In  the  treatment  of  amenorrhoea,  the  preparations  of  nux-vomica 
and  strychnine  frequently  enter  into  the  composition  of  prescriptions.  In 
post-partum  haemorrhage,  Fordyce  Barker  prescribes  the  tincture  of 
nux-vomica  (twenty  drops),  and  fluid  extract  of  ergot  (thirty  drops), 
"  every  half -hour  until  well  assured  that  the  uterus  is  well  contracted." 
It  is  obvious  that  not  more  "  than  two  or  three  doses  "  of  such  strength 
will  be  safe.  The  neuralgic  form  of  dysmenorrhoea  may  be  permanently 
removed  by  nux-vomica  given  during  the  interval. 

When  impotence  is  due  to  mere  relaxation  and  atony  of  the  erectile 
apparatus,  and  is  not  dependent  on  organic  defects,  the  preparations  of 
nux-vomica  are  indicated  and  are  useful.  Incontinence  of  urine,  when 
due  to  a  paralytic  state  of  the  sphincter,  may  sometimes  be  cured  by 
strychnine.  Nocturnal  incontinence,  which  is  most  successfully  treated 
by  belladonna,  ergot,  and  iodide  of  iron,  is  sometimes  not  relieved  by 
these  agents,  when  strychnine  may  be  tried.  The  author  can  not  state 
with  precision  the  cases  in  which  it  succeeds,  but  it  has  appeared  to 
him  most  successful  in  those  cases  dependent  on  simple  atony  of  the 
bladder,  associated  with  general  laxity  of  fiber. 

The  most  important  uses  of  nux-vomica  and  its  alkaloid  are  in  the 
treatment  of  nervous  affections,  chiefly  in  paralysis.  It  may  be  used 
with  advantage  in  hemiplegia,  when  sufficient  time  has  elapsed  to  per- 
mit repair  of  the  damage  done  by  the  extravasation.  It  is  improper  to 
use  strychnine  during  the  period  of  "  early  rigidity,"  and  it  is  without 
avail  in  cases  of  "  late  rigidity  "  of  the  paralyzed  members.  It  is  most 
useful  when  the  paralyzed  members  are  completely  relaxed.  It  is  use- 
less when  the  paralysis  has  existed  so  long  that  the  muscles  have  under- 
gone fatty  degeneration,  so  that  they  no  longer  respond  to  a  f aradic  or 
slowly-interrupted  galvanic  current.  Even  if  the  necessary  conditions 
as  respects  the  state  of  the  muscles  are  present,  strychnine  is  inadmis- 
sible in  cases  of  paralysis  of  cerebral  origin  when  there  are  vertigo, 
headache,  and  tinnitus. 

In  paraplegia  of  reflex  origin,  in  rheumatismal paraplegia,  in  syphi- 
loma  of  the  spinal  meninges,  paraplegia  continuing  after  the  removal 
of  the  deposits,  strychnine  is  a  most  serviceable  remedy. 

The  best  results  are  obtained  from  the  use  of  strychnine  in  local 
paralysis,  in  lead-colic  and  constipation,  and  in  drop-wrist,  in  mercu- 
rial and  paludal  palsies,  in  rheumatismal  paralyses — for  example,  fa- 
cial paralysis,  from  exposure  of  the  face  to  cold — torticollis,  spinal 
curvature,  from  paresis  of  the  muscles  on  one  side,  etc. 

In  certain  forms  of  spasms  strychnine  sometimes  achieves  most  im- 
portant results.  The  evidence  which  has  been  accumulated  as  to  the 
curative  power  of  strychnine  in  tetanus  would  be  very  conclusive  if 


484  EXCITO-MOTORS. 

it  were  worthy  of  credence,  which  seems  to  the  author  doubtful.  In 
this  disease  it  should  be  given  so  as  to  substitute  the  strychnic  for  the 
traumatic  tetanus,  but  the  symptoms  induced  should  not  exceed  those 
due  to  a,  full  medicinal  dose.  Strychnine  is  most  successful — as  indeed 
are  all  the  appropriate  remedies — in  the  more  chronic  cases  of  tetanus, 
and  in  those  of  spontaneous  rather  than  traumatic  origin. 

Trousseau's  experience  is  strongly  in  favor  of  the  use  of  strychnine 
in  the  treatment  of  chorea.  The  method  which  he  has  pursued  does 
not  commend  itself — it  is  heroic,  and  indeed  unsafe.  It  consists  in  the 
use  of  such  doses,  beginning  with  one  dose  a  day  and  increasing  them, 
until  stiffness  of  the  muscles  of  the  neck,  spasmodic  jerkings,  and  a 
"  meaningless  smile,"  indicate  the  beginning  of  strychnic  poisoning. 

Strychnine  is  a  very  serviceable  remedy  in  idiopathic  or  essential 
epilepsy.  It  is  adapted  to  pale,  anaemic  young  subjects  who  have  the 
petit  mal,  as  well  as  the  grand  mal,  and  whose  attacks  are  nocturnal. 
It  exerts  no  influence  but  an  injurious  one  over  symptomatic  epilepsy — 
that  dependent  on  "  coarse  organic  lesions  of  the  brain."  It  is  said 
that  the  state  of  the  retinal  circulation  furnishes  an  indication  for 
strychnine  or  bromide  of  potassium,  fullness  of  the  retinal  vessels  be- 
ing an  indication  for  the  latter  agent,  and  pallor  and  anaemia  for  the 
former. 

In  that  functional  irritability  of  the  nervous  system  manifested  by 
restlessness  and  wandering  neuralgic  pains,  strychnine  affords  relief. 

Spasmodic  asthma  of  nervous  subjects,  when  the  paroxysms  are 
due  to  an  irritable  state  of  the  nervous  system,  are  associated  with 
vague  neuralgic  pains,  and  are  determined  by  psychical  influences,  may 
be  so  far  influenced  by  the  persistent  use  of  strychnine  as  to  occur 
much  less  frequently. 

Amaurosis  of  a  functional  kind,  from  lead,  tobacco,  and  alcohol, 
may  be  cured  by  strychnine.  Paralysis  of  the  ocular  muscles  (proso- 
palgia),  of  the  muscle  of  accommodation,  and  paralysis  of  a  single 
muscle,  when  these  affections  are  due  to  an  arrest  of  function  of  the 
nerve  or  nerves,  and  do  not  involve  changes  of  structure,  are  curable 
by  strychnine.  Nagel,  however,  reports  a  cure  of  amaurosis  in  which 
there  existed  white  atrophy  of  the  optic  disks  ! 

Holtenhof  points  out  the  kind  of  amblyopia  most  benefited  by  this 
treatment.  The  cases  without  serious  lesion,  those  dependent  on  ane- 
mia, on  a  reflex  effect  from  some  part  of  the  trigeminus  or  sympa- 
thetic, or  due  to  the  abuse  of  tobacco  and  alcohol,  are  especially 
amenable  to  the  strychnic  treatment.  "  In  central  amblyopia,"  says 
Holtenhof,  "  without  lesion  of  the  macula  and  with  decoloration  of  the 
temporal  portion  of  the  optic  disk,  I  have  obtained  remarkable  im- 
provement by  the  use  of  strychnine."  Again,  when  there  are  lesions 
resulting  from  the  deep-seated  inflammation  of  the  membranes,  im- 
provement may  be  hoped  for  when  the  primary  inflammation  has 


NUX  VOMICA.  485 

ceased  and  the  consecutive  atrophy  is  stationary.  In  retinitis  pigmen- 
tosa  the  results  produced  by  strichnine  are  very  striking.  In  five  cases 
the  diurnal  dimness  of  vision  and  the  nocturnal  blindness  were  relieved 
considerably,  in  four  cases  there  ensued  an  augmentation  in  the  acuity 
of  vision,  and  in  two  the  visual  field  for  white  light  was  enlarged. 
Holtenhoi  finds  strychnine  inferior  to  electricity  in  the  treatment  of  pa- 
ralysis of  the  ocular  muscles. 

Strychnine  has  remarkable  powers  as  a  respiratory  stimulant.  Since 
the  introduction  of  Aitken's  formula  for  the  phosphate  of  iron,  qui- 
nine, and  strychnine,  the  fact  of  its  utility  in  chronic  bronchitis,  in- 
cipient phthisis,  dilated  bronchi,  etc.,  has  been  distinctly  recognized. 
The  good  effects  of  this  combination  are  due  chiefly  to  the  strychnine. 
We  possess  no  remedy  more  generally  effective  in  the  vomiting  of 
phthisis  than  strychnine.  This  vomiting  is  reflex  mainly,  and  occurs 
at  the  termination  of  a  paroxysm  of  coughing,  but  there  is  also  more 
or  less  stomachal  indigestion.  As  the  stomach  is  emptied,  the  vomiting 
interferes  with  nutrition.  Strychnine  has  also,  as  Murrell  has  shown, 
some  power  to  lessen  the  sweating  of  phthisis.  This  agent  may,  there- 
fore, be  regarded  as  an  important  remedy  in  consumption.  There  are 
several  modes  of  administration,  but  the  best  is  by  solution,  the  alka- 
loid dissolved  in  water  with  a  mineral  acid  :  ^  Strychninse,  gr.  j  ; 
acid,  muriatic,  dil.,  §  j.  M.  Sig.  :  Five  to  ten  drops  in  water  three 
times  a  day. 

Strychnine  is  one  of  the  antidotes  to  chloral,  as  was  first  shown  by 
Liebreich,  but  it  is  not  the  chief.  It  may  be  utilized  cautiously  as  one 
of  the  means  of  counteracting  the  respiratory  and  cardiac  depression, 
but  it  should  not  be  depended  on  wholly. 

Nux-vomica  has  been  used  with  success  in  the  treatment  of  inter- 
mittents.  At  present  it  is  rather  employed  as  an  adjuvant  to  quinine, 
than  relied  on  as  the  sole  curative  agent. 

HYPODERMATIC  INJECTION  OF  STRYCHNINE. — This  important  thera- 
peutical measure  needs  to  be  separately  discussed.  The  solution  which 
the  author  advises  is  as  follows  :  ^  Strychninae  sulphat.,  gr.  j  ;  aquae 
destil.  vel  aqua?  lauro-cerasi,  §  j.  M.  Sig.  :  Ten  minims  contain  one- 
forty-eighth  of  a  grain.  Some  heat  is  usually  necessary  to  procure 
a  perfect  solution. 

"  The  effects  of  strychnine,"  as  has  been  well  remarked  (Echeverria), 
"  are  widely  different  when  administered  hypodermically  or  by  the 
mouth.  By  the  latter  method  the  quantity  may  be  repeated  and  in- 
creased, unsuccessfully,  .  .  .  and  yet  a  smaller  dose  of  the  substance, 
exhibited  hypodermically,  be  capable  of  regenerating  at  once  the  lost 
muscular  power." 

The  indications  for  the  subcutaneous  use  of  strychnine  are  precisely 
as  those  given  above  for  its  stomach  administration  :  it  is  contraindi- 
cated  in  cases  of  hemiplegia  when  the  injury  to  the  brain  has  been 


486  EXCITO-MOTORS. 

recent.  It  generally  does  no  good,  but  harm,  when  the  paralyzed 
muscles  are  rigid.  It  is  most  useful  in  old  cases  of  hemiplegia,  the 
subjects  not  being  advanced  in  life,  the  paralysis  incomplete,  the 
muscles  flaccid  but  not  wasted,  and  having  preserved  their  electro- 
contractility.  Very  remarkable  improvement  not  unfrequently  fol- 
lows from  this  mode  of  treatment  in  suitable  cases. 

The  hypodermatic  injection  of  strychnine  sometimes  is  entirely 
successful  in  curing  paraplegia,  but  the  limits  of  its  utility  are  well 
defined.  It  is  not  proper,  and  is  in  every  way  injurious,  in  acute 
cases  involving  structural  alterations  of  the  spinal  cord.  In  doubtful 
cases,  a  strychnine  injection  may  be  used  as  a  means  of  diagnosis  be- 
tween structural  and  functional  diseases  of  the  cord  :  in  the  former, 
the  symptoms  are  increased  in  definition  ;  in  the  latter,  they  are  ame- 
liorated by  the  injection.  This  mode  of  using  strychnine  is  curative 
in  reflex  paraplegia,  in  paraplegia  due  to  anaemia  of  the  cord,  in  hys- 
terical paraplegia,  and  in  those  cases  of  paresis  of  the  muscles  of  the 
inferior  .extremities  due  to  concussion  of  the  cord,  to  rheumatism  of 
the  meninges,  and  to  syphiloma,  after  the  local  morbid  process  has 
ceased. 

In  infantile  paralysis,  the  hypodermatic  injection  of  strychnine  is 
an  important  addition  to  other  means  of  treatment.  If  the  electro- 
contractility  of  the  affected  muscles  is  not  lost,  very  beneficial  results 
may  be  expected  :  the  injection  promotes  the  capillary  circulation, 
and  increases  the  growth  and  power  of  the  muscles. 

In  no  form  of  paralysis  is  the  use  of  strychnine  more  conspicuous 
for  good  than  in  diphtheritic  paralysis.  Few  cases  are  not  promptly 
benefited  and  most  are  quickly  cured.  The  utility  of  the  subcutaneous 
injection  of  strychnine  has  been  most  signally  exhibited  in  the  local 
paralyses  •  e.  g.,  facial  paralysis,  aphonia  from  paralysis  of  the  vo- 
cal cords  ;  paralysis  of  the  extensors  by  lead  ;  paralysis  of  the  sphinc- 
ter vesicce,  of  the  sphincter  ani,  etc. 

The  mode  of  practicing  the  injection  is  of  considerable  importance. 
The  solution  should  be  thrown  into  the  substance  of  the  paralyzed 
muscles.  For  example,  in  hemiplegia,  the  muscles  in  turn,  of  the 
paralyzed  side,  should  be  pierced  by  the  needle,  and  the  solution  dis- 
charged into  them.  In  drop-wrist  the  extensors  should  be  grasped, 
made  tense,  and  the  needle  of  the  syringe  be  thrust  well  into  them.  In 
paralysis  of  the  sphincter  ani  and  prolapse  of  the  bowel,  the  muscle 
affected  should  be  penetrated  by  the  needle.  When  the  affected  mus- 
cles are  beyond  reach,  the  injection  may  be  practiced  at  any  indifferent 
point. 

Next  to  the  treatment  of  paralyses,  the  most  frequent  application 
of  strychnine  by  the  hypodermatic  method  is  in  certain  ocular  mala- 
dies. In  the  normal  condition,  strychnine  affects  the  visual  functions. 
Hippel  first  studied  these  effects,  afterward  Sandi  and  Cohn,  and  sub- 


NUX  VOMICA.  487 

sequently,  in  France,  Coumetou  and  Rouire.  According  to  Coumetou, 
strychnine  augments  the  excitability  of  the  retinal  elements,  increas- 
ing the  sharpness  of  vision,  central  and  peripheral,  and  also  enlarging 
the  visual  field.  He  advises  its  use  in  amblyopia  without  lesions,  de- 
pendent on  functional  disorder  of  the  retina,  and  says  it  may  also,  if 
the  lesions  are  not  too  far  advanced,  effect  favorable  changes  in 
chronic  diseases  of  the  optic  nerve  and  retina.  Rouire  also  agrees 
with  previous  observers  in  stating  that  strychnine  affects  the  optic 
nerve-fibers,  increasing  the  normal  acuity  of  vision  and  enlarging  the 
visual  field.  He  advocates  its  use  in  tabetic  atrophy,  and  calls  atten- 
tion to  the  fact  that  in  certain  atrophies  good  results  are  obtained 
only  by  a  progressive  increase  in  the  amount  administered.  In  these 
ocular  maladies  the  solution  may  be  injected  in  the  temple,  or  in  the 
nape  of  the  neck,  taking  the  usual  precautions  against  accident. 

In  infra-orbital  neuralgia,  good  results  have  been  obtained  from 
the  subcutaneous  injection  of  strychnine.  This  practice  may  be  very 
useful  in  neuralgia  characterized  by  anaemia  and  depression.  It  may 
also  be  highly  serviceable  in  epilepsy,  the  cases  selected  according  to 
the  rules  already  defined. 

Authorities  referred  to  : 

BERNARD,  CL'.  Legons  sur  les  Effets  des  Substances  Toxiques  et  Medicamenteuses,  Paris, 
1857. 

BRUNTON,  DR.  T.  L.     St.  Bartholomew's  Hospital  Reports,  vols.  xii  and  xv. 

BUSCH,  DR.     Berliner  klin.  Wochenschrift,  No.  37,  1874. 

COUMETOU,  DR.     These  de  Paris.     Strychnia  dans  la  Chirurgie  Oculaire. 

DELIOUX  DE  SAVIGNAC,  DR.  Bull.  General  de  Therap.,  1871,  January,  February,  and 
March. 

ECHEVERRIA,  DR.  M.  GONZ.  Treatment  of  Paralysis  by  the  Hypodermic  Injection  of 
Strychnine.  Connecticut  Med.  Society,  Trans,  for  1868. 

EULENBURG,  DR.  ALBERT.  Lehrbuch  der  functionellen  Nervenkrankheiten,  Berlin,  1871, 
p.  450.  Also,  HypodermatiscJie  Injectionen. 

FALCK,  F.  A.     Archiv  fur  experimentette  Pathologic  und  Pharmacologie,  Band  iii,  p.  77. 

FREUSBERG,  A.  Ibid.,  Band  iii,  p.  204  u.  308.  Ueber  die  Wirkung  des  Strychnint 
und  Bermerkungen  iiber  die  reflectorische  Erregung  der  Nervencentren. 

GOROCHOFZEFF,  N.     Deutsche  Klinik,  xl,  1874,  p.  316.      Versuche  mit  Strychnin. 

HOLTENHOF,  DR.  Lyon  Medicale.  Quoted  by  Annuaire  de  Therapeutique,  1877,  p. 
55,  et  seq. 

HAUGHTON,  DR.  SAMUEL.  The  British  Medical  Journal,  June  22,  1872,  p.  660.  Poi- 
soning by  Strychnine  treated  by  Nicotine. 

HEINEMANN,  DR.  CARL.     Virchovfs  Archiv,  vol.  xxxiii,  p.  394. 

HUNTER,  MR.  CHARLES.  Pamphlet  containing  reprints  of  various  papers  on  Hypoder- 
mic Injections. 

JOCHELSOHN,  DR.  On  the  Influence  of  Artificial  Respiration  over  Poisoning  by  Strychf 
nine.  London  Medical  Record,  vol.  i,  p.  82. 

KLAPP,  DR.  W.  H.     The  Journal  of  Nervous  and  Mental  Diseases,  vol.  v,  1878,  p.  619. 

LEUBE,  DR.  WILLIAM.     Archiv  fur  Anat.  und  Physiologic,  1867,  p.  629. 

KOLLIKER,  PROF.  DR.      Virchow's  Archiv,  Band  x,  p.  239. 

MAYER,  DR.  S.    Archiv  fur  experimented  Pathologic  und  Pharmacologie,  Band  ii,  p.  458. 

NAGEL,  PROF.  DR.     Berliner  klinische  Wochenschrift,  vol.  viii,  p.  6,  1861. 


488  EXCITO-MOTORS. 

SCHLESINGER,  DR.     London  Medical  Record,  vol.  ii,  p.  35. 

SPITZKA,  DR.  E.  C.     Journal  of  Nervous  and  Mental  Diseases,  vol.  vi,  1879. 

YULPIAN,   DR.     Archives   de   Physiologic,  Normale  et   Pathologique,   1870,   p.    116 

et  seq. 

Ignatia. — Ignatia.  The  seed  of  Strychnos  Ignatii  Bergius  (Nat. 
Ord.  Loganiacece).  St.  Ignatius's  bean  ;  Feve  de  /Saint- Iff nace,  Fr. ; 
Ignazbohnen,  Ger.  (Not  official.) 

Tinctura  Ignatice. — Tincture  of  ignatia  (10  parts  of  ignatia  to  IOC 
parts  of  menstruum).  Dose,  m  ij — tn,  x. 

COMPOSITION. — Ignatia  has  the  same  composition  as  nux-vomica, 
but  yields  relatively  larger  proportions  of  the  alkaloids  strychnine  and 
brucine.  These  principles  exist  in  the  bean  in  combination  with  iga- 
suric  acid.  Formerly,  the  bean  of  St.  Ignatius  was  the  principal 
source  of  commercial  strychnine,  but  the  abundance  and  low  price  of 
nux-vomica  now  compensate  for  the  difference  in  strength.  The 
preparations  of  ignatia  are  stronger  than  the  corresponding  ones  of 
nux-vomica. 

ANTAGONISTS,  INCOMPATIBLES,  and  SYNEBGISTS  are  the  same  as  for 
nux-vomica. 

ACTIONS  AND  USES. — Ignatia,  containing  the  same  principles  as 
nux-vomica,  must  have  the  same  physiological  actions  and  correspond- 
ing therapeutical  properties. 

The  tincture  of  ignatia,  the  most  useful  preparation,  has  a  power- 
ful and  persistent  bitter  taste,  and,  in  common  with  bitters,  has  the 
effect  known  as  stomachic  tonic.  It  is  a  very  effective  stimulant  of 
the  gastric  mucous  membrane,  promotes  the  flow  of  gastric  juice,  and 
hence  increases  the  activity  of  the  stomach  digestion,  and  may  there- 
fore be  used  with  advantage  in  atonic  dyspepsia,  and  in  the  nausea 
and  vomiting  of  gastric  and  cerebral  anaemia.  It  is  also  often  highly 
serviceable  in  the  gastralgia  of  nervous  women  having  impoverished 
blood.  The  migraine  or  sick-headache  of  such  subjects,  also,  may  be 
relieved  by  ignatia.  It  may  be  very  useful  in  the  various  disturbances 
belonging  to  chronic  gastric  catarrh,  but  it  is  contraindicated  in  all 
acute  inflammatory  affections.  It  is  in  these  stomachal  affections 
more  especially  that  ignatia  is  preferred  to  nux-vomica  by  many  prac- 
titioners. 

Ignatia  affects  the  nervous  system  of  animal  life  in  the  same  way, 
but  more  energetically  in  the  same  dose,  that  nux-vomica  does.  It 
exalts  in  the  same  way  the  reflex  function  of  the  spinal  cord,  and  simi- 
larly arrests  respiration  by  a  tetanic  fixation  of  the  respiratory  mus- 
cles. It  is,  however,  not  used  in  affections  of  the  nervous  system,  the 
alkaloid  strychnine  being  now  universally  employed. 

Cocculus. — The  fruit  of  Anamirta  cocculus,  or   Cocculus  Indicus 
(Not  official.) 


COCCULUS.  489 

There  are  no  official  preparations  except  picrotoxin,  the  active  prin- 
ciple. A  saturated  tincture  may  be  used.  Dose,  rn,  ij — m  xv.  A 
fluid  extract  can  be  made,  and  is  a  useful  form  for  administration. 
Dose,  TTJ,  ij — TTI  x,  gradually  increased. 

COMPOSITION. — The  effects  of  cocculus  are  due  chiefly  to  the  pres- 
ence in  it  of  a  peculiar  neutral  principle  known  as  picrotoxin.  This 
has  been  admitted  to  the  Pharmacopoeia,  and  is  therefore  official. 

Picrotoxinum — picrotoxin — is  not  an  alkaloid,  although  allied  to 
this  group  of  substances.  It  does  not  combine  with  acids  to  form  salts. 
It  is  neutral,  crystallizable,  forming  needle-shaped,  stellar,  or  foliaceous 
crystals.  It  is  soluble  in  240  parts  of  cold  and  25  parts  of  warm  water, 
and  in  alcohol,  and  dissolves  freely  in  alkaline  solutions.  It  is  unaffected 
in  solution  by  the  metallic  salts,  tannin,  etc.,  and  is  not  precipitated  by 
the  tests  for  the  alkaloids.  It  may  be  administered  in  pill-form,  and 
can  be  combined  with  any  of  the  usual  so-called  nervine  tonics.  Pi- 
crotoxin may  be  administered  subcutaneously,  in  solution  in  water — 
one  grain  to  3  ss — the  dose  ranging  from  -^  of  a  grain  to  -fa  of  a 
grain.  By  the  stomach  it  may  be  given  in  from  -^  of  a  grain  to  -fa. 

ANTAGONISTS. — The  carefully  -  conducted  researches  of  Browne 
show  that  chloral  is  its  physiological  antagonist  in  rabbits  and  Guinea- 
pigs,  and  probably  will  prove  to  be  of  value  in  cases  of  poisoning  in 
man.  The  anaesthetics,  and  the  motor  depressants  in  general,  are  an- 
tagonistic in  respect  to  its  power  to  produce  spasm. 

SYNERGISTS. — All  the  remedies  of  this  group,  notably  strychnine, 
brucine,  and  ergot,  increase  the  effects  of  picrotoxin. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  picrotoxin  is  bitter.  It 
increases  the  flow  of  saliva.  In  what  form  soever  administered,  more 
or  less  nausea  is  produced,  when  the  quantity  given  is  sufficient  to 
cause  cerebral  effects.  It  is  not  an  irritant  to  the  gastro-intestinal 
mucous  membrane  ;  it  increases  secretion,  and  promotes  peristalsis, 
but  no  hyperaemia  of  the  mucous  membrane  has  been  observed  after 
death  from  a  toxic  dose.  The  secretions  of  the  glandular  appendages 
of  the  mucous  membrane,  probably  also  of  the  pancreas  and  liver,  are 
decidedly  increased,  the  stools  becoming  soft  and  more  copious.  Ad- 
ministered at  any  point,  picrotoxin  diffuses  readily  into  the  blood, 
but  nothing  is  known  at  present  of  the  changes  which  it  induces,  if 
any,  in  the  composition  of  the  blood.  After  death  the  right  side  of 
the  heart  is  distended,  and  the  left  side  incompletely  emptied  and. 
flaccid.  The  action  of  the  heart  varies  with  the  stage  of  the  effects, 
and  doubtless  also  more  or  less  according  to  the  size  of  the  dose.  At 
first  the  cardiac  movements  are  slowed,  the  arterial  tension  somewhat 
elevated  ;  during  the  convulsions  the  action  grows  rapid,  but,  succeeding 
the  convulsions,  and  during  the  stage  of  coma,  the  pulse  becomes  slow 
again.  According  to  Planat,  by  small  doses,  the  cardiac  pulsations  are 
slowed  before  the  convulsions  come  on  :  then  the  muscular  excitement 


490  EXCITO-MOTORS. 

induces  rapid  action,  to  be  succeeded  again  by  the  retarding  effects  of 
the  remedy,  increased  by  the  coina.  Roeber  also  finds  that  the  cardiac 
contractions  are  retarded,  and  the  walls  of  the  heart  dilated  and  flac- 
cid. The  respiration  is  also  accelerated,  and  there  occurs  strong  in- 
spiratory  dilatation,  because  of  spasm  of  the  glottis — effects  which  are 
due  to  stimulation  of  the  pulmonary  portion  of  the  vagus,  and  which 
cease  on  division  of  this  nerve  (Roeber).  When  the  convulsions  cease, 
the  respiration  becomes  slower  and  more  shallow.  No  engorgement  of 
the  lungs  is  found  after  death  (Browne). 

The  pupils  are  not  specifically  affected.  During  the  convulsions 
they  dilate  somewhat,  when  the  tonic  spasms  come  on,  and  contract 
again  during  the  clonic  spasms.  The  fundus  of  the  eye,  examined  by 
the  ophthalmoscope,  exhibits  considerable  hyperaemia. 

The  cerebral  effects  of  picrotoxin  are  variously  interpreted.  Drow- 
siness, stupor,  some  muscular  trembling,  are  observed  in  cold-  and 
warm-blooded  animals,  and  have  also  been  experienced  in  man.  A 
heavy,  stupid  intoxication,  with  vertigo,  inco-ordination,  and  dimin- 
ished sensibility,  followed  by  after-headache,  depression,  and  nausea, 
are  symptoms  ascribed  to  the  action  of  cocculus  Indicus  in  beer  so- 
phisticated by  this  drug.  Restlessness,  unsteady  gait,  and  weakness  of 
the  hind  extremities,  also  precede  the  convulsions  in  animal:?.  Twitch- 
ing of  the  ears,  shaking  of  the  head,  and  spasms  in  the  eyelids,  eye- 
brows, lips,  and  fore-paws,  now  come  on.  Then  follows  a  distinct 
tonic  convulsive  stage,  with  opisthotonos,  or  emprosthotonos,  tetanic 
fixation  of  the  muscles  of  respiration,  cyanosis,  and  stertor.  This 
tetanic  stage  is  succeeded  by  the  general  clonic  convulsions,  and  the 
seizure  is  terminated  by  a  temporary  paralysis  and  coma.  In  the  order 
and  succession  and  character  of  phenomena,  a  remarkable  similarity  in 
the  actions  of  picrotoxin  to  the  epileptic  paroxysm  must  be  discerned. 
By  Roeber  the  convulsions  are  referred  to  the  effects  of  the  poison  on 
the  medulla.  He  finds  that,  after  destruction  of  the  brain,  the  symp- 
toms are  the  same  as  before  ;  after  destruction  of  the  optic  lobes,  the 
convulsions  are  less  violent ;  but  when  the  medulla  is  removed  the  con- 
vulsions do  not  occur,  and  a  large  dose  causes  coma  only.  These  facts 
indicate  that  picrotoxin  acts  on  the  spasm  and  vagus  centers  in  the 
medulla,  and  on  Setschenow's  inhibitory  center.  Planat,  Chirone, 
and  Testa,  also  hold  that  this  agent  acts  on  the  cerebellum,  medulla, 
and  spinal  cord,  and  leaves  the  brain  exempt.  Against  these  opinions 
we  have  the  carefully-considered  but  still  hypothetical  view  of  Browne, 
who  finds  in  Ferrier's  cortical  centers  the  real  seat  of  the  action  of 
picrotoxin.  That  the  center,  and  not  the  periphery,  is  the  place 
where  the  action  of  the  poison  is  expended,  seems  proved  by  the 
studies  of  Roeber,  who  finds  that  the  electrical  reactions  of  nerve  and 
muscle  remain  unaltered. 

The  action  of  the  heart  is  arrested  in  the  diastole,  and,  while  the 


COCCULUS.  491 

cavities  are  full,  the  capillaries  at  the  periphery  are  empty.  The  vas- 
cular lesions, post  mortem,  are  similar  to  those  of  epilepsy.  That  some 
of  the  poison  is  yet  in  the  blood,  is  proved  by  the  fact  that  flies  eating 
it  are  poisoned.  Elimination  probably  takes  place  by  the  various  chan- 
nels of  excretion,  but  chiefly  by  the  kidneys.  The  skin  is  powerfully 
acted  on,  and  hence  picrotoxin  ranks  among  the  most  active  diapho- 
retics. The  urinary  excretion  is  also  increased,  but  more  exact  obser- 
vations are  needed  on  these  points. 

THERAPY. — Picrotoxin  will,  probably,  be  found  very  useful  in 
cases  of  torpor  of  the  intestines,  dependent  on  deficient  secretion  and 
paresis  of  the  muscular  layer.  In  the  night-sweats  of  consumption  it 
has  been  used  with  great  success  by  Murrell,  who  had  but  one  failure 
in  twenty  cases.  He  finds  that  it  is  best  to  give  the  necessary  dose  at 
night — from  T^  grain  to  ^5-.  The  effect  lasts  about  ten  days,  when 
the  sweating  begins  again,  and  the  remedy  must  be  repeated.  Picro- 
toxin has  been  used  with  success  in  the  treatment  of  epilepsy  by  Pla- 
nat,  Dujardin-Beaumetz,  Hurd,  and  by  Hammond.  It  is  more  espe- 
cially adapted  to  the  weak  and  anaemic  type.  It  has  been  also  used 
with  success  in  chorea,  and  with  promising  results  in  paralysis  agitans. 
In  a  case  of  glosso-labio-laryngeal  paralysis  Gubler  obtained  a  notable 
amelioration.  Further  experiences  with  these  diseases  are  much  need- 
ed. It  is  probable  that  this  remedy  may  be  applied  with  advantage 
to  the  treatment  of  other  paralyses.  According  to  Tschudi,  it  has 
been  given  in  paralysis  of  the  sphincters  with  good  results.  The 
tremors  of  chronic  alcoholism  have,  it  is  said,  been  removed  by  it. 
One  of  the  forms  of  sick-headache — that  occurring  at  or  about  the 
menstrual  period — is  sometimes  greatly  relieved  by  its  timely  exhibi- 
tion. An  ointment  of  picrotoxin — ten  grains  to  an  ounce  of  simple 
ointment — has  been  applied  with  success  to  the  treatment  of  para- 
sitic skin-affections.  Care  is  necessary,  and  abraded  surfaces  must  be 
avoided. 

A  saturated  tincture  of  cocculus  Indicus  might  be  employed  in  place 
of  picrotoxin.  Planat  recommends  a  tincture  composed  of  one  part 
of  the  berries  to  four  parts  of  alcohol,  and  of  this  one  drop  is  the  ini- 
tial dose,  morning  and  evening,  increased  daily  by  the  addition  of  two 
drops,  up  to  sixty  or  seventy  drops  for  an  adult,  daily.  In  the  diseases 
for  which  it  is  prescribed,  it  is  necessary,  to  secure  curative  effects,  that 
the  physiological  action  be  produced.  Planat  has  used  this  tincture 
successfully  in  chorea,  epilepsy,  eclampsia  (infantile),  and  in  painful 
contractures  of  the  extremities.  Gubler  advises  the  dose  of  a  mille- 
gramme  of  picrotoxin  for  subcutaneous  use.  He  has  observed  that 
indurated  spots  result  from  the  injections,  but  they  slowly  disappear. 

Authorities  referred  to  : 

BROWNE,  DR.  CRICHTON.  The  British  Medical  Journal,  vol.  i,  1875,  pp.  409,  443, 
476,  540. 


492  EXCITO-MOTORS. 

CHIROSE  AND  TESTA.  Annali.  Univ.  di  Med.  e  Chirurg.  Quoted  in  London  Med.  Rec* 
on/,  October  15,  1880. 

Dt'JARDiN-BEAUMEiz.     Annuaire  de  Therap.  for  1876,  p.  33. 

GUBLER,  PROF.  A.     Bull.  General  de  Therap.,  1875. 

HAMMOND,  DR.  W.  A.     St.  Louis  Clinical  Record,  October,  1876. 

HURD,  DR.     Michigan  Med.  News,  February  10,  1881. 

KOHLER,  PROF.  DR.     Berl  klin.  Woclienschrift,  No.  47,  1867. 

MURRELL,  DR.  WILLIAM.     The  Practitioner,  October,  1879,  vol.  xxiii,  p.  241. 

PLANAT,  DR.     Bull.  Gen.  de  Therap.,  1876.     Also  Annuaire  de  TJierap.,  1876,  p.  29. 

ROEBER,  DR.     Archiv  fur  Physiol.,  etc.,  for  1869,  p.  30. 

Ergota. — Ergot.  The  sclerotium  of  Claviceps  purpurea,  replacing 
the  grain  of  Secede  cereale  Linne  (Nat.  Ord.  Graminece).  Ergot  de 
seigle,  Fr.  ;  MutterJcorn,  Ger. 

Extractum  Ergotce  Fhiidum. — Fluid  extract  of  ergot.     Dose,  3  ss 

—  3J- 

Vinum  Ergotce. — Wine  of  ergot.     Dose,  3  j —  i  ss. 

Ergotin. — This  preparation  must  not  be  confounded  with  a  con- 
stituent of  ergot,  supposed  to  be  an  active  principle.  The  ergotin  of 
the  shops  gets  its  name  from  "  Bonjean's  ergotin."  It  varies  very 
much  in  strength,  owing  to  faulty  modes  of  preparing  it,  and  is 
not  unfrequently  inert.  As  prepared  by  Squibb  it  is  entirely  soluble 
in  water,  and  represents  the  powers  of  the  drug.  Ergotin  (the  aque- 
ous extract)  is  the  most  eligible  preparation  for  hypodermatic  injec- 
tion. From  one  to  five  grains  may  be  injected  at  one  time.  In  pre- 
paring it  for  this  purpose,  the  quantity  to  be  injected  should  be  rubbed 
up  with  fresh  distilled  or  rain  water,  and  then  passed  through  the  filter. 
It  is  always  better  to  prepare  it  whenever  required.  If  it  is  necessary 
to  preserve  the  solution,  the  addition  of  a  little  carbolic  acid — one  grain 
to  four  ounces — will  usually  suffice.  The  addition  of  glycerin  is  not 
necessary,  except  as  a  preservative  fluid  ;  and  is  objectionable,  because 
it  greatly  increases  the  pain  which  attends  the  subcutaneous  injection. 

COMPOSITION. — Some  confusion  yet  exists  in  regard  to  the  con- 
stituents of  ergot,  notwithstanding  recent  advances  in  our  knowledge. 
An  unfortunate  nomenclature  is  in  part  responsible  for  the  confusion  ; 
but  the  subject  is  difficult,  and  the  views  of  chemists  have  differed  much. 

Ergot  contains  about  thirty  per  cent  of  a  saponifiable,  non-drying 
oil,  with  which  is  associated  a  small  quantity  of  resin  and  cholesterin. 
When  extract  of  ergot  is  treated  with  an  alkali,  a  peculiar  fishy  odor 
is  developed,  due  to  methylamine,  according  to  some  authorities,  and 
trimethylamine  according  to  others.  Ergot  also  contains  lactic  and 
phosphoric  acids  and  phosphates.  The  two  principles,  ecbolina  and 
ergotina,  separated  by  Wenzell  in  1864,  are  not  true  alkaloids  of  ergot, 
and  are  said  by  Dragendorff  to  be  identical.  In  1830  a  supposed  al- 
kaloid was  obtained  by  Wiggers,  which  he  named  ergotin,  but  this  is 
not  the  true  active  principle.  Unfortunately,  an  aqueous  extract,  pre- 
pared by  Bonjean,  was  also  named  ergotin.  Kohler  has  examined  the 
ergotin  of  Wiggers  and  that  of  Bonjean,  and  finds  that  they  are 


ERGOT.  493 

mixtures  :  the  former  containing  the  ingredients  of  ergot  not  soluble 
in  water  ;  the  latter,  those  that  are  soluble  in  water.  According  to 
Kohler,  neither  of  these  so-called  ergotins  represents  the  properties  of 
ergot.  More  recently  Dragendorff  and  Podwissotzky  have  gone  over 
the  chemistry  of  ergot  anew,  with  different  results.  They  have  in- 
troduced new  terms  also,  which  add  to  the  complications.  The  most 
important  principles  obtained  by  them  are  sclerotic  or  sclerotinic  acid, 
and  scleromucin,  the  former  existing  in  good  ergot  in  the  proportion 
of  about  four  per  cent,  and  the  latter  two  to  three  per  cent.  Another 
alkaloid  has  lately  been  discovered  by  Tanret,  to  which  he  has  given  the 
name  ergotinine.  This  substance  seems  to  be  a  genuine  alkaloid  ;  but 
Robert  has  proved  that  it  is  inert,  or,  at  least,  has  no  action  on  the  uterus. 
It  is  a  white,  crystallizable  solid,  insoluble  in  water,  and  soluble  in  ether 
and  chloroform.  It  is  alkaline  in  reaction  and  has  strong  basic  proper- 
ties, and  combines  with  acids  to  form  salts.  It  is  an  unstable  substance, 
and  in  the  air  soon  decomposes.  The  investigations  of  Kobert,  made  in 
Schmiedeberg's  laboratory  and  published  last  year,  have  all  the  author- 
ity which  the  brilliant  talents  of  the  disciple  and  the  immense  knowl- 
edge of  the  great  master  can  confer  on  any  production.  Robert's  study 
of  the  chemistry  of  ergot  resulted  in  the  separation  of  two  acids, 
ergotinic  acid  and  sphacelinic  acid,  and  an  alkaloid,  cornutine. 

Ergotinic  acid  is  the  principal  part  of  the  sclerotic  acid  of  Dragen- 
dorff and  Podwissotzky,  mentioned  above,  and  of  Bonjean's  ergotin. 
It  has  no  effect  on  the  uterus,  but  does  act  on  the  circulation  in  a  man- 
ner unfavorable  to  the  general  purposes  of  the  remedy.  Sphacelinic 
acid  is  the  most  actively  toxic,  and  is  the  principle  that  produces  the 
ergot-gangrene.  According  to  Recklinghausen,  who  made  a  careful 
investigation  of  the  pathological  state  induced  by  it,  the  initial  change 
takes  place  in  the  hyaline  tissue  of  the  intima  of  the  blood-vessels  ; 
the  lumen  of  the  vessels  is  encroached  on,  thromboses  form,  and  ex- 
travasations of  blood  occur  in  various  places.  Hyaline  degeneration 
occurs  in  the  lens,  also,  and  cataract  is  thus  formed.  These  effects 
are  increased  by  the  stimulation  of  the  muscular  fiber  of  the  arterioles 
lessening  their  caliber,  and  thus  raising  the  general  blood-pressure. 
It  acts  on  the  uterus  powerfully,  and  is  an  abortifacient.  Cornutine, 
the  alkaloid,  is  contained  in  ergot  in  minute  quantity.  It  causes  tonic 
and  clonic  convulsions,  and  death  is  due  to  paralysis  of  respiration. 
The  ecbolin  of  Wenzell  contains  more  or  less  cornutine,  and  owes  to 
it  any  active  property  that  it  may  exhibit.  Tanret's  crystallizable 
ergotinine  is  not  cornutine  ;  but  if  any  given  specimen  proves  to  have 
active  property,  Robert  supposes  it  to  contain  cornutine. 

The  most  eligible  preparation  of  ergot,  Robert  asserts,  is  an  ex- 
tract so  prepared  as  to  contain  the  sphacelinic  acid  and  cornutine,  and 
for  which  he  proposes  the  name  extractum  cornuti  secalis  cornutino- 
sphacelinicum  Koberti.  Thus  far  this  preparation,  which  is  to  be  put 
forth  by  Gehe,  of  Dresden,  awaits  the  new  crop  of  ergot. 


494  EXCITO-MOTORS. 

The  composition  of  ergot  has  been  so  nearly  arrived  at  that  it  will 
require  but  little  additional  investigation  to  decide  finally.  Mean- 
while, the  practitioner  can  obtain  the  best  results  from  the  fluid  ex- 
tract of  the  U.  S.  Pharmacopoeia,  if  honestly  prepared  from  fresh  and 
genuine  ergot. 

The  symptoms  by  which  the  physician  may  recognize  the  effects 
of  the  ergot  administered,  in  any  case  requiring  the  exhibition  of  mass- 
ive doses,  are  partly  subjective.  The  patient  experiences  more  or  less 
headache,  with  a  sense  of  constriction  of  the  forehead,  singing  in  the 
ears,  and  a  vertigo,  which  consists  in  a  sensation  of  floating  off.  The 
pupils  dilate,  and  are  rather  sluggish  in  their  response  to  stimulation  ; 
the  eyes  appear  suffused,  and  are  sensitive  to  light ;  the  sense  of  hear- 
ing becomes  abnormally  acute,  and  loud  sounds  make  a  painful  im- 
pression. The  action  of  the  heart  is  slowed,  but  the  pulse  is  not  tense, 
and  the  respirations  are  slower,  with  something  of  a  sighing  super- 
added.  To  this  complex  of  symptoms  must  be  added  a  feeling  of 
anxiety,  and  a  restlessness  which  is  apparently  due  to  the  sensation  of 
"  fidgets,"  as  it  is  commonly  known — a  feeling  of  unrest,  which  impels 
to  constant  movement  of  the  limbs.  As  the  effects  increase,  nausea 
comes  on,  and  with  it  vomiting,  that  takes  place  suddenly,  with  little 
or  no  warning,  the  nausea  and  vomiting  almost  coincident.  This  cere-' 
bral  vomiting  is  to  be  distinguished  from  that  which  is  attendant  on 
the  gastro-enteritis  of  cases  of  poisoning. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies  and  the 
metallic  salts  are  chemically  incompatible.  Aconite,  veratrum  viride, 
tobacco,  lobelia,  and  amyl  nitrite  (Shafer),  antagonize  the  action  of 
ergot  on  the  circulation. 

SYNEKGISTS. — Electricity,  cold,  digitalis,  belladonna,  are  synergis- 
tic  as  regards  the  vascular  system.  Savin,  gossypium,  rue,  borax, 
increase  its  parturient  action. 

PHYSIOLOGICAL  EFFECTS. — In  small  medicinal  doses  ergot  does  not 
produce  sensible  physiological  effects.  In  large  doses  it  causes  symp- 
toms referable  to  the  gastro-intestinal  canal,  and  to  the  cerebro-spinal 
axis.  It  is  bitter  to  the  taste,  and  excites  more  or  less  heat  and  dry- 
ness  of  the  throat,  followed  by  thirst,  stomach-pain,  vomiting,  intesti- 
nal pain,  and  occasionally  purging.  These  gastro-intestinal  symptoms 
are  unquestionably  due  to  the  local  irritant  action  of  the  drug  ;  for, 
after  death,  in  a  few  fatal  cases  which  have  resulted  from  its  adminis- 
tration, there  have  been  found  patches  of  inflammatory  redness  in  the 
stomach  and  intestines. 

The  active  constituents  of  ergot  diffuse  into  the  blood.  What 
changes,  if  any,  are  caused  in  the  composition  of  the  blood,  are  at 
present  quite  unknown.  Very  characteristic  effects  are,  however,  pro- 
duced in  the  circulatory  system  :  the  action  of  the  heart  becomes 
slower,  and  an  enormous  rise  takes  place  in  the  blood-pressure.  This 
influence  on  the  circulatory  system  modern  research  has  shown  to  be 


ERGOT.  495 

due  to  the  action  of  ergot  on  the'  vaso-motor  nervous  system  ;  it 
increases  the  action  of  this  system,  and  causes  a  contraction  of  the 
arterioles. 

The  dilatation  of  the  pupil  which  follows  is  another  evidence  of 
this  action.  Pain  in  the  head  (usually  frontal),  dimness  of  vision, 
giddiness,  and  stupor,  are  also  produced  by  it.  The  action  of  ergot 
on  unstriped  muscular  fiber  is  further  shown  in  the  contractions  of  the 
parturient  womb,  the  arrest  of  haemorrhage,  and  the  difficulty  of  mic- 
turition, which  follows  its  medicinal  administration.  The  power  of 
ergot  to  contract  the  arterioles  has  been  repeatedly  demonstrated  in 
the  web  of  the  frog's  foot. 

The  phenomena  above  described,  due  to  the  administration  of  large 
medicinal  or  toxic  doses,  are  known  as  acute  ergotism.  The  peculiar 
morbid  effects  of  ergot,  when  used  for  a  long  period  of  time  as  food 
(diseased  grain),  are  known  as  chronic  ergotism,  which  exists  in  two 
forms,  the  convulsive  and  gangrenous.  Generally  the  convulsive  form 
begins  by  vertigo,  disorders  of  vision,  tinnitus  aurium,  numbness  of 
the  fingers  and  toes,  and  afterward  of  the  integuments  of  the  body. 
These  symptoms  are  followed  by  tetanoid  contractions  of  the  fingers, 
of  the  forearms  on  the  arms,  and  of  the  arms  against  the  chest ;  of 
the  toes  on  the  palmar  surface  of  the  foot,  of  the  leg  on  the  thigh. 
The  thoracic,  abdominal,  and  diaphragm  muscles  are  also  tetanically 
contracted,  and  respiration  becomes  painful  and  difficult,  and  attacks 
occur  similar  to  asthma.  The  intestinal  muscles  become  affected  by 
cramp,  doubtless  tetanoid  in  character,  colics  ensue,  and  diarrhoea  ;  the 
uterus  in  pregnant  females  takes  on  action,  and  abortion  may  result. 
The  pulse  is  small,  action  of  heart  slow,  and  the  surface  cold.  The 
appetite  is  generally  ravenous. 

The  tetanic  spasms,  at  first  separated  by  distinct  intervals,  become 
continuous,  and  opisthotonos  or  emprosthotonos  is  produced.  Anaes- 
thesia (complete)  of  the  surface  succeeds  to  the  tetanoid  attacks,  and 
gangrene  of  limited  spots  may  occur.  The  organs  of  sense  lose  their 
sensibility  and  taste,  hearing  and  smell  are  abolished.  The  pupils  are 
dilated,  sometimes  unequal,  and  various  disturbances  of  vision  ensue. 
Epileptiform  convulsions  may  occur  in  addition  to  the  tetanoid  spasms, 
delirium  sets  in,  and  complete  insensibility  at  last  supervenes. 

As  has  been  shown  by  Lasegue  and  Tardieu,  the  gangrenous  and 
convulsive  forms  of  chronic  ergotism  are  not  separated  by  any  well- 
marked  pathological  differences.  The  gangrenous  form  begins  by 
tingling,  numbness,  formication,  an  insupportable  sense  of  fatigue  in 
the  members,  an  earthy  hue  of  the  skin,  coldness  of  the  surface  ; 
nausea,  vomiting,  and  diarrhea,  with  intestinal  cramps,  then  occur  ; 
muscular  contractions  take  place  ;  an  eruption  of  vesicles  filled  with 
a  dark  ichorous  fluid  appears  on  one  or  more  extremities,  and  gan- 
grene, dry  or  moist,  quickly  destroys  the  toes,  the  legs,  the  nose,  or 
other  parts. 


496 


EXCITO-MOTORS. 


The  phenomena  of  chronic  ergotism  are  evidently  due  to  two  causes 
— to  the  dyscrasia  which  exists  in  the  subjects  of  this  malady,  owing 
to  insufficient  food  and  bad  hygienic  surroundings,  and  to  the  action 
of  the  ergot  of  the  diseased  grain,  in  diminishing  the  blood-supply  to 
the  cerebro-spinal  axis,  to  the  vegetative  organs,  and  to  the  skin  and 
muscular  system. 

To  this  general  sketch  of  the  actions  of  ergot,  it  may  be  well  to 
add  some  particulars  of  its  most  important  physiological  properties, 
and  some  observations  on  the  actions  of  the  recently  discovered  active 
principles.  The  most  conspicuous  effect  of  ergot,  and  that  on  which 
depends  its  therapeutical  applications,  is  the  influence  which  it  exerts 
over  the  vascular  apparatus.  It  is  an  undoubted  fact,  in  respect  to 
which  all  the  investigators  agree,  that  ergot  diminishes  the  number 
and  alters  the  character  of  the  cardiac  pulsations.  The  frog's  heart 
may  be  arrested  in  the  diastole  by  the  intravenous  injection  of  a  full 
dose.  By  Rossbach  and  Wernich  it  was  observed  that  a  vermicular 
or  peristaltic  motion  was  given  to  the  heart  of  frogs.  The  arrest  of 
the  heart's  action  is  attributed  by  Eberty  to  stimulation  of  the  vagus 
and  a  consequent  increase  of  the  inhibition.  By  Rossbach  it  is  referred 
to  an  action  on  the  cardiac  muscle.  It  is  in  a  high  degree  probable, 
however,  that  the  slowing  and  depression  of  the  cardiac  functions  is 
due  to  the  action  of  ergot  on  the  cardiac  ganglia.  To  this  may  be 
opposed  the  observation  of  Willebrand,  that  the  normal  or  hyperto- 
phied  heart  so  contracts  under  the  action  of  ergot  that  the  difference 
in  size  is  appreciable  by  percussion  !  There  is  no  dispute  in  regard  to 
the  contraction  of  the  arteries  induced  by  ergot.  It  has  been  observed 
and  measured  by  Wernich,  Briesemann,  and  Holmes.  The  notion  that 
ergot  causes  contraction  of  the  arteries  by  stimulating  the  vaso-motor 
system  and  its  muscular  apparatus  has  long  been  entertained.  An 
enormous  rise  in  the  blood-pressure  has  been  stated  to  occur  by  Eberty, 
Kohler,  and  H.  C.  Wood,  and  their  opinion  was  based  on  kymographic 
observations.  Holmes,  Hermann,  and  Wernich,  on  the  other  hand, 
maintain  that  the  blood-pressure  is  actually  reduced.  Wernich  shows 
that  the  veins  are  dilated,  and  that  a  great  accumulation  of  blood  takes 
place  in  them,  while,  at  the  same  time,  the  arteries  contract,  not  re- 
ceiving from  the  slowly  acting  heart  sufficient  blood.  The  contrac- 
tion of  the  arteries  is  not,  therefore,  an  active  contraction,  as  has  been 
supposed,  but  a  collapse,  the  result  of  deficient  supply  of  blood,  which 
has  accumulated  in  the  dilated  veins.  By  the  theory  of  vaso-motor 
stimulation,  it  was  easy  to  explain  the  action  of  ergot  on  the  muscular 
fiber  of  the  uterus  and  intestinal  canal.  If,  however,  the  blood-press- 
ure falls  after  the  administration  of  considerable  doses,  as  Handelin, 
Brown-Sequard,  and  others  affirm,  and  the  arterial  contraction  is 
not  active,  how  explain  the  uterine  and  intestinal  action  of  ergot? 
This  result  is  due  to  arterial  anaemia  (Wernich,  Schlesinger,  Mayer, 


ERGOT.  497 

etc.).  It  is  now  clearly  established  that  active  movements  occur  in 
the  muscular  fiber  of  the  intestinal  canal  and  uterus  by  inducing  an 
arterial  anaemia.  According  to  this  view,  then,  the  active  peristalsis 
and  the  uterine  contractions  which  follow  the  exhibition  of  ergot  are 
the  result,  not  of  a  direct  stimulation  of  the  sympathetic  system,  but 
of  the  diminished  cardiac  energy,  dilatation  of  the  veins,  and  arterial 
anaemia. 

The  action  of  ergot  is  not  limited  to  the  vascular  apparatus.  The 
arterial  anasmia  which  it  induces  may  serve  to  explain  the  cerebral 
effects  which  follow  its  free  administration  in  man,  but,  besides  these, 
the  functions  of  the  spinal  cord  and  peripheral  nerves  undergo  changes. 
In  frogs  ergot  induces  paralysis,  beginning  in  the  hind  extremities, 
and  thence  involving  all  parts,  the  circulation  and  respiration  being 
the  last  to  yield.  In  warm-blooded  animals  the  same  effects  are  pro- 
duced, and,  if  the  action  continues,  finally  the  cardiac  and  respiratory 
centers  are  paralyzed.  By  Zweifel  these  central  effects  are  held  to 
be  the  principal,  and  all  others  merely  secondary.  On  the  other  hand, 
the  depression  in  the  motor  and  reflex  functions  of  the  cord  may  be 
explained  by  the  arterial  anaemia,  which  is  an  undisputed  effect  of 
ergot,  how  much  soever  the  mechanism  of  its  production  may  be  dis- 
puted. Indeed,  it  must  be  admitted  that  the  actions  of  ergot  are  still 
subjudice.  The  numerous  and  often  diverse  views  which  have  been 
expressed  may  be  in  part  explained  by  the  character  of  the  prepara- 
tions. There  can  be  no  doubt  that  the  active  constituents  are  un- 
stable, and  hence  the  pharmaceutical  products  vary,  not  only  in  the 
degree,  but  decidedly  also  in  the  character,  of  the  actions.  In  Koh- 
ler's  investigation,  in  which  he  compared  the  ergotin  of  Wiggers  and 
Bonjean,  thei^e  were  very  wide  differences  between  them.  The  ergotin 
of  Bonjean — an  aqueous  extract — excites  the  vaso-motor  center  in  the 
medulla  and  the  cardiac  inhibitory  center,  and  very  large  doses  para- 
lyze the  heart,  the  muscular  tissue  losing  its  excitability  to  galvanism. 
Wiggers's  ergotin  has  no  effect  on  the  vascular  apparatus.  In  these  ex- 
periments of  Kohler,  with  which  Eberty  was  associated,  the  power  of 
ergot  to  increase  the  blood-pressure  is  an  important  point.  The  atten- 
tive reader  will  observe  that  in  these  experiments  the  heart  was  para- 
lyzed, and  the  irritability  of  its  muscular  tissue  destroyed.  Wiggers's 
ergotin  causes  cramps  of  the  intestines,  and  violent  inflammation  of 
the  gastro-intestinal  mucous  membrane,  effects  which  never  result 
from  Bonjean's.  Both  kinds  of  ergotin  lower  the  temperature,  and 
both  retard  the  respiration.  Bonjean's  ergotin  diminishes  the  irri- 
tability of  the  peripheral  motor  nerves,  and  Wiggers's  increases  it. 
Both  lessen  the  irritability  of  the  sensory  nerves.  Kohler  concludes 
that,  when  it  is  desired  to  slow  the  heart,  contract  the  vessels,  dimin- 
ish reflex  actions,  and  lessen  temperature,  the  ergotin  of  Bonjean 
should  be  used. 
34 


498  EXCITO-MOTORS. 

The  physiological  action  of  sclerotinic  acid  has  been  carefully 
studied  by  Nikitin  in  Rossbach's  laboratory.  He  starts  out  by  affirming 
the  identity  of  action  between  this  principle  and  ergot.  In  frogs  the 
reflex  excitability  of  the  spinal  cord  is  reduced,  then  destroyed,  but 
in  warm-blooded  animals  it  is  reduced  only.  It  does  not  affect  the 
irritability  of  the  motor  nerves,  nor  the  contractility  of  the  muscles, 
but  when  brought  in  contact  with  sensory  nerves,  paralyzes  them. 
Sclerotinic  acid  depresses  the  action  of  the  heart  in  frogs,  but  not  in 
mammals.  In  toxic  doses  it  lowers  the  blood-pressure  and  reduces 
the  temperature.  The  respiration  is  slowed,  and,  when  toxic  doses 
are  given,  the  movements  of  respiration  cease  before  the  heart  stops. 
The  peristaltic  movements  are  increased  in  warm-blooded  animals, 
and  the  uterus,  whether  gravid  or  not,  is  excited  to  action.  Death  is 
due  to  paralysis  of  respiration. 

Sclerotinic  acid  has  been  freely  prescribed  by  Von  Hoist,  who  finds 
it  possessed  of  a  high  degree  of  activity,  but  other  clinicians  have 
been  less  successful — thus  Kobert,  of  Halle,  finds  it  can  not  be  substi- 
tuted for  ergot.  In  my  own  experiments,  I  have  found  it  produce 
effects,  but  not  those  of  ergot  proper.  Sclerotinic  acid  is  separated  by 
alcohol,  but  Handelin,  who  had  investigated  this  subject  under  the 
superior  direction  of  Schmiedeberg,  finds  that  ergot  loses  none  of  its1 
activity  by  being  extracted  with  alcohol.  Handelin's  experiments, 
made  with  an  aqueous  extract,  present  some  points  of  interest.  He 
found  that  small  doses  cause  anaesthesia  and  impair  the  power  of  co- 
ordination, and  large  doses  paralyze  reflex  and  voluntary  motions.  As 
the  peripheral  nerves  are  unaffected,  the  paralysis  is  centric.  Small 
doses  lower  the  blood-pressure  temporarily,  and  large  doses  perma- 
nently. The  pulse  is  at  first  quickened,  and  then  declines,  becoming 
more  and  more  slow  until  the  heart  is  arrested. 

The  first  trials  with  Tanret's  crystallized  ergotinine  were  made  by 
Dr.  Mole,  who  found  it  as  effective  in  uterine  haemorrhage  as  ergot. 
The  amount  that  he  administered  did  not  exceed  four  milligrammes 
in  twenty-four  hours.  Galippe  and  Budin  have  also  experimented  with 
ergotinine  on  frogs,  cats,  and  dogs,  and  produced  many  of  the  effects 
ascribed  to  ergot,  namely,  slowing  of  the  pulse,  reduction  of  tempera- 
ture, paralysis,  and  convulsions.  Peton,  another  investigator,  has  also 
experimented  with  ergotinine,  the  results  of  the  action  being  contrac- 
tion of  the  arteries,  restlessness,  trembling,  diarrhoea,  etc. 

An  examination  of  the  results  obtained  from  the  experimental  and 
clinical  trials  with  the  so-called  principles  and  alkaloids  of  ergot  dem- 
onstrates that  in  no  single  one  are  contained  all  the  powers  and  prop- 
erties of  the  drug.  It  is  also  evident  that  ergot,  and  those  principles 
possessing  its  powers  most  nearly,  depress  the  heart,  and  lower -rather 
than  elevate  the  tension  of  the  arteries.  The  contraction  of  the  ar- 
teries is  not,  therefore,  an  active  contraction  ;  and,  as  the  blood  accu- 


ERGOT.  499 

mulates  in  the  veins,  there  is  an  anaemia  of  the  cerebro-spinal  axis  and 
of  the  organic  muscular  fiber.  To  this  condition  of  things  may  be 
referred  the  phenomena  resulting  from  the  exhibition  of  ergot. 

THERAPY. — The  only  diseases  of  the  intestinal  canal  to  which  ergot 
is  applied  are  chronic  diarrhoea  and  dysentery.  It  is  best  adapted  to 
those  cases  in  which  the  chronic  succeeds  to  the  acute  form,  and  is  not 
so  serviceable  in  the  chronic  diarrhoea  of  warm  climates,  which  has  de- 
veloped slowly,  without  preliminary  acute  symptoms.  ]J  Ext.  ergotae 
fluidi,  siijss;  tinct.  opii  deodor.,  3  ss.  M.  Sig. :  A  teaspoonful  three 
times  a  day.  I£  Ergotinae  (aq.  ex.),  3j  ;  ext.  nucis  vomicae,  gr.  v  ; 
ext.  opii,  gr.  v.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  every  four  or  six 
hours.  This  last  prescription  is  highly  useful  in  persistent  chronic 
diarrhoea. 

Dr.  L.  G.  Andrew  has  treated  acute  dysentery  successfully  with 
the  fluid  extract  of  ergot.  Dr.  "W.  C.  Dabney,  of  Virginia,  urges  the 
local  application  of  fluid  extract  of  ergot  in  affections  of  the  mucous 
membrane  characterized  by  enlarged  vessels,  as,  conjunctivitis,  cervi- 
citis,  pharyngitis,  etc.,  and  by  Dr.  Eldridge  it  has  been  applied  to  the 
treatment  of  gonorrhoea,  acne  rosacea,  etc.  The  theory  of  its  action 
in  these  maladies  is  the  artificial  anaemia  which  it  induces  in  the  arterial 
vessels.  Inflammation  can  not  go  on,  because  the  blood-supply  is  in- 
adequate. In  the  local  application  the  fluid  extract  of  ergot  is  used. 
In  most  cases  this  may  be  applied  directly  to  the  membrane  undiluted. 
The  aqueous  extract,  or  ergotin,  may  be  utilized  for  these  purposes 
also  ;  made  into  a  paste  more  or  less  thick  according  to  the  character 
of  the  surface,  it  may  be  plastered  on  the  affected  part. 

Ergot  in  the  form  of  the  fluid  extract,  with  or  without  nux-vomica, 
will  often  arrest  the  bleeding  of  haemorrhoids,  and  cause  such  a  con- 
traction of  the  vessels  in  recent  cases  as  that  the  symptoms  may  en- 
tirely disappear.  This  treatment  is  especially  serviceable  in  the  haemor- 
rhoids which  succeed  to  delivery.  Relaxation  of  the  sphincter  ani  and 
prolapsus  of  the  rectum  may  be  ameliorated  and,  when  recent,  cured 
by  the  same  means. 

Ergot  is  a  useful  remedy  in  cases  of  enlarged  heart  (dilated  cavities) 
without  valvular  lesion.  It  may  be  given  with  digitalis  :  I£  Ext. 
ergotae  fluidi,  3  iijss  ;  tinct.  digitalis,  §  ss.  M.  Sig.  :  A  teaspoonful 
three  times  a  day.  There  is  now  no  longer  any  doubt  as  to  the  value 
of  ergot  in  aneurisms,  and  especially  in  internal  aneurisms  beyond  the 
reach  of  surgical  treatment.  In  these  cases  the  methodus  medendi  is 
as  follows  :  ergot  slows  the  action  of  the  heart,  and  causes  such  a  de- 
gree of  contraction  of  the  arterioles  as  to  produce  a  great  increase  of 
the  blood-pressure,  whence  it  follows  that  the  coagulation  of  the  blood 
in  the  aneurismal  sac  is  greatly  promoted.  It  is  quite  conceivable  that, 
as  respects  small  aneurisms  of  the  peripheral  main  arterial  trunks, 
ergot  may  effect  a  cure  in  the  mode  suggested  by  Langenbeck,  viz., 


500  EXCITO-MOTORS. 

by  direct  contraction,  under  the  influence  of  the  ergot,  of  the  unstripeci 
muscular  fibers  in  the  affected  portion  of  the  vessel.  With  the  uss  of 
ergot  should  be  enjoined  rest  in  the  recumbent  posture,  and  other 
measures  to  favor  hyperinosis  and  the  coagulation  of  the  blood  in  the 
aneurismal  sac. 

The  recent,  more  accurate  notions,  regarding  the  physiological  ac- 
tion of  ergot,  have  led  to  its  employment  in  various  forms  of  hemor- 
rhage. With  suitable  means  for  improving  the  quality  of  the  blood, 
ergot  is  very  serviceable  in  the  hcemorrhagic  diathesis  /  but  it  is  not 
to  be  relied  on  alone.  The  special  indication  for  its  use  in  haemorrhage 
is  a  want  of  tonicity  of  the  vessels.  It  is  used  in  epistaxis,  haemoptysis, 
renal,  intestinal,  and  uterine  haemorrhage.  Large  doses  of  a  suitable 
preparation  are  necessary  ;  for,  if  the  drug  be  inert,  nothing  but  dis- 
appointment will  be  experienced  from  its  use,  and  small  doses  do  not 
produce  sufficient  effect.  From  half  a  drachm  to  a  drachm  of  the  pow- 
dered ergot,  or  one  to  two  drachms  of  the  fluid  extract,  given  every 
half-hour  or  hour,  will  be  necessary  in  urgent  cases.  As  powdered  er- 
got rapidly  loses  its  activity  by  keeping,  the  fluid  extract  should  be 
used,  and  only  that  prescribed  which  has  been  carefully  made  from  the 
fresh  drug.  Attention  to  these  precautions  will  insure  more  uniform 
results  in  haemorrhage  than  have  hitherto  been  obtained.  In  hcemop-* 
tysis  the  fluid  extract  of  ergot  may  be  given  with  other  appropriate 
remedies  ;  I£  Ext.  ergotse  fluidi,  §  iij  ;  ext.  ipecac,  fluidi,  tinct.  opii 
deodor. ,  aa  f  ss.  M.  Sig. :  A  teaspoonful  every  half-hour  or  hour. 
When  the  sputa  are  heavily  charged  with  blood,  and  there  is  no  de- 
fined haemorrhage,  the  following  may  be  used  :  ^  Ergotinse  (aq.  ex.), 
3j  ;  pulv.  ipecac.,  gr.  x  ;  acid,  gallic.,  $  j.  M.  Ft.  pil.  no.  xx.  Sig.: 
One  every  hour  or  two.  In  renal  haemorrhage,  the  following  is  a  use- 
ful formula  and  generally  very  effective  :  IJ  Ext.  ergotae  fluidi,  tinct. 
krameriae,  aa  f  ij.  M.  Sig. :  A  teaspoonful  every  hour  or  two.  Or, 
ergotine  may  be  prescribed  with  gallic  acid,  as  in  the  prescription  above 
given. 

The  indication  for  the  use  of  ergot  in  menorrhagia  is  the  existence 
of  the  large,  spongy  uterus — the  condition  of  things  which  depends  on 
subinvolution  of  the  womb.  Menorrhagia,  when  caused  by  ovarian 
excitement,  is  usually  more  promptly  relieved  by  bromide  of  potas- 
sium, and  metrorrhagia,  produced  by  fibroids  or  fungous  granulations, 
is,  in  the  author's  experience,  much  more  decidedly  held  in  check  by 
diluted  sulphuric  acid  than  by  ergot. 

When  there  is  reason  to  believe  that  vertigo,  epistaxis,  headache, 
and  tinnitus  aurium,  are  due  to  miliary  aneurisms  of  the  intra-cranial 
arterioles,  most  favorable  results  can  be  produced  by  the  use  of  ergot. 
Also,  when  there  is  a  sluggish  and  partially  obstructed  state  of  the 
intra-cranial  veins,  usually  due  to  chronic  arteritis,  and  accompanied 
by  hebetude  of  mind,  giddiness,  epistaxis,  etc.,  these  symptoms  are 


ERGOT.  501 

made  to  disappear,  and  the  mental  condition  is  much  improved  by 
ergot. 

Dr.  Crichton  Browne,  a  physician  of  large  experience  in  these  dis- 
orders, finds  ergot  a  very  useful  remedy  in  certain  forms  of  mental 
disease,  for  example,  "  in  recurrent  mania,  chronic  mania  with  lucid 
intervals,  and  in  epileptic  mania."  In  these  mental  disorders  he  as- 
sumes the  existence  of  cerebral  hypersemia,  and  he  deduces  the  cura- 
tive value  of  ergot  from  its  power  to  cause  contraction  of  the  vessels. 

Migraine,  when  the  attacks  are  accompanied  by  suffusion  of  the 
face,  injected  conjunctivas,  and  a  full  pulse — the  congestive  form — is 
cured  by  ergot,  and  Dr.  Kitchen  indeed  extends  its  use  to  almost  all 
kinds  of  headache. 

In  epidemic  cerebro-spinal  meningitis,  ergot  is  one  of  the  remedies 
from  which  the  best  results  are  to  be  expected.  In  congestion  of  the 
spinal  meninges  and  the  cord,  and  in  acute  myelitis,  this  remedy  has 
probably  been  more  uniformly  successful  than  any  other,  but  it  must 
be  given  in  large  doses. 

Excellent  results  have  been  obtained  from  the  use  of  ergot  in  acute 
inflammation  of  the  conjunctiva,  in  blepharitis,  and  in  the  phlyctenu- 
lar  ophthalmia  of  children. 

The  long-continued  use  of  ergotin  has  achieved  remarkable  results 
in  chronic  metritis.  Uterine  fibroids  and  polypi  of  the  uterus  are 
greatly  benefited  in  two  modes  by  ergot :  uterine  action  is  set  up,  by 
which  the  growth  is  either  compressed  or  extruded,  and  the  nutrient 
vessels  are  so  diminished  in  caliber  that  atrophy  of  the  morbid  growth 
occurs.  The  numerous  reported  instances  of  success  by  this  treatment, 
and  the  author's  personal  experience  of  its  utility,  justify  him  in  urging 
a  trial  of  this  remedy  in  uterine  fibroids  and  polypi. 

In  congestive  dysmenorrhcea,  much  good  may  be  expected  from  the 
use  of  ergot  when  the  menstrual  molimen  begins.  3  Ext.  ergotse 
fluidi,  3  vij  ;  tinct.  gelsemii,  3  j  ;  tinct.  aconiti  rad.,  gtt.  xvj.  M. 
Sig.  :  A  teaspoonful  every  two,  three,  or  four  hours.  Amenorrhcea, 
when  dependent  on  plethora,  has  been  cured  by  ergot. 

When  incontinence  of  urine,  nocturnal  or  diurnal,  is  caused  by  a 
paretic  or  paralytic  state  of  the  sphincter  vesicce,  relief  may  be  confi- 
dently expected  from  the  use  of  ergot.  The  fact  that  one  of  the  ill 
results  of  the  administration  of  ergot  in  large  doses  is  an  inability  to 
void  the  urine,  is  an  interesting  explanation  of  the  methodus  medendi 
of  ergot  in  these  cases. 

Ergot  is  one  of  the  most  satisfactory  remedies  in  the  treatment  of 
spermatorrhoea.  It  is  not  useful  when  the  losses  are  due  simply  to 
plethora.  Its  curative  value  is  especially  exhibited  in  those  cases  in 
which  the  erections  are  feeble  and  infrequent,  the  intromittent  power 
wanting,  and  the  testes  relaxed  and  deficient  in  secretory  activity. 

Paralysis  of  the  bladder,  the  result  of  over-distention,  and  occasion- 


502  EXCITO-MOTORS. 

ally  when  due  to  cerebral  or  spinal  lesion,  is  greatly  benefited  or  cured 
by  ergot. 

Ergot  was  first  employed  by  Da  Costa  in  the  treatment  of  diabetes 
insipiclus,  and  a  number  of  cases  have  been  cured  by  Murrell,  Saun- 
ders,  and  others.  The  remedy  must  be  perseveringly  used,  and  in  full 
doses,  up  to  the  stomach  capacity  or  evidence  of  physiological  action. 

Heitzmann  has  found  ergot  extremely  useful  in  acne  rosacea,  and 
other  forms  of  acne.  He  uses  Squibb's  fluid  extract  of  ergot  mixed 
with  glycerin  and  water,  giving  3  ss  internally,  daily. 

ERGOT  IN  OBSTETRIC  PRACTICE. — It  is  no  longer  a  matter  of  doubt 
that  ergot  promotes  uterine  contractions  ;  that  it  originates  them  with- 
out previous  effort  of  the  womb,  is  questionable.  The  contractions 
due  to  ergot  differ  from  the  spontaneous,  natural  contractions,  in  being 
less  rhythmical  and  more  tetanic.  When  large  doses  of  ergot  are  used, 
a  continuous  expulsive  effort  may  be  produced.  Ergot  is  indicated  in 
labor  when  there  is  uterine  inertia,  the  first  stage  being  completed, 
and  no  obstacle  existing  at  the  outlet.  If  given  before  dilatation  is 
completed,  the  perinseum  rigid,  and  the  oslium  vaginae  not  relaxed,  dis- 
astrous consequences  may  ensue,  both  to  mother  and  child.  On  the 
part  of  the  mother,  the  violent  and  continuous  pains — the  resistance  in 
front  remaining — may  cause  a  rupture  of  the  womb,  or  the  resistance 
may  be  overcome  by  laceration  of  the  perinseum.  On  the  part  of  the 
child,  it  arrests  hsematosis,  partly  by  direct  action  on  the  placental 
blood,  and  partly  by  the  continuous  compression  of  the  body  ;  but  the 
chief  danger  is  paralysis  of  the  foetal  heart. 

It  is  highly  approved  by  obstetricians  at  the  present  time  to  admin- 
ister a  dose  of  ergot  at  the  conclusion  of  the  second  stage  of  labor,  to 
insure  firm  uterine  contractions.  This  practice  is  held  to  be  the  more 
necessary  when  previous  experience  justifies  the  apprehension  of  trou- 
blesome haemorrhage.  When  post-partum  haemorrhage  occurs,  it  is 
universally  conceded  to  be.  the  proper  thing  to  administer  a  full  dose 
of  ergot  ;  but  at  the  same  time  other  measures  must  be  resorted  to  in 
order  to  procure  firm  uterine  contractions,  on  which  alone  depends  the 
safety  of  the  patient.  In  these  conditions  the  ergot  is  usually  admin- 
istered in  substance — one  scruple  to  a  drachm  of  coarsely-powdered 
ergot  infused  in  a  cup  of  hot  water,  the  whole  being  drunk  by  the  pa- 
tient. From  3  j  to  f  j  of  the  fluid  extract  may  be  given  instead — the 
official  preparation  representing  a  grain  of  ergot  to  the  minim. 

THE  HYPODERMATIC  INJECTION  OF  ERGOTIN. — The  subcutaneous 
injection  of  ergot  has  become  so  important  a  therapeutical  resource 
that  it  is  necessary  to  treat  the  subject  in  a  separate  division.  The 
solution  employed  for  this  purpose  is  usually  as  follows  :  §  Ergotinae 
(aq.  ex.),  3  j  ;  glycerini,  3  j  ;  aquas  destil.,  3  vij.  M.  Sig.  :  Eight 
minims  contain  one  grain  of  ergotin.  Squibb  has  prepared  "  an  ex- 
tract of  ergot  which  is  almost  entirely  soluble  in  cold  water,  and  rep- 


ERGOT.  503 

resents  good  rye  ergot  in  the  proportion  of  one  grain  of  extract  for 
five  grains  of  ergot.  Sixty  grains  of  this  extract,  dissolved  in  two 
hundred  and  fifty  minims  of  water — the  solution  filtered,  and  made  up 
to  three  hundred  minims  by  passing  water  through  the  filter  to  wash 
it  and  the  residue  upon  it — makes  a  solution  which  represents  ergot  in 
the  proportion  of  minim  for  grain,  and  is  of  the  same  strength  as  the 
fluid  extract  of  ergot,  but  is  free  from  alcohol  or  other  irritant  sub- 
stance." This  preparation  the  author  has  found  to  be  admirably 
adapted  for  subcutaneous  administration.  When  the  aqueous  extract 
of  ergot  of  good  quality  can  not  be  obtained,  the  fluid  extract  may  be 
used. 

The  rules  for  the  administration  of  ergot  are  the  same  as  for  other 
agents  applied  in  this  way. 

In  the  treatment  of  hcemorrhage,  when  a  prompt  effect  is  desired, 
the  hypodermatic  injection  is  preferable  to  the  stomach  administration. 
In  hcemoptysis,  the  injection  may  be  practiced  while  suitable  remedies 
are  administered  by  the  stomach.  In  hcematemesis,  especially  if  the 
stomach  be  irritable,  better  results  may  be  obtained  by  subcutaneous 
use  of  ergot  than  by  any  form  of  internal  medicine.  In  post-partum 
haemorrhage,  when  to  await  the  action  of  ergot  may  endanger  the  life 
of  the  mother,  the  subcutaneous  administration  should  be  resorted  to. 
The  happy  results  which  have  attended  this  mode  of  administration 
in  serious  cases,  demand  that  the  accoucheur  be  provided  with  the 
necessary  appliances  for  the  hypodermatic  injection  of  ergot  in  every 
obstetrical  case.  This  mode  of  using  ergot  is  not  only  prompter  in 
results,  but  is  more  effective  in  securing  uterine  contractions  and  arrest 
of  haemorrhage. 

The  good  results  which  are  obtained  from  the  stomach  administra- 
tion of  ergot  in  subinvolution  of  the  uterus  and  in  chronic  metritis, 
are  much  more  quickly  and  decisively  obtained  from  the  subcutaneous 
administration.  Since  the  memoir  of  Hildebrandt  appeared,  numerous 
cases  of  successful  treatment  of  uterine  fibroids  by  hypodermatic  injec- 
tion of  ergotin  have  been  published.  There  seems  to  be  no  longer 
any  doubt  that  this  agent  administered  in  this  way,  and  less  effectively 
and  for  a  much  longer  period  by  the  stomach  also,  has  the  power  to 
arrest  the  growth  of  uterine  fibroids,  to  cause  them  to  atrophy,  or  to 
set  up  such  a  degree  of  uterine  action  as  to  compel  their  extrusion  as 
polypi  from  the  uterine  cavity.  It  has,  of  course,  long  been  known 
that  ergot  administered  by  the  stomach  may  induce  such  a  degree  of 
uterine  contraction  as  to  expel  a  polypus.  In  those  instances  in  which 
the  hypodermatic  injection  fails  to  arrest  the  growth  of  a  polypus, 
notable  improvement  in  the  amount  of  the  haemorrhage  and  of  the 
muco-purulent  discharge  is,  at  least,  a  result  of  the  treatment.  The 
author  is  enabled  to  speak  from  personal  observation  of  the  excellent 
results  obtained  by  this  mode  of  treatment  in  many  cases. 


504  EXCITO-MOTORS. 

From  two  to  six  grains  of  the  aqueous  extract  of  ergot  (ergotin) 
may  be  injected  under  the  skin  in  these  cases  of  uterine  fibroids  on 
alternate  days,  or  thrice  or  twice  each  week.  The  abdomen  is  usually 
preferred  as  the  site  of  the  injection.  More  or  less  pain  is  experienced 
at  the  moment  of  the  insertion  of  the  solution,  and  an  indurated  spot,, 
which  may  be  more  or  less  sore,  will  remain  for  a  week  or  more.  Sup- 
puration may  result  from  the  injection,  but  it  is  not  a  frequent  accident. 

The  hypodermatic  injection  is  an  effective  mode  of  treating  vari- 
cocele.  About  two  grains  of  the  extract  in  solution  is  a  suitable  dose. 
The  needle  is  inserted  so  that  its  point  will  rest  among  the  dilated 
veins,  but  care  must  be  taken  not  to  puncture  a  vein.  Very  severe 
pain  follows,  and  there  may  be  great  faintness,  but  the  effects  subside- 
in  a  few  hours  unless  considerable  swelling  should  ensue,  which  is- 
quite  usual.  A  single  injection  may  cure  a  very  extensive  varicocele,. 
and  more  than  two  are  rarely  necessary.  Varicose  veins  in  other 
parts,  especially  of  the  inferior  extremities,  have  been  cured  by  the 
same  treatment.  The  following  is  the  mode  of  proceeding  in  these 
cases  :  the  needle  is  inserted  under  the  skin,  in  close  juxtaposition  to 
the  enlarged  vein,  and  the  fluid  is  so  injected  as  to  lie  alongside  of  the 
vein,  but  not  to  enter  it.  The  cure  which  follows  in  many  of  these 
cases  has  been  ascribed  to  the  inflammatory  swelling  which  takes  place,. 
but  there  is,  doubtless,  besides  this  effect,  a  dynamical  influence  ex- 
erted on  the  vessel- walls. 

It  has  lately  been  asserted  that  deficient  erections  and  loss  of  the 
capacity  for  coitus  are  not  unfrequently  due  to  enlargement  of  the 
dorsal  vein  of  the  penis,  and  consequent  too  rapid  emptying  of  the 
veins  of  the  erectile  tissue.  Acting  upon  this  plausible  suggestion,  the 
author  has  practiced  the  hypodermatic  injection  of  ergotin  about  the 
dorsal  vein  of  the  penis,  and  he  has  had  apparently  excellent  results. 

Before  closing  this  article,  it  may  be  advisable  to  recall  to  the  read- 
er's attention  the  fact  that  the  hypodermatic  injection  of  ergot,  or  its- 
internal  administration  in  large  doses,  may  cause  such  tonic  contrac- 
tion of  the  sphincter  vesicce  as  to  render  micturition  impossible.  Care- 
ful inquiry  and  frequent  examinations  of  the  hypogastric  region  should 
be  made  during  a  course  of  ergot  preparations. 

Authorities  referred  to  : 

BAILLT,  PROF.  M.  Ergot,  Ergotine — Action  physiologiqut,  etc.  Bulletin  General  de 
Therapeutique,  vol.  Ixxviii,  pp.  433,  481,  529. 

BRIESEMANN,  DR.  C.     Schmidfs  Jahrbiicher,  vol.  cliii,  p.  30. 

BROWNE,  DR.  CRICHTON.     The  Practitioner,  vol.  vi,  p.  321. 

CYR,  DR.  JULES.  Traite  de  F  Alimentation,  Paris,  1869,  article  Ergotisme,  p.  425, 
et  seg. 

DUTOIT,  DR.     Schmidt's  Jahrbiicher,  vol.  cliv,  p.  315. 

EBERTY,  DR.  P.     Schmidfs  Jahrbiicher,  vol.  clviii,  p.  126. 

EULKNBURG,  DR.  ALBERT.  Die  hypodermatischen  Injection  der  Arzneimittel,  1867,, 
p.  283. 


USTILAGO.  505 

FLUCKIGER  AND  HANBURT.      Pharmacograpkia,  p.  672,  at  xeq. 

HILDEBRANDT,  PROF.  Ucber  die  Einwirkung  Subcutaner  Injectionen  von  extr.  secal. 
eornut.  aq.  auf  Fibro-Myome  des  Uterus.  Berliner  klinische  Wochenschrift,  No.  25,  1872,, 
p.  29. 

HOLMES,  DR.  CH.  L.     Schmidt's  Jahrbiicher,  vol.  clviii,  p.  126. 

HUSEMANN,  DRS.  THEO.  CND  AUG.  Die  Pflanzenstoffe  ;  Alkaloide  des  Mutterkorns, 
p.  520. 

HUSEMANN,  DR.  THEOD.  Handbuch  der  gesammten  Arzneimettellehre,  Berlin,  1875, 
p.  203. 

KITCHEN,  DR.  DANIEL.     The  American  Journal  of  Insanity,  July,  1873. 

EGBERT,  PROF.  DR.  Archiv  fur  experiment.  Pathol.  und  Pharmacol.  for  1886,  and 
The  Practitioner,  for  1886. 

LANGENBECK,  PROF.     Berliner  klinische  Wochenschrift,  No.  6,  1869. 

LCTON,  DR.  A.      Gazette  Hebdomadaire,  October,  1871. 

MEADOWS,  DR.  ALFRED.     The  Practitioner,  September,  1868. 

NICOL,  DR.  PATRICK,  AND  ISAAC  MOSSOP.  On  the  Action  of  Certain  Neurotics  on  the 
Cerebral  Circulation.  British  and  Foreign  Medico-Chirurgical  Review,  July,  1872. 

SCHNEIDER,  DR.     Berliner  klinische  Wochenschrift,  vi,  36,  p.  390. 

UstilagO. — Ustilago.  Ustilago  maydis  Leveille  (Nat.  Ord.  Fungi} 
grows  upon  Zea  mays  Linne  (Nat.  Ord.  Graminacece). 

Extractum  Ustila  girds  May  d  is  Fluidum. — Fluid  extract  of  usti- 
lago.  Dose,  tn,x  —  3  j. 

COMPOSITION. — An  active  principle — ustilagine — has  been  lately 
found,  and  some  of  the  ingredients  existing  in  ergot  have  been  detected, 
as  secaline  so  called,  and  trimethylamine  ;  but  the  latter  is  regarded 
by  others  as  a  decomposition  product  and  not  existing  preformed. 
Besides  other  substances,  Parsons  has  separated  an  acid,  which  he  re- 
gards as  similar  to  the  sclerotic  acid  of  Dragendorff,  and  a  substance 
soluble  in  ether  but  not  in  alcohol. 

PHYSIOLOGICAL  ACTIONS. — Several  important  investigations  of 
the  actions  of  ustilago  have  been  made  in  the  laboratory  of  experi- 
mental therapeutics  of  Jefferson  Medical  College,  which  agree  for 
the  most  part  with  the  account  to  follow,  and  which  we  owe  to  Dr. 
Hoffman,  whose  work  was  done  in  the  college  laboratory  three  years 
ago. 

The  researches  above  referred  to  will  appear  in  a  special  volume, 
now  preparing. 

Both  in  cold-  and  warm-blooded  animals,  ustilago  acts  as  a  spinal 
excitant,  causing  convulsions  of  a  tonic  character.  It  also  heightens 
sensibility  and  the  reflex  function,  so  that  the  least  irritation  of  the 
skin  induces  general  tonic  convulsions  of  the  tetanic  or  strychnic 
character.  Frequent  irritation  and  repeated  convulsions  rapidly  ex- 
haust the  animal.  On  the  other  hand,  quiet,  darkness,  and  relief 
from  all  irritation,  diminish  the  severity  of  the  convulsions,  and  pro- 
long life,  if  not  prevent  a  fatal  result.  Death  may  ensue  in  a  con- 
vulsion by  tetanus  of  the  respiratory  muscles.  Muscular  tremors, 
general,  occur  in  warm-blooded  animals,  and  muscular  weakness 


506  EXCITO-MOTORS. 

(paresis)  appears  in  the  intervals  between  the  convulsions.  The  irri- 
tability of  the  motor  nerves,  and,  toward  the  end,  of  the  sensory 
nerves  also,  declines,  but  is  not  entirely  lost,  and  the  contractility  of 
the  muscles  lessens  semewhat.  That  the  convulsions  are  spinal,  is  a 
fact  proved  by  destroying  the  cord  in  a  frog  before  administering 
the  medicament,  when  no  muscular  action  of  any  kind  takes  place. 
Section  of  the  medulla  or  decapitation  does  not  prevent  the  occur- 
rence of  the  convulsions. 

Ustilago  slows  the  heart,  and  by  numerous  control  experiments 
this  action  was  shown  to  be  due  to  stimulation  of  the  pneumogastric 
and  its  terminal  ganglia.  It  dilates  the  pupil,  and  affects  the  acute- 
ness  of  vision  for  near  objects. 

"We  have  no  exact  data  in  regard  to  the  action  of  this  agent  on  the 
uterine  system.  An  impregnated  cat,  dying  by  a  merely  lethal  dose 
slowly,  did  not  abort  ;  but  it  is  said  that  pregnant  cows  and  bitches, 
after  eating  ustilago,  have  dropped  their  young. 

The  modes  of  dying  are  two:  in  the  tetanus  ;  by  exhaustion.  In 
the  former,  the  respiration  is  arrested,  violent  tonic  extension  of  the 
voluntary  muscles  takes  place,  the  head  being  drawn  back,  the  toes 
incurved.  In  the  latter  there  is  gradually  increasing  paresis  between 
the  convulsions,  and  slowing  of  the  heart's  action.  The  difference  is 
largely  due  to  the  dose  and  rapidity  of  administration.  A  lethal  dose 
for  a  rabbit  weighing  25  ounces  seems  to  be  one  drachm  of  the  fluid 
extract. 

Digitalis. — The  leaves  of  Digitalis  purpurea  Lhm6  (Nat.  Ord. 
Scrophulariacece),  from  plants  of  the  second  year's  growth.  (IT.  S.  P.) 
Feuilles  de  digitale,  Fr.  ;  Finger hutblatter,  Ger. 

Infusum  Digitalis. — Consists  of  digitalis,  bruised,  15  grm. ;  alco- 
hol, 100  c.  c.  ;  cinnamon-water,  150  c.  c.  ;  boiling  water,  150  c.  c.  ; 
and  cold  water  sufficient  to  make  1,000  c.  c. 

The  boiling  water  is  poured  over  the  digitalis  in  a  suitable  vessel 
and  allowed  to  macerate  until  cold  ;  it  is  then  strained  and  the  alcohol 
and  cinnamon-water  are  added,  and  enough  cold  water  is  passed  over 
the  residue  on  the  strainer  to  measure  1,000  c.  c.  Dose,  3  ij —  §  ss. 

Extractum  Digitalis  Fluidum. — Fluid  extract  of  digitalis.     Dose, 

mj— miij. 

Extractum  Digitalis. — Extract  of  digitalis.     Dose,  gr.  ss — gr.  ij. 

Tinctura  Digitalis. — Tincture  of  digitalis.     Dose,  niv — 3  j. 

COMPOSITION. — Digitalis  contains  an  active  principle,  digitaline. 
This  exists  in  the  amorphous  and  crystalline  form.  The  amorphous 
form — the  digitaline  of  Homolle  and  Quevenne — possesses  consider- 
able activity,  and,  according  to  some  authorities,  is  quite  equal  to  the 
crystalline  in  strength.  The  crystalline  digitaline  (Nativelle's  digital- 
ine) occurs  in  needle-shaped  crystals  and  has  an  extremely  bitter  taste. 


DIGITALIS,  507 

According  to  Schmiedeberg,  digitalis  contains  digitonine,  which 
strongly  resembles  saponine  ;  digitaline,  which  is  insoluble  in  water, 
and  is  the  chief  constituent  of  Homolle  and  QueVenne's  digitaline  ; 
digitale'in,  which  is  readily  soluble  and  has  the  same  action  as  German 
digitaline  ;  digitoxine,  the  most  powerful,  and  is  the  principal  constit- 
uent in  Nativelle's  digitaline.  Koppe  has  examined  the  action  of  digi- 
taline, digitalein,  and  digitoxine,  and  finds  that  they  agree  in  their 
action,  and  with  the  crude  drug,  but  differ  in  degree  of  activity. 

Digitalinum. — Digitaline.  A  white,  or  yellowish-white  powder, 
without  odor,  and  having  a  very  bitter  taste.  Dose,  -fa  —  -fa  of  a 
grain. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  cinchona  preparations, 
acetate  of  lead,  the  sulphate  and  tincture  of  the  chloride  of  iron,  are 
chemically  incompatible.  Tannic  acid  and  the  preparations  containing 
it  diminish  the  physiological  activity  of  digitalis.  Opium,  aconite, 
lobelia,  and  the  cardiac  paralyzers,  antagonize  some  of  the  actions  of 
digitalis,  but  the  antagonism  does  not  extend  throughout  the  whole 
range  of  their  influence.  The  most  complete  physiological  antago- 
nism exists  between  digitalis  and  saponine  (Kohler),  the  active  princi- 
ple of  Saponaria  officinalis,  closely  allied  to  senegine.  Aconite  antag- 
onizes the  cardiac  action  of  digitalis,  and  morphine,  also,  to  a  less 
degree. 

SYNEKGISTS. — Cold,  ergot,  belladonna,  increase  the  physiological 
activity  of  digitalis. 

PHYSIOLOGICAL  ACTION. — Digitalis  has  a  disagreeable,  bitter  taste. 
In  considerable  doses,  of  the  infusion,  for  example,  it  disturbs  the 
stomach  and  gives  rise  to  nausea  and  vomiting,  and  frequently  purges. 
Loss  of  appetite  results  from  its  medicinal  administration  in  some 
subjects,  even  when  the  quantity  is  small ;  but,  in  others,  the  appetite 
is  increased.  The  active  constituents  of  digitalis  diffuse  into  the 
blood,  but  nothing  is  definitely  known  as  to  the  action  of  this  agent 
on  the  composition  of  the  blood,  or  the  influence  which  it  has,  if  any, 
on  the  morphological  elements. 

On  the  heart  digitalis  exerts  a  peculiar  action  which  requires  atten- 
tive examination  :  it  prolongs  the  diastole  and  increases  the  vigor  of 
the  systole.  A  lethal  dose  arrests  the  heart  in  systole,  inducing  a  tetan- 
ic state  of  the  heart-muscle.  While  digitalis  increases  the  power  of 
the  systole,  the  diastole  is  prolonged,  hence  the  number  of  pulsations 
per  minute  is  reduced.  With  ordinary  medicinal  doses  this  slowing  of 
the  heart  may  be  considerable,  and  the  pulsations  may  descend  to  fifty 
or  even  forty  per  minute.  Microscopic  examination  of  the  mesentery 
(Ackermann)  and  of  the  web  of  the  frog  has  definitely  ascertained 
that  a  marked  contraction  of  the  arterioles  takes  place  under  the  influ- 
ence of  digitalis.  The  increased  power  of  the  systolic  contraction  of 
the  heart  and  the  greatly-increased  resistance  in  front  from  a  narrow- 


508  EXCITO-MOTORS. 

ing  of  the  caliber  of  the  vessels  produce,  as  might  a  priori  be  ex- 
pected, a  considerable  rise  of  the  blood-pressure.  When  the  pulse  is 
greatly  reduced  by  the  administration  of  large  medicinal  doses,  a 
change  from  the  recumbent  to  the  upright  posture  causes  a  remarkable 
increase  in  the  number,  and  diminution  in  the  force,  of  the  cardiac  pul- 
sations. When  lethal  doses,  short  of  a  sudden  toxic  effect,  have  been 
experimentally  administered,  the  slowing  of  the  heart  and  rise  of  ar- 
terial tension  first  produced  are  succeeded  by  a  quick,  feeble  pulse,  and 
fall  in  the  blood-pressure.  These  results  are  obviously  due  to  the  loss 
of  power  (paresis)  which  results  from  over-stimulation. 

A  temporary  rise  of  temperature  follows  the  administration  of  a 
lethal  dose  of  digitalis,  but  this  rise  is  soon  succeeded  by  a  marked  and 
sustained  reduction.  Owing  to  the  increased  resistance  from  diminu- 
tion of  the  caliber  of  the  arterioles,  the  actual  energy  expended  by  the 
heart  is  in  part  converted  into  heat.  Subsequently  the  slowing  of  the 
circulation,  especially  through  the  lungs  (Traube),  hinders  the  combus- 
tion process,  and  hence  the  fall  of  temperature. 

Digitalis  in  full  medicinal  doses  produces  headache,  a  band-like  feel- 
ing around  the  forehead,  dizziness,  disturbances  of  vision  (mistiness^ 
vibratory  movements  of  external  objects,  chromatic  dispersion,  etc.), 
drowsiness,  languor,  and  a  sense  of  weariness,  and  it  may  even  cause 
hallucinations,  illusion,  and  delirium.  Digitalis  lessens  the  reflex  func- 
tion of  the  cord,  lowers  the  sensibility  of  the  nerves,  motor  and  sen- 
sory, and  impairs  the  electro-contractility  of  muscles  ;  but  these  effects 
are  not  produced  by  medicinal  doses,  but  are  toxic  in  character. 

As  might  be  anticipated  from  a  study  of  its  physiological  actions, 
digitalis  acts  like  ergot  on  the  enlarged  uterus  ;  it  stimulates  to  ener- 
getic contraction  the  muscular  fibers,  and  in  this  way  arrests  uterine 
haemorrhage.  On  the  genital  organs  of  man  it  has  a  similar  action  ;  by 
diminishing  the  blood-supply  to  the  erectile  tissue  it  lessens  the  power 
of  erections,  and,  secondarily,  affects  the  venereal  appetite,  producing 
anaphrodisia. 

Considerable  difference  of  opinion  exists  as  to  the  influence  of  digi- 
talis on  the  function  of  nutrition — the  metamorphosis  of  tissue.  By 
some  an  increase  in  the  production  of  urea,  by  others  a  diminution,  has 
been  noted.  The  truth,  most  probably,  is  that  it  has  no  real  influence 
on  urea  formation,  and  that  the  variations  observed  are  accidental.  The 
phosphoric  acid  and  chlorides  are  diminished.  In  health  digitalis  af- 
fects but  little  the  water  of  the  urinary  secretion  ;  according  to  some 
the  water  is  diminished,  according  to  others  increased.  It  is  difficult 
to  reconcile  these  opposing  statements,  in  view  of  the  fact  which  has 
recently  been  ascertained  by  Brunton,  that  the  diuretic  action  of  digi- 
talis in  dropsy  is  not  due  to  the  increased  blood-pressure,  but  to  a  spe- 
cial action  on  the  Malpighian  tufts. 

THEBAPY. — To  obtain  the  best  results  from  the  administration  of 


DIGITALIS.  509 

digitalis,  it  must  be  of  good  quality  and  the  preparations  made  with 
great  care.  Every  precaution  taken,  it  is  still  difficult  to  manage,  be- 
cause so  apt  to  disorder  the  stomach  and  derange  digestion.  Recent 
experience  has  appeared  to  show  that  the  most  powerful  and  effective, 
yet  manageable,  of  the  constituents  is  digitoxine.  This  is  a  white 
crystalline  substance,  insoluble  in  water,  of  which  the  dose  is  T^-g- 
grain  to  T^g-  grain,  and  is  best  administered  in  pill  or  wafer.  It  may 
be  advantageously  combined  with  adonidin  and  sparteine  in  various 
cardiac  affections  and  dropsy. 

Digitalis  has  an  undoubted  power  to  arrest  hcemorrhage  (Ley den). 
The  mechanism  of  its  action  is  similar  to  that  of  ergot ;  it  slows  the 
action  of  the  heart  and  contracts  the  arterioles.  In  haemoptysis  it  is 
especially  useful  in  the  following  state  of  things  :  frequent  expectora- 
tions of  bloody  mucus,  with  occasionally  a  mouthful  of  florid  blood, 
accompanied  by  fever.  This  group  of  symptoms  is  dependent  on 
transudation  from  a  number  of  small  vessels  about  the  site  of  a  pneu- 
monia due  to  a  tubercular  or  caseous  deposition.  The  same  kind  of 
expectoration,  due  to  pulmonary  congestion  from  mitral  regurgita- 
tion,  is  amenable  to  the  same  treatment.  In  uterine  hcemorrhage  digi- 
talis is  also  serviceable,  but  it  is  more  especially  indicated  in  menor- 
rhagia  and  metrorrhagia  of  plethoric  subjects.  Like  ergot,  digitalis 
has  the  power  to  induce  uterine  contractions,  and  hence  it  has  been 
used  successfully  to  arrest  post-partum  hcemorrhage.  Cases  of  menor- 
rhagia,  of  a  peculiarly  obstinate  kind,  are  caused  by  mitral  regurgi- 
tation  or  stenosis,  the  mechanical  result  being  to  increase  the  blood- 
pressure  in  the  venous  system  of  the  uterus.  Digitalis  is  the  appro- 
priate remedy  in  such  cases.  Granules  of  digitaline  may  be  prescribed 
for  some  days  previously  to  the  occurrence  of  the  menstrual  molimen, 
but  during  the  attack  the  infusion  of  digitalis  is  more  serviceable.  In 
cases  of  haemorrhage,  generally  speaking,  the  infusion  is  the  most  ef- 
fective form  in  which  to  employ  digitalis.  If  the  symptoms  are  urgent, 
a  tablespoonful  of  the  infusion  may  be  given  every  half -hour  until 
four  doses  are  taken.  In  ordinary  cases  a  tablespoonful  of  the  infu- 
sion twice  a  day  is  a  sufficient  quantity  to  maintain  a  constant  physio- 
logical effect.  In  the  treatment  of  haemorrhage,  digitalis  may  be 
combined  with  other  remedies  which  are  synergistic.  $  Infus.  digi- 
talis, 3  ij  ;  tinct.  kramerise,  ext.  ergot*  fluidi,  aa  f  j.  M.  Sig.  :  A 
tablespoonful  pro  re  nata. 

Inpurpura  and  the  hvemorrhagic  diathesis,  digitalis  is  useful  when 
given  conjointly  with  restorative  medicines  ;  but,  as  a  dyscrasia  exists 
on  which  the  extravasations  of  blood  depend,  it  is  obviously  necessary 
to  correct  this  state  of  things,  in  order  that  the  patient  shall  be  bene- 
fited by  a  remedy  which  gives  tone  to  the  heart  and  vascular  system. 

The  most  important  uses  of  digitalis  are  in  cardiac  diseases.  In 
general  terms  it  may  be  said  that  it  is  indicated  when  the  action  of  the 


510  BXCITO-MOTORS, 

heart  is  rapid  and  weak  and  the  arterial  tension  low,  and  is  contrain* 
dicated  when  the  action  of  the  heart  is  vigorous  and  the  arterial  ten- 
sion high. 

In  simple  hypertrophy,  which  is  compensatory,  digitalis  has  no 
utility.  In  stenosis  of  the  aortic  orifice,  with  compensatory  hypertro- 
phy, it  is  not  only  useless,  but  it  may  give  rise  to  serious  symptoms, 
and  even  cause  a  fatal  result,  if  administered  in  doses  sufficient  to 
produce  physiological  effects  (Fernet).  When  stenosis  of  the  aortic 
orifice  leads  to  incompetence  and  regurgitation  of  the  mitral,  then 
digitalis  may  be  used  with  advantage.  As  respects  the  nature  of  the 
cardiac  lesion  merely,  digitalis  is  useful  in  dilated  heart  with  incom- 
petence of  the  mitral,  in  disease  of  the  mitral  orifice  with  stenosis  or 
regurgitation,  and  in  dilatation  of  the  right  heart  with  incompetence 
of  the  tricuspid.  As  respects  the  mechanical  difficulties  which  ensue 
from  cardiac  lesions  merely,  digitalis  is  useful,  by  reason  of  the  in- 
creased power  which  it  gives  the  auricles  and  ventricles  to  empty  their 
respective  cavities,  and  the  longer  intervals  between  the  pulsations, 
which  enable  the  auricles  more  perfectly  to  discharge  their  contents 
into  the  ventricles.  The  mechanical  difficulty  consists  in  a  deficiency 
of  blood  (ischcemia)  on  the  arterial  side,  and  a  stasis  of  blood  on  the 
venous  side,  of  the  systemic  and  pulmonary  circulation.  Digitalis, 
therefore,  assists  in  the  "  compensation,"  or,  in  other  words,  by  its  ac- 
tion on  the  heart  restores  the  mechanical  balance  of  the  circulation, 
deranged  by  the  cardie  lesions.  As  respects  the  rational  symptoms  of 
heart-disease,  digitalis  is  useful  when  the  action  of  the  heart  is  rapid 
and  weak,  the  tension  of  the  pulse  low,  when  there  are  cough,  diffi- 
culty of  breathing,  a  dusky  countenance,  pulsating  jugulars,  scanty 
and  high-colored  urine,  and  general  dropsy.  As  a  rule,  it  may  be 
stated  that  the  rational  signs  furnish  more  conclusive  indications  of 
the  need  of  digitalis  than  the  physical.  If  given  in  suitable  cases,  the 
action  of  digitalis  in  heart-diseases  is  most  conspicuous  for  good  ;  but 
careful  consideration  should  be  given  to  the  conditions  detailed  above 
if  the  practitioner  would  procure  thoroughly  satisfactory  results.  The 
form  in  which  digitalis  is  prescribed  is  most  important.  The  infusion 
is  the  best  form  in  cases  of  cardiac  disease  with  dropsy.  It  should 
be  given  in  tablespoonful  doses,  twice  a  day,  until  some  characteris- 
tic physiological  effects  are  produced.  After  the  subsidence  of  the 
severe  symptoms,  digitaline-granules  may  be  substituted  for  the  infu- 
sion, or  the  powder  of  the  leaves  may  be  given  in  pill-form.  As  very 
decided  anaemia  is  present  in  these  cases,  the  best  results  are  obtained 
by  a  combination  of  digitalis  with  quinine  and  iron.  I£  Pulv.  digi- 
talis, 3ij  ;  ferri  redacti,  quininae  sulph.,  aa  3  j.  M.  Ft.  pil.  no",  xx. 
Sig.  :  One  pill  two  or  three  times  a  day. 

The  antipyretic  effect  of  digitalis  is  a  fact  much  insisted  on  in 
Germany  (Traube,  Wunderlich,  Thomas,  Liebermeister,  etc.).  In  the 


DIGITALIS.  511 

recent  elaborate  work  of  Husemann  digitalis  is  classed  with  the  Fie- 
bermittel — the  "  antipyretica."  The  results  which  have  followed  its 
administration  as  an  antipyretic  in  fevers  (typhoid,  typhus,  etc.)  do 
not,  it  appears  to  the  author,  justify  its  use  in  these  maladies,  notwith- 
standing its  power  to  lower  the  temperature.  Prof.  Leyden  regards 
it  as  unsafe  as  an  antipyretic.  The  indications  for  its  use  are,  ac- 
cording to  Liebermeister,  just  the  opposite  of  those  which  obtain  in 
cardiac  disease  ;  that  is,  "  digitalis  is  only  to  be  used  in  those  cases  of 
typhoid  fever  in  which  there  is  no  considerable  degree  of  cardiac 
weakness."  He  usually  gives  from  eleven  to  twenty-two  grains,  ex- 
tended over  a  period  of  about  thirty-six  hours. 

In  scarlet  fever  the  utility  of  digitalis  is  very  great ;  it  lowers  the 
temperature  and  maintains  the  action  of  the  kidneys,  thus  obviating 
the  two  principal  sources  of  danger  in  that  disease.  Dr.  Daniel  Lewis, 
of  New  York,  influenced  by  the  author's  opinions  on  this  point,  system- 
atically used  digitalis  as  the  chief  remedy  in  an  epidemic  of  scarlet 
fever  in  New  York,  and  presented  the  results  in  a  paper  submitted  to 
the  State  Medical  Society.  While  the  mortality  from  this  disease,  for  the 
city  at  large,  is  23  per  cent,  for  Dr.  Lewis's  cases  it  was  less  than  11 
per  cent.  From  a  teaspoonful  to  a  tablespoonf ul  (according  to  age)  of 
the  infusion  every  two,  three,  or  four  hours,  is  a  suitable  mode  of  ad- 
ministration. If  uraemia  occur,  the  infusion  is  the  proper  remedy,  con- 
joined, of  course,  with  other  means.  The  author  has  seen  most  excel- 
lent results  from  a  poultice  of  digitalis-leaves,  applied  to  the  abdomen 
and  back,  in  cases  of  urcemic  convulsions,  the  patient  being  unable  tc 
swallow,  or  the  stomach  so  irritable  as  to  reject  all  medicines. 

Digitalis  has  been  used  with  success  in  erysipelas,  but  it  is  by  no 
means  equal  to  belladonna  in  this  affection. 

In  rheumatic  fever  the  testimony  in  favor  of  the  use  of  digitalis  is 
certainly  very  strong.  It  lowers  the  temperature,  and  apparently  ma- 
terially shortens  the  duration  of  the  disease.  It  may  be  given  in 
powders — two  grains  every  four  hours — or  a  corresponding  quantity 
of  the  infusion.  In  rheumatism,  as  in  every  other  affection,  very 
prompt  effects  do  not  follow  the  use  of  digitalis  ;  a  day  or  two  must 
elapse  before  any  marked  reduction  of  temperature  takes  place,  but  a 
cessation  of  the  joint-trouble  may  be  looked  for  in  seven  to  ten  days. 
Digitalis  is  more  particularly  useful  in  the  cardiac  compilations  of 
acute  rheumatism,  when  irregular  and  feeble  action  of  the  heart,  diffi- 
cult breathing,  cyanosis,  and  general  cedema,  are  present.  The  follow- 
ing is  a  prescription  of  Oppolzer  in  this  condition  :  $  Inf.  digitalis, 
3  ij ;  liq.  potassii  citrat.,  |  jss  ;  acet.  scillae,  §  ss.  M.  Sig.  :  A  table- 
spoonful  every  four  hours. 

Digitalis  has  recently  been  much  employed  in  inflammatory  affec- 
tions, notably  pneumonia.  On  examination  of  the  reported  cases  the 
author  finds  that  the  defervescence,  produced  apparently  by  digitalis 


512  EXCITO-MOTORS. 

from  the  sixth  to  the  tenth  day,  occurred  at  the  time  when  the  crisis 
in  pneumonia  is  to  be  expected,  and  hence  it  is  difficult,  if  not  impos- 
sible, to  estimate  the  precise  share  which  the  remedy  had  in  the  results. 
That  digitalis  has  any  power  to  prevent  the  deposition  of  fibrinous 
material,  to  prevent  or  check  the  migration  of  the  white  corpuscles,  or 
to  arrest  the  multiplication  of  the  cellular  elements  of  inflamed  parts, 
seems  to  the  author  highly  improbable.  That  it  may  be  useful  to  com- 
bat some  of  the  symptoms — high  temperature,  ischaemia  of  the  arterial 
system  from  pulmonary  obstruction,  and  low  tension  of  the  vessels — 
may  be  well  admitted. 

There  is  considerable  evidence  to  show  that  digitalis  is  serviceable 
in  chronic  bronchitis  with  interstitial  pneumonia  (fibroid  lung),  when 
accompanied  with  difficult  breathing,  secondary  dilatation  of  the  right 
cavities,  and  general  anasarca.  It  diminishes  the  cough  and  expec- 
toration, tones  up  the  weakened  and  laboring  heart,  and  reduces  the 
oedema.  That  digitalis  has  any  curative  power  in  pulmonary  tubercu- 
losis or  caseous  pneumonia,  can  hardly  be  credited,  notwithstanding 
the  claims  which  have  been  put  forward.  It  may  be  used  as  an  anti- 
pyretic when  there  is  much  hectic,  but  the  derangement  of  the  intes- 
tinal canal  produced  by  it  is  a  most  serious  bar  to  its  employment  in 
phthisis. 

Some  important  results  have  been  obtained  by  the  use  of  digitalis 
in  nervous  diseases.  The  congestive  form  of  hemicrania  may  not  un- 
frequently  be  permanently  relieved  by  the  persistent  use  of  digitaline- 
granules  (one  sixtieth  of  a  grain  bis  die).  Acute  maniacal  delirium, 
chronic  mania,  and  delirium  tremens,  are  disorders  of  the  brain  in 
which  digitalis  has  proved  very  useful.  The  conclusions  of  Dr.  Will- 
iams, of  Hay  ward's  Heath  Asylum,  are  as  follow  : 

"  1.  That  digitalis  is  a  valuable  sedative  in  the  treatment  alike  of 
recent  and  chronic  mania,  and  when  these  forms  of  disease  are  compli- 
cated with  general  paresis  and  with  epilepsy. 

"  2.  That  the  average  dose  of  the  tincture  is  from  3  ss  to  3  j,  and 
this  quantity  may  be  certainly  given  with  impunity  for  several  days, 
and  subsequently — adjusted  to  the  state  of  the  pulse — may  be  advan- 
tageously used  for  several  months. 

"  3.  That  the  indication  by  which  the  use  of  this  drug  is  regulated 
is  the  state  of  the  pulse,  any  marked  intermittence  requiring  its  imme- 
diate discontinuance. 

"  4.  That  the  weakness  of  the  circulation  is  no  indication  against 
its  employment ;  on  the  contrary,  experience  shows  that  the  most  en- 
feebled subjects  bear  its  administration  as  well  as  the  most  robust." 

In  delirium  tremens  extraordinary  doses  of  the  tincture  of  digitalis 
have  been  used  with  success  (  3  ij —  3  iv),  but  these  large  doses  are  un- 
necessary. This  treatment  is  most  useful  in  the  young  and  robust, 
with  marked  cerebral  hyperaemia,  according  to  some  ;  but,  according  to 


DIGITALIS.  513 

others,  in  pale  subjects  with  a  tendency  to  cyanosis,  the  state  of  the 
brain  being  one  of  anaemia,  with  effusion  and  (Edema.  According  to 
the  author's  observation,  the  latter  indications  are  the  more  correct. 
The  infusion  is  doubtless  a  better  preparation  than  the  tincture,  and 
of  this  a  tablespoonful  may  be  administered  every  four  hours. 

Some  supposed  cases  of  arachnitis  have  been  reported  cured  by 
digitalis,  but  grave  doubts  must  exist  as  to  the  accuracy  of  the  diag- 
nosis. 

Cases  of  exophthalmic  goitre  in  young  subjects,  purely  functional 
in  character,  have  been  cured  by  digitalis,  and  the  cardiac  irregulari- 
ties, and  the  dilatation  of  the  cervical  vessels,  ameliorated  in  even  in- 
curable cases.  Digitaline  is  the  form  in  which  to  employ  this  remedy, 
or  powdered  digitalis  may  be  given  in  pill,  with  iron  and  manganese  to 
remove  the  anaemia. 

Since  the  anaphrodisiac  properties  of  digitalis  were  ascertained,  it 
has  been  much  used  in  spermatorrhoea.  It  is  adapted  to  the  same  class 
of  cases  as  those  in  which  ergot  has  been  shown  to  be  so  beneficial,  viz., 
feeble  erections,  frequent  emissions,  and  cold  hands  and  feet.  The  au- 
thor has  seen  better  results  from  the  combination  of  bromide  of  potas- 
sium and  digitalis,  in  the  spermatorrhoea  of  plethora,  than  from  any 
other  remedies  :  $  Inf.  digitalis,  §  viij  ;  potassii  bromidi,  §  j.  M. 
Sig. :  A  tablespoonful  morning  and  night,  and,  after  a  week,  at  night 
only. 

Digitalis  is  one  of  the  most  generally  useful  remedies  in  dropsy 
which  we  possess.  It  is,  of  course,  specially  indicated  in  the  mechanical 
dropsy  of  valvular  lesions.  In  renal  dropsy  from  acute  desquamative 
nephritis  (tubal  nephritis)  "of  all  drugs,  digitalis  is  of  the  greatest 
value,"  and  the  best  form  in  which  to  administer  it  is  the  infusion. 
Several  days  usually  elapse  before  very  decisive  results  are  achieved, 
but  the  flow  of  urine  is,  then,  often  enormous.  The  fact  that,  contrary 
to  what  has  been  heretofore  believed,  digitalis  has  a  direct  action  on 
the  glomerule  of  the  kidney,  is  of  great  interest  in  this  connection. 
The  author  has  seen  very  favorable  results  from  the  use  of  digitalis 
in  granular  degeneration  of  the  kidney  when  dropsy  supervened,  but 
its  use  in  this  disease  requires  caution  in  consequence  of  the  fact 
that  the  elimination  of  urea  and  of  the  chlorides  is  retarded  by  this 
agent. 

The  so-catted  Cumulative  Effects  of  Digitalis. — The  author  agrees 
in  opinion  with  those  who  hold  that  digitalis  is  not  a  cumulative  poison 
in  the  sense  in  which  this  term  was  formerly  used.  Doses  of  digitalis 
frequently  repeated,  so  that  the  effect  of  one  is  added  to  those  before 
given,  will  certainly  produce  toxic  symptoms.  In  this  sense  opium, 
belladonna,  strychnine,  etc.,  are  cumulative  poisons.  If  full  doses  of 
digitalis  are  given  at  proper  intervals,  and  the  effects  of  one  dose  are 
permitted  to  cease  before  the  next  is  given,  no  accumulation  will  take 


514  EXCITO-MOTORS. 

place.  Sudden  toxic  symptoms  are  developed  as  follows  :  "When,  after 
the  administration  of  large  doses,  the  pulse  is  much  reduced  in  the  re- 
cumbent posture,  on  rising,  the  heart  is  suddenly  found  unequal  to 
maintaining  the  circulation  in  face  of  the  increased  resistance  in  the 
arterioles  and  against  the  force  of  gravity.  It  must  not  be  forgotten, 
further,  that  the  irritability  of  the  vaso-motor  nervous  system  may  be 
destroyed  by  over-stimulation  by  digitalis,  and  lethal  effects  be  pro- 
duced in  this  way. 

Authorities  referred  to  : 

ACKERMANN,  PROF.  TH.  Ueber  die  Wirkungen  der  Digitalis.  Volkmanrts  Sammlung, 
No.  48. 

BOEHM,  DR.  RUDOLPH.  Ueber  die  physiologische  Wirkung  der  Digitalis  und  des  Digi' 
talin.  ScJimidfs  Jahrbucher,  vol.  cliii,  1872. 

BRIESEMANX,  DR.  C.     Schmidt's  JahrbucJier,  vol.  cliii,  p.  29. 

DTBKOWSKY,  W.,  UND  PELIKAU,  BUG.     Schmidfs  Jahrbucher,  vol.  cxvi,  p.  170. 

FOSTER,  DR.  B.  Clinical  Medicine:  lectures  and  Essays,  1874,  p.  92.  Digitalis  in 
Heart  Disease. 

FOTHESQILL,  DR.  J.  MILNER.  Prize  Essay.  British  Medical  Journal,  July  and  August, 
1871. 

GOURVAT,  M.  Gazette  de  Paris,  July  to  December,  1871,  and  January  to  February, 
1872. 

HIRTZ,  DR.     Gazette  Medicale  de  Strasbourg,  1862.  « 

HOLLAND,  SIR  HENRY.     Medical  Notes  and  Reflections,  American  edition. 

HOMOLLE,  M.     Archives  Generates,  July,  1861,  p.  5. 

HUSEMANN,  PROF.  DR.  TH.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  914,  et  seq. 

KOHLER,  DR.  H.  Ueber  den  Antagonismus  der  physiologischen  Wirkungen  der  Saponin 
und  Digitalin.  Archiv  f.  exper.  Path,  und  Phar. ,  1873,  p.  138. 

LIEBERMEISTER,  PROF.  DR.  KARL.  Ziemssen's  Cyclopaedia  of  the  Practice  of  Medicine, 
vol.  i,  p.  217. 

LEYDEN,  PROF.  DR.     Deutsche  med.  Zeitschrift,  No.  23,  1881. 

MAUDSLEY,  DR.  HENRY.     Tlie  Practitioner,  January,  1869. 

SCHMIEDEBERG,  PROF.     Archiv  fiir  exper.  Pathol.  und  Pharmacol,  Band  iii,  p.  16. 

TAYLOR,  DR.  A.  S.     On  Poisons,  third  edition,  London,  p.  796. 

TRAUBE,  PROF.  DR.  L.  Berliner  klinische  Wochenschrift,  No.  17,  April,  1870,  and  No. 
18,  May  2,  1870. 

WEIL,  DB.  A.     Schmidfs  Jahrbucher,  vol.  cliv,  p.  143. 

Convallaria. — The  rhizoma  and  roots  of  Convallaria  majalis  (Nat. 
Ord.  LiliacecB). 

THE  PREPARATIONS. — It  is  a  remarkable  fact  that  different  proper- 
ties are  possessed  by  extracts  made  from  the  various  parts  of  the  plant. 
An  extract  made  from  the  root  has  very  powerful  emeto-cathartic 
property,  while  it  but  little  affects  the  action  of  the  heart.  The  same 
fact  is  true,  to  a  less  or  greater  extent,  of  extracts  from  the  whole 
plant.  This  emeto-cathartic  action  is  due  to  the  presence  of  a  rather 
acrid  resin,  and  hence  for  the  purpose  now  intended  to  be  subserved 
by  the  administration  of  Convallaria  the  preparation  used  must  be 
freed  from  this  resin.  An  extract  prepared  from  the  flowers  and 


CONVALLARIA.  515 

stalks,  mixed  with  a  third  of  their  weight  of  leaves  and  root,  is,  ac- 
cording to  Langlebert,  the  best  preparation,  when  deprived  of  the 
resin.  In  this  shape  it  is  a  solid  extract,  has  a  shining  black  color 
and  a  bitter  taste,  and  is  freely  soluble  in  water  and  alcohol. 

Extractum  Convallaria  Fluidum. — Fluid  extract  of  convallaria. 
Dose,  mv —  3  ss. 

An  infusion  of  the  flowers,  leaves,  and  stems  is  also  used.  Troitz- 
ky  employed  several  formulas  in  his  trials — from  two  to  four  scruples 
of  convallaria  to  four  ounces  of  water. 

Infusuin  Convallarice. — Infusion  of  convallaria  (convallaria,  50 
parts  ;  water,  200  parts).  Dose,  a  tablespoonful.  Another  formula 
is  eight  ounces  of  convallaria  to  a  pint  of  boiling  water,  which  is  twice 
the  strength  of  the  above. 

As  the  active  principle  presents  many  advantages,  this  will  proba- 
bly be  preferred  for  administration  in  cardiac  affections. 

COMPOSITION. — In  1858  Walz  announced  the  presence  in  this  plant 
of  two  glucosides — convallarin  and  convallamarin.  There  are  impor- 
tant differences  in  the  qualities  of  these  substances.  The  former,  con- 
vallarin, occurs  in  colorless,  rectangular  prisms,  is  slightly  soluble  in 
water,  but  freely  so  in  alcohol.  Convallarin,  as  Marme  first  ascertained, 
is  a  purgative  in  doses  of  three  or  four  grains  (Husemann).  It  is 
probable  that  the  presence  of  this  glucoside  in  the  resin  is  the  secret 
of  the  cathartic  property  of  this  substance,  in  part  at  least.  Conval- 
lamarin is  not  crystallizable,  is  a  white  powder,  bitter,  and  freely  sol- 
uble in  water  and  alcohol,  but  not  in  ether.  The  dose  when  admin- 
istered by  the  stomach  will  range  from  one  fourth  of  a  grain  to  two 
grains  ;  but  further  investigations  are  needed  to  decide  this  point. 
This  is  the  principle  of  convallaria,  to  which  its  cardiac  actions  are 
due.  It  is  probable  that  the  perfectly  pure  alkaloid  possesses  much 
greater  activity  than  the  dose  above  stated  indicates. 

PHYSIOLOGICAL  ACTIONS. — For  some  time  no  other  powers  were 
attributed  to  convallaria  than  those  of  a  cathartic  intermediate  in 
action  between  scammony  and  aloes.  In  Russia  it  has  long  been 
known  as  a  remedy  for  dropsy.  This  fact  finally  induced  Troitzky 
and  Bojojawlensky  to  study  its  action  more  closely,  and  Prof.  Bot- 
kin,  of  St.  Petersburg,  subsequently  confirmed  their  researches. 

It  was  not,  however,  until  Prof.  See  undertook  the  study  of  its 
powers  and  actions,  that  general  interest  was  aroused,  although  Marme 
had,  as  is  stated  above,  some  time  before,  given  an  accurate  account 
of  the  physiological  actions  of  convallaria.  Since  the  publication  of 
See's  observations,  the  actions  of  this  medicament  have  been  inves- 
tigated by  various  English  and  American  observers.  From  these 
sources,  and  some  personal  studies,  the  author  makes  up  the  follow- 
ing account : 

Notwithstanding  the  emeto-cathartic  action,  if  the  extract  freed 


516  EXCITO-MOTORS. 

from  the  resin,  or  convallamarin,  the  active  principle,  is  given,  no  dis- 
turbance of  the  stomach  occurs.  It  stimulates  the  appetite  somewhat, 
and  digestion  is  not  impaired.  An  increase  of  peristalsis  occurs,  and 
the  evacuations,  without  being  loose,  become  easy.  In  warm-blooded 
animals  it  slows  the  heart  and  raises  the  arterial  tension.  At  the 
same  time  the  respiratory  movements  are  rendered  more  full  and 
somewhat  less  frequent.  These  effects  are  due  to  stimulation  of  the 
vagus,  but  the  nerve  does  not  lose  its  irritability.  If  the  dose  be  lethal, 
after  this  first  stage,  the  heart  becomes  irregular  in  rhythm,  the  force 
of  the  cardiac  contractions  varies,  and  the  respirations  are  disturbed, 
inspiration  growing  deep  and  prolonged,  owing  to  spasm  of  the  inspir- 
atory  group  of  muscles  (See).  In  the  third  period  of  the  action,  just 
before  death,  the  arterial  tension  rises  very  high,  but  the  pulse  is  ex- 
ceedingly rapid  ;  then  the  pressure  falls,  the  respiration  growing 
deeper  and  very  slow,  and  the  heart  stops  in  systole,  before  the  breath- 
ing finally  ceases.  The  vagus  does  not  wholly  lose  its  irritability,  but 
near  the  end  a  strong  faradic  current  does  not  stop  the  heart.  The 
irritability  of  the  motor  and  sensory  nerves  remains  unaffected,  and 
the  muscles  preserve  their  contractility.  The  pupil  is  unaffected  and 
the  functions  of  the  brain  are  undisturbed. 

The  diuretic  effect  of  convallaria  is  very  constant  and  decided,  a* 
fact  long  known  in  Russia,  but  no  change  occurs  in  the  composition 
of  the  urine. 

THERAPY. — In  suitable  doses — 15  to  25  grains  of  the  extract— con- 
vallaria slows  the  heart-beats,  and  often  restores  the  normal  rhythm 
of  the  heart  when  disturbed,  increases  the  energy  of  the  cardiac  con- 
tractions, raises  the  arterial  tension,  and  at  the  same  time  the  respira- 
tory movements  acquire  increased  force  and  volume.  These  impor- 
tant therapeutical  effects  are  wrought  without  affecting  the  functions 
of  the  brain  and  spinal  cord.  It  is  also  a  prompt  and  certain  diuretic, 
increasing  the  discharge  of  all  the  urinary  constituents.  The  therapeu- 
tical indications  based  on  these  physiological  actions  are  the  follow- 
ing :  Palpitation,  disordered  rhythm,  or  vehement  action,  dependent  on 
impaired  function  of  the  pneumogastric,  or  on  hypertrophy  of  the  mus- 
cular walls  ;  narrowing  of  the  mitral  orifice  (mitral  stenosis)  or  insuf- 
ficiency of  the  mitral  valves,  with  stasis  in  the  venous  circulation,  with 
or  without  spasmodic  breathing  ;  dilated  heart,  with  or  without  fatty 
change  or  sclerosis  ;  in  all  cardiac  affections  accompanied  by  dropsy 
(See).  The  signal  advantage  which  it  offers  over  digitalis  is  the 
absence  of  danger  from  its  administration,  and  the  freedom  of  the 
cerebro-spinal  axis  and  the  digestive  organs  from  disturbance.  It 
has  now  been  used  in  the  maladies  above  mentioned  by  numerous 
observers  in  various  parts  of  the  world  ;  and,  although  the  reports  are 
not  uniformly  favorable,  there  can  be  no  doubt  that  we  have  in  con- 
vallaria an  important  addition  to  our  resources. 


STROPHANTHUS.  517 

Authorities  referred  to  : 

FERRAND,  DR.  G.  Sur  le  Muguet  [convallaria].  Annuaire  de  Therapeutique,  Bouchar- 
dat,  1 883,  p.  13fi. 

JUK,  DR.     London  Medical  Record,  June  15,  1883. 

LANGLEBERT,  M.  ADOLPHE.  Note  sur  le  Convallaria  Ma'ialis.  Bull.  Gen.  de  Therap., 
vol.  ciii,  p.  74. 

MOCTARD-MARTIN,  DR.  Sur  la  valeur  de  Pextrait  de  Muguet  comme  medicament  diu- 
retique.  Bouchardafs  Annuaire  for  1883,  p.  132. 

SEE,  PROF.  GERMAIN.  Recherches  experimentales  sur  le  Muguet  (Convallaria  Ma'ialis). 
Bull.  Gen.  de  Therapeutique,  vol.  ciii,  p.  49. 

TANRET,  C.  Ibid.,  vol.  cii.  Convallamarine,  principe  actif  de  Muguet  (Convallaria 
Ma'ialis). 

TROITZKT  AND  BOJOJAWLENSKY.  Wratch  47  and  49.  Annuaire  de  Therapeutique, 
1883,  p.  127. 

Strophanthus. — (The  Kombe"  arrow-poison.)  The  seeds  of  Stro- 
phanthus  his2)idus  De  Candolle  (Nat.  Ord.  Apocynacece). 

COMPOSITION  AND  PROPERTIES. — The  active  constituent  of  stro- 
phanthus  is  a  glucoside,  to  which  the  name  strophanthin  has  been 
given.  It  is  contained  in  largest  proportion  in  the  seeds — from  eight 
to  ten  per  cent.  The  dose  is  y^-  to  -fa  grain. 

Strophanthin  is  crystallizable,  slightly  acid  in  reaction,  freely  solu- 
ble in  water  and  in  alcohol,  but  insoluble  in  ether,  chloroform,  and 
benzine. 

Tinctura  Strophanthi. — Tincture  of  Strophanthus.  Strophanthus 
in  Xo.  30  powder,  50  grm.  ;  alcohol  and  water,  of  each  a  sufficient 
quantity  to  make  up  to  1,000  c.  c.  Dose :  the  initial  quantity 
may  range  from  one  minim  to  ten  minims,  according  to  the  man- 
ner of  giving  it.  To  maintain  a  uniform  action,  the  initial  dose 
may  be  larger,  and  the  impression  continued  by  small  doses  at  short 
intervals. 

An  extract  may  be  prepared  by  evaporation  of  the  tincture,  after 
the  method  of  Rice.  By  a  committee  of  the  United  States  Pharma- 
copoeia Revision,  experiments  were  made  with  the  extract  and  tinc- 
ture, and  also  with  strophanthin,  confirmatory  of  the  observations  of 
Rothziegel  and  Koralzewski,  who  had  previously  found  that  the  glu- 
coside was  most  active  ;  but  the  physiological  actions  are  the  same. 

Strophanthin  can  be  administered  subcutaneously  by  means  of  a 
solution  of  one  grain  to  the  ounce  of  chloroform  water.  Five  minims 
contain  about  T^-g-  grain.  Such  a  solution  will  remain  sterile  for  at 
least  several  days. 

ACTIONS  AND  USES. — Strophanthus  is  bitter  in  taste,  and,  like  many 
other  bitters,  promotes  appetite  and  digestion.  It  is  not  irritating  to 
the  stomach,  and  apparently  does  not  cause  nausea.  The  property  for 
which  it  is  now  introduced,  however,  is  the  more  important  one — that 
of  cardiac  tonic.  Strophanthus  slows  the  heart-beat,  lengthens  the  in- 


518  EXCITO-MOTORS. 

terval  between  the  contractions,  and  increases  the  energy  of  the  cardiac* 
muscular  tissue.  The  arterioles  are,  to  some  extent,  acted  upon,  and 
contract  ;  but  the  rise  of  the  blood-pressure  is  due  more  especially  to 
the  increased  power  of  the  cardiac  contractions.  The  action  of  the 
heart  is  arrested  in  the  diastole. 

In  consequence  of  the  slower  movement  of  the  heart  and  the  less- 
ened caliber  of  the  peripheral  vessels,  the  quantity  of  blood  distributed 
in  a  given  time  is  relatively  diminished  ;  hence  the  consumption  of 
oxygen  is  smaller,  and  the  activity  of  the  combustion-process  corre- 
spondingly depressed.  Strophantus  is  therefore  an  antipyretic  within 
a  quite  limited  range.  Some  diuretic  power  is  also  attributed  to  it. 

On  the  foregoing  physiological  data  the  therapeutical  properties 
are  based.  It  has  been  prescribed  with  very  distinct  good  effect  in 
cases  of  mitral  disease  not  compensated.  Like  digitalis,  it  lessens  the 
ischsemia  of  the  arteries,  and  increases  the  rate  of  movement  of  the 
blood  in  the  veins  ;  but,  unlike  digitalis,  it  does  not  much  affect  the 
caliber  of  the  arterioles,  and  consequently  does  not  so  much  increase  the 
work  of  the  heart  by  contracting  them.  If  these  valuable  observations, 
which  we  owe  to  Prof.  Fraser,  be  entirely  confirmed  by  future  inves- 
tigations, strophantus  will  largely  supersede  digitalis  in  mitral  lesions 
with  its  attendant  disturbances. 

Strophantus  does  not  have  a  cumulative  action,  it  is  said  ;  but 
that  must  depend  on  the  frequency  of  administration,  for  if  the  doses 
are  given  at  such  a  rate  that  the  effects  of  one  have  not  ceased  before 
another  is  administered,  clearly  some  accumulation  of  power  must  take 
place. 

Sparteine. — As  a  member  of  that  group  of  which  digitalis  has  so 
long  been  the  chief,  it  well  deserves  attentive  consideration. 

Sparteince  Sulphas. — Sulphate  of  sparteine.  A  neutral  sulphate  of 
an  alkaloid  obtained  from  Scoparius.  Occurs  in  colorless,  white,  pris- 
matic crystals,  or  a  granular  powder,  odorless  and  having  a  slightly 
saline  and  somewhat  bitter  taste.  Very  soluble  in  water  and  in  alcohol. 

HISTORY  AND  PROPERTIES. — Sparteine  was  discovered  so  long  ago 
as  1856  by  Stenhouse,  but  it  was  not  until  1883  that  it  was  taken  up 
for  examination.  It  is  a  liquid  alkaloid,  contains  no  oxygen,  its  for- 
mula being  CsoHggNgj,  and  it  has  strong  basic  qualities,  combining 
readily  with  acids  to  form  salts.  The  sulphate,  which  is  crystal- 
lizable,  dissolves  freely  in  water,  while  the  alkaloid  itself  is  entirely 
insoluble. 

The  dose  of  the  sulphate  of  sparteine  is  from  gr.  ss.  to  gr.  ij.  This 
salt  crystallizes  in  rhomboidal  plates,  and,  as  it  is  so  readily  soluble  in 
water,  it  can  be  administered  subcutaneously  or  by  the  stomach,  as 
circumstances  may  require. 

ACTIONS,  PHYSIOLOGICAL  AND  THERAPEUTICAL. — The  physiological 


SPARTEINE.  519 

actions  of  sparteine  were  first  studied  by  Mills  in  1863,  and  by  Fick 
in  1870,  afterward  by  Rymon  in  Yulpian's  laboratory,  by  Laborde 
and  Legris,  by  Gluzinski  and  others,  and  its  therapeutical  applications 
have  been  illustrated  by  Voigt  in  Nothnagel's  clinic,  and  by  Prof. 
See.  From  these  various  sources,  and  from  his  personal  investigations, 
the  author  has  formulated  his  conceptions  of  the  real  place  which  spar- 
teine should  occupy  as  a  remedy. 

The  salts  of  sparteine  are  bitter,  but  not  irritating  to  the  stomach, 
and  apparently  have  the  tonic  action,  the  power  to  improve  appetite 
and  digestion,  common  to  the  bitters.  Unlike  digitalis,  sparteine  acts 
within  an  hour  or  two  (Laborde,  Voigt)  after  it  is  taken,  the  charac- 
teristic impression  on  the  heart  being  made.  It  more  truly  deserves 
the  title  of  "  heart-tonic  "  than  any  other  remedy.  Irregularity  in 
rhythm,  inequality  in  the  force  of  the  contractions,  are  almost  imme- 
diately corrected,  and  the  action  is  lasting  as  well  as  thorough.  It  is 
especially  in  derangement  of  the  motor  apparatus  of  the  heart,  with 
weakness  and  irregularity  of  the  pulse,  that  sparteine  affords  relief  in 
an  hour  or  two,  when  digitalis  would  require  a  day  or  two  to  accom- 
plish the  same  result.  So  small  a  dose  as  one  half  a  grain,  as  a  rule, 
brings  about  the  result  above  described,  and  the  effect  persists  twelve 
to  twenty-four  hours,  although  a  single  dose  had  been  given.  The 
special  conditions  in  which  it  is  most  useful  are  weakness  of  the  right 
heart  and  incompetence  of  its  valves,  and  in  lesions  and  functional  de- 
rangement of  the  mitral  (see  Voigt  and  others).  That  the  curative 
results  obtained  by  the  use  of  sparteine  are  not  hampered  by  gastric 
disorder  is  another  proof  of  its  superiority  to  digitalis. 

If  digitalis  is  to  be  administered  in  cases  of  mitral  disease  and 
prompt  action  is  necessary,  sparteine  performs  a  valuable  function, 
for  if  at  once  given  the  heart  is  relieved,  and  the  relief  continues  until 
digitalis  has  had  time  to  act.  Laborde  and  Legris,  Rymon,  Gluzinski, 
and  others  from  the  experimental  standpoint,  and  Vulpian,  Huchard, 
Voigt,  and  others  from  the  clinical,  conclude  that  sparteine  is  the  first 
of  the  remedies  now  available  as  a  "  heart-tonic,"  and  as  a  regulator 
of  the  cardiac  rhythm  when  disordered  in  function  merely,  and  when 
due  to  lesions  of  the  heart-muscle  or  valves. 

Sparteine  has  no  "  cumulative  action  "  in  the  sense  in  which  that 
phrase  is  applied  to  digitalis.  In  summing  up  their  observations  La- 
borde and  Legris  assert  that  in  all  cases  of  weak  heart  with  asthenia, 
whether  or  not  organic  lesions  exist,  sparteine  is  the  appropriate 
remedy,  and  they  do  not  know  of  any  proper  centra-indications,  as  it 
agrees  well  with  the  stomach,  and  has  no  injurious  effect  on  the  cere- 
bro-spinal  nerves. 

Adonidin. — The  active  principle — a  glucoside — of  Adonis  vernalis, 
a  member  of  the  Ranunculacece. 


520  EXCITO-MOTORS. 

PROPERTIES. — Adonidin  is  an  amorphous  substance,  without  odor, 
colorless,  and  intensely  bitter.  It  is  soluble  to  a  very  trivial  extent 
in  water,  but  is  freely  soluble  in  alcohol.  The  dose  of  adonidin  is  one 
eighth  to  one  half  grain,  and  the  best  form  for  administration  is  the 
compressed  pellet  or  granule. 

The  first  study  of  adonidin  was  made  by  Bubnow  in  Prof.  Botkin's 
laboratory  ;  but  he  failed  to  isolate  the  active  principle,  which  was 
subsequently  accomplished  by  Cervello,  of  Strasburg. 

ACTIONS  AND  USES. — Although  there  are  differences  of  opinion  on 
this  point,  it  is  probable  that  adonidin,  in  many  subjects,  causes  nau- 
sea, vomiting,  and  diarrhoea  (Leyden).  The  chief  function  for  which 
it  has  been  used  in  medicine  is  as  a  substitute  for  digitalis.  It  slows 
the  heart,  lengthens  the  interval  between  the  beats,  and  raises  the 
general  vascular  tension  by  contracting  the  arterioles.  It  has  also  con- 
siderable diuretic  power,  increasing  the  flow  of  water  and  of  solids 
(Lublinski). 

Adonidin  acts  more  quickly  and  also  more  powerfully  than  digi- 
talis, and,  in  some  instances,  it  has  seemed  to  have  more  curative 
power.  To  begin  the  action  before  digitalis  has  had  time  to  act,  to 
supply  its  place  in  cases  of  idiosyncrasy,  and  to  form  combinations 
when  the  action  of  each  is  supplemented,  are  the  various  conditions 
vhich  justify  the  use  of  adonidin. 

Authorities  for  strophantus,  sparteine,  and  adonidin  : 

ALTMANN,  DR.  -Semaine  Med.  Abstract  in  Annuaire  de  Therap.  for  1886.  (Substi- 
tutes for  digitalis.) 

BUBXOW,  PR.  Adonidin.  Abstract  in  Centralblatt  fur  die  gesammte  Therapie  for 
1885. 

CERVELLO,  V.  DR.     Archiv  fur  experimentelle  Pathologic  und  Pharmacologie,  vol.  xv. 

DURAND,  DR.  These  de  Parit,  1886.  (On  Adonidin.)  Annuaire  de  Therapeutique 
for  1886. 

ERASER,  PROF.  THOMAS  R.  The  British  Med.  Journal,  January  22,  1887.  (Stro- 
phantus.) 

GLUZINISKI,  DR.     (Sparteine.)    Note  in  Lancet  of  February  19,  1887. 

LABORDE  ET  LEGRIS,  DBS.  Archives  de  Physiol.  Normaleet  Pathologique,  May,  1886. 
(Sparteine.) 

LEYDEN,  PROF.  DR.     Annuaire  de  Therap.,  1886.     (Sparteine,  etc.) 

LUBLINSKI,  DR.     Ibid. 

SEE,  PROF.  DR.     Bull.  Gen.  de  Therap.    Various  numbers  for  1885,  1886,  and  1887. 

Cimicifuga. — Black  snake-root.  The  rhizoma  and  rootlets  of  Cimi* 
cifuga  racemosa  Elliott  (Nat.  Ord.  Ranunculacece). 

Extraetum  Cimicifugce  Fluidum. — Fluid  extract  of  cimicifuga. 
Dose,  3  ss —  3  ij. 

Tinctura  Cimicifugce. — Tincture  of  cimicifuga.    Dose,  3  ss  —  3  ij. 

COMPOSITION. — When  fresh,  the  root  contains  a  volatile  oil,  which 
possesses  in  a  high  degree  the  characteristic  odor  of  the  drug. 
A  true  active  principle  has  not  yet  been  isolated,  yet  Conard  has 


CIMICIFUGA.  521 

obtained  a  neutral  substance,  crystallizable,  and  having  a  very  acrid 
taste.  The  so-called  cimicifugin  is  nothing  more  than  an  impure 
resin,  obtained  by  precipitation  from  the  tincture  by  the  addition  of 
water.  The  root  contains  resin,  coloring  matters,  tannic  and  gallio 
acids. 

ANTAGONISTS  AND  INCOMPATIBLES. — As  the  preparations  of  cimici- 
fuga  contain  tannic  and  gallic  acids,  they  are  incompatible  with  the 
salts  of  iron.  Stimulants,  as  alcohol,  ammonia,  antagonize  cimicifuga 
therapeutically. 

SYXEBGISTS. — In  its  action,  although  feeble,  cimicifuga  lies  between 
digitalis  and  ergot.  Its  physiological  effects  are  increased  by  cold, 
digitalis,  ergot,  belladonna,  etc. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  cimicifuga  is  bitter  and 
astringent,  with  an  after  acrid  feeling.  In  small  doses,  without  pro- 
ducing any  sensible  physiological  effect,  it  promotes  the  appetite  and 
digestion.  In  full  doses  it  increases  the  gastro-intestinal  secretions. 
On  the  heart  and  circulatory  system,  cimicifuga  has  an  action  not  un- 
like digitalis,  but  less  powerful :  it  slows  the  heart-beats  but  increases 
their  force,  and  elevates  the  tension  of  the  arterial  system.  Its  effects 
on  the  nervous  system,  when  administered  in  large  doses,  are  very  de- 
cided. It  causes  vertigo,  dilated  pupils,  and  in  many  subjects  consid- 
erable soporific  and  anodyne  effects.  There  is  little  doubt  that  it 
increases  the  contractility  of  unstriped  muscular  fiber  in  a  manner 
that  resembles  ergot,  but  much  less  energetically.  It  stimulates  the 
venereal  appetite  in  man,  and  promotes  the  menstrual  flow  in  women. 
Diaphoresis  and  increased  bronchial  secretion  are  produced  by  it,  and 
the  urine  possesses  a  distinct  odor  of  the  drug. 

In  order  to  procure  physiological  effects  from  cimicifuga,  it  is 
essential  that  preparations  made  from  the  fresh  root  be  employed. 

THERAPY. — Cimicifuga  is  an  excellent  stomachic  tonic,  and  is  espe- 
cially adapted  to  the  treatment  of  the  irritative  dyspepsia  of  drunk- 
ards. In  fevers  and  inflammatory  disorders,  when  the  action  of  the 
heart  is  quick  and  the  tension  of  the  vessels  low,  cimicifuga  may 
take  the  place  of  digitalis,  but  it  is  much  less  efficient  than  the  lat- 
ter. It  is  an  excellent  expectorant,  useful  in  bronchitis  and  in  neuro- 
pathic pulmonary  disorders.  $  Ext.  cimicifugae,  fl.  |  ss ;  tinct.  opii 
deod.,  3  j  ;  syrup,  tolu.,  3  xj.  M.  Sig. :  A  teaspoonful  every  four 
hours.  This  combination  is  efficacious  in  acute  catarrh  (common  cold), 
and  in  acute  bronchitis  after  the  more  active  symptoms  have  subsided. 
Good  results  have  been  obtained  from  cimicifuga  in  phthisis.  It 
would  be  idle  to  claim  that  it  is  curative  ;  but,  to  moderate  hectic,  to 
improve  the  appetite,  and  to  facilitate  expectoration,  it  is  undeniably 
of  service.  It  is  in  that  form  of  phthisis  now  called  caseous  pneumo- 
nia that  cimicifuga  can  be  expected  to  relieve  symptoms,  and  not  in 
tuberculosis. 


522  EXCITO-MOTORS. 

Dilated  heart,  fatty  heart,  languid  circulation,  oppressed  breath- 
ing, general  dropsy,  are  conditions  in  which  cimicifuga  takes  the 
role  of  digitalis,  and  although  less  efficient,  is  safer,  especially  in  the 
case  of  fatty  heart. 

Most  favorable  reports  have  been  made  of  cimicifuga  in  acute  rheu- 
matism. Chronic  rheumatism,  with  tumefaction  of  the  joints,  lum- 
bago, intercostal  pain,  and  myalgia,  are  disorders  affecting  the  mus- 
cular system,  in  which  this  drug  sometimes  succeeds  in  a  wonderful 
manner  ;  yet  it  very  often  fails,  and  we  are,  unfortunately,  unable  to 
indicate  beforehand  the  particular  kind  of  cases  in  which  it  is  most 
beneficial. 

The  power  of  cimicifuga  to  relieve  certain  kinds  of  pain  is  well 
established.  Neuralgia  of  the  fifth,  arising  from  cold,  rheumatic  head- 
ache, ovarian  neuralgia,  succeeding  to  suppressed  or  arrested  menstru- 
ation, etc.,  are  forms  of  pain  in  which  this  remedy  is  frequently  very 
effective. 

Puerperal  mania,  hypochondriasis,  and  convulsions,  due  to  men- 
strual irregularities,  have  been  cured  by  cimicifuga.  The  greatest 
successes  of  this  drug  have  been  achieved  in  chorea.  It  is  useful  in 
those  cases  which  arise  about  the  period  of  puberty,  and  are  connected 
with  disorders  or  perversions  of  the  menstrual  flow. 

Cimicifuga  relieves  the  pains  of  dysmenorrhcea  when  of  the  con- 
gestive variety.  Seat  of  head,  flushings  of  the  face,  pain  in  the  head, 
back,  and  limbs,  quick  pulse,  and  nervousness,  when  due  to  arrest  of 
the  monthly  flow,  are  often  remarkably  benefited  by  this  agent.  It  has 
been  used  to  promote  parturient  pains,  to  induce  uterine  contractions 
after  delivery,  and  to  relieve  after-pains,  but  it  is  inferior  to  ergot  for 
most  of  these  purposes.  It  is  serviceable  in  subinvolution  of  the  uterus, 
and  may  be  given  in  combination  with  ergot. 

The  aphrodisiac  effects  of  cimicifuga  render  it  useful  in  sperma- 
torrhcea.  It  is  not  adapted  to  physiological  spermatorrhoea,  which  is 
really  a  condition  of  normal  plethora,  but  to  those  cases  in  which  the 
organs  are  relaxed,  the  erections  weak,  and  the  seminal  discharges 
feeble  and  occur  on  slight  excitement. 

To  obtain  curative  effects  from  cimicifuga,  it  must  be  adminis- 
tered in  sufficiently  large  doses  to  produce  some  of  its  cerebral 
or  other  physiological  actions. 

Authorities  referred  to  : 

DAVIS,  DR.  N.  S.     Transactions  of  the  American  Medical  Association,  i.  352. 
HILDRETH,  DR.     American  Journal  of  Medical  Sciences,  October,  1842. 
PHILLIPS,  DR.  CHARLES   D.  F.     Materia  Medico  and   Therapeutics,  London,  1874^ 
p.  39. 

PORCHER,  DR.  FRANCIS  P.     Resources  of  the  Southern  Fields  and  Forests,  p.  18, 
RINGER,  DR.  SYDNEY.     Handbook  of  Therapeutics,  article  Actcea. 
STILLE,  DR.  ALFRED.     Therapeutics  and  Materia  Medica,  vol.  ii,  p.  662. 


BELLADONNA.  523 

Belladonna. — Deadly  nightshade. 

Belladonnce  Folice. — Belladonna-leaves.  The  leaves  of  Atropa 
belladonna  Linne  (Nat.  Ord.  Solanacece),  U.  S.  P.  Feuilles  de  bella- 
done,  Fr.  ;  Tollkraut,  Ger. 

Belladonnce  Radix. — Belladonna-root.  The  root  of  Atropa  bel- 
ladonna, as  above.  Racine  de  belladone,  Fr.  ;  Belladonnawurzel, 
Ger. 

Emplastrum  Belladonnce. — Belladonna-plaster.  (Belladonna-root 
and  resin-plaster.) 

Extractum  Belladonnas. — Extract    of  belladonna.     Dose,  gr.  \ — 

gr- j- 

Extractum  Belladonnce  Alcoholicum. — Alcoholic  extract  of  bella- 
donna. Dose,  gr.  \ — gr.  j.  Prepared  from  the  leaves. 

Extractum  Belladonnce  Fluidum. — Fluid  extract  of  belladonna. 
Dose,  m  j — Til  v.  Prepared  from  the  root. 

Tinctura  Belladonnce. — Tincture  of  belladonna.  Prepared  from 
the  leaves.  Dose,  tit  v —  3  ss. 

COMPOSITION. — Belladonna  contains  a  peculiar  alkaloid,  atropine, 
on  the  presence  of  which  the  physiological  activity  of  the  drug  de- 
pends. This  principle  is  found  chiefly  in  the  bark  of  the  root,  and  of 
young  root.  Another  principle  has  also  been  discovered  analogous  to 
atropine,  to  which  the  name  belladonnine  has  been  given.  Ladenburg 
has  shown  that  belladonnine  is  identical  with  the  active  principle  of 
hyoscyamus,  or  hyoscyamine.  It  is  identical  with  atropine  in  compo- 
sition, and  can  only  differ  in  the  arrangement  of  its  molecules.  The 
root  also  contains  a  fluorescent  substance  and  a  coloring  matter,  which 
has  been  called  atrosin.  Atropine  exists  in  the  plant  in  combination 
with  malic  acid  as  bimalate. 

Atropina. — Atropine.  Is  in  yellowish-white,  silky,  prismatic  crys- 
tals, without  smell,  but  having  a  bitter  and  acrid  taste.  It  is  soluble 
in  three  hundred  parts  of  water  at  60°  Fahr.,  in  twenty-five  parts  of 
ether,  and  in  much  less  alcohol.  It  has  a  strong  alkaline  reaction,  and 
forms  crystallizable  salts  with  acids. 

Atropince  Sulphas. — Sulphate  of  atropine.  Is  a  white,  crystal- 
line powder,  very  soluble  in  water  and  in  alcohol.  Dose,  gr.  Tfg — 

gr-TfV 

Atropince  Salicylas,  Atropince  Hydrobromas. — The  salicylate  and 
hydrobromate,  especially  the  former,  are  preferred  to  the  sulphate  by 
many  ophthalmologists. 

ANTAGONISTS  AND  INCOMPATIBLES. — Caustic  alkalies  act  on  atro- 
pine, and  ammonia  is  evolved  ;  they  are,  therefore,  incompatible  with 
the  preparations  of  belladonna.  As  respects  physiological  antagonism, 
pilocarpus  and  physostigma  counterbalance  the  actions  of  belladonna 
in  almost  the  whole  range  of  its  influence,  and  opium — within  certain 


524  EXCITO-MOTORS. 

limitations  to  be  hereinafter  described — prevents  the  respiratory  fail- 
ure, the  cause  of  death. 

PHYSIOLOGICAL  ACTIONS. — Dryness  of  the  mucous  membrane  of 
the  nose,  mouth,  throat,  and  larynx,  is  produced  by  the  direct  appli- 
cation of  atropine  to  these  parts,  and  the  same  effects  in  a  more 
positive  manner  follow  the  stomach  or  subcutaneous  administration. 
A  peculiar  bluish  appearance  of  the  lips,  as  well  as  dryness,  the 
author  has  frequently  observed.  Nausea  is  occasionally  produced 
by  belladonna,  but  this  effect  is  probably  due  to  cerebral  disturb- 
ance. Dryness  of  the  mucous  membrane  of  the  stomach  and  intes- 
tines is  doubtless  produced  by  belladonna,  but  increased  secretion 
occurs  subsequently,  for  the  stools  are  rendered  more  liquid,  and  are 
also  voided  more  frequently.  Increased  peristalsis  is  most  probably  a 
result  of  the  action  of  belladonna  on  the  unstriped  muscular  fiber  of 
the  intestines. 

The  active  principle  of  belladonna  (atropine)  is  an  extremely  dif- 
fusible substance.  What  changes  it  induces  in  the  blood,  if  any,  are 
not  known.  It  affects  the  circulation  in  a  remarkable  manner.  In 
some  subjects  a  decided  slowing  of  the  heart  takes  place  immedi- 
ately after  the  administration  of  a  considerable  dose  (atropine  hy- 
podermatically)  and  in  all,  most  probably,  an  instantaneous  retarda- 
tion of  the  pulse-rate,  but  a  very  decided  rise  in  the  number  of  pul- 
sations quickly  follows.  Not  only  is  the  number  of  the  heart-beats 
increased,  but  their  vigor  also,  and  the  area  over  which  the  pulsa- 
tions are  distributed  is  enlarged.  It  has  been  conclusively  shown 
that  the  increased  action  of  the  heart  is  due,  first,  to  stimulation  of 
the  cardiac  ganglia  of  the  sympathetic,  and,  secondly,  to  a  paralyzing 
action  on  the  pneumogastric  terminal  filaments.  In  other  words,  the 
motor  power  of  the  heart  is  increased  in  activity,  and  the  inhibiting 
control  is  lessened. 

The  stimulation  of  the  vaso-motor  centers  by  belladonna,  or  atro- 
pine, causes  a  general  rise  of  blood-pressure  owing  to  contraction  of 
the  arterioles.  This  action  of  atropine  rapidly  produces  a  state  of 
over-excitation,  and  the  irritability  of  the  vaso-motor  nervous  system, 
at  first  increased,  soon  diminishes  ;  the  action  of  the  heart  becomes 
weak,  the  vessels  dilate,  and  the  blood-pressure  falls  below  the  normal. 
In  large  medicinal  doses  this  effect  is  easily  seen,  and,  in  lethal  doses 
in  animals,  it  may  be  most  certainly  demonstrated. 

As  regards  the  function  of  respiration,  atropine  increases  the  num- 
ber and  depth  of  the  respiratory  movements,  but  the  increase  is  not  in 
the  same  ratio  as  is  the  elevation  of  the  pulse-beat.  The  more  rapid 
action  of  the  heart,  the  increased  respiratory  movements,  the  contrac- 
tion of  the  arterioles,  result  in  an  increased  supply  of  blood  to  the 
periphery,  more  rapid  nutritive  changes,  and  consequent  elevation  of 
temperature.  The  rise  in  temperature  in  man,  from  a  full  medicinal 


BELLADONNA.  525 

dose,  is  from  \°  to  1°  Fahr.  This  increased  body-heat  is  not  long 
maintained  ;  with  the  fall  in  the  blood-pressure  (vaso-motor  paresis), 
there  ensues  a  diminution  in  temperature. 

In  persons  of  a  light  complexion,  more  especially  in  women,  a  full 
dose  of  atropine  is  frequently  followed  by  a  diffused  redness  of  the 
skin,  not  unlike  the  rash  of  scarlatina,  but  wanting  in  the  punctated 
character  of  this  specific  eruption.  Redness  of  the  fauces,  and  some 
difficulty  of  swallowing,  owing  to  the  dryness  of  the  mucous  mem- 
brane, occur  at  the  same  time,  rendering  the  similitude  to  scarlet  fever 
very  striking.  The  flush  of  atropine  succeeds  to  a  marked  but  tem- 
porary pallor,  which  is  the  first  effect,  and  is  a  symptom  of  the  vaso- 
motor  paresis  which  succeeds  to  the  vaso-motor  stimulation.  The  bel- 
ladonna rash  is  sometimes  followed  by  desquamation. 

Dilatation  of  the  pupil  is  a  conspicuous  effect  of  atropine.  Whether 
dropped  into  the  eye,  introduced  into  the  stomach,  or  injected  under  the 
skin,  prompt  and  decided  dilatation  of  the  pupil  follows.  A  much 
smaller  quantity  suffices  to  produce  this  effect,  when  applied  directly 
to  the  eye.  Paresis  of  the  muscle  of  accommodation  is  caused  by 
atropine.  and  this  agent  also  lessens  the  intraocular  pressure.  It  has 
been  conclusively  shown  that  atropine  produces  these  remarkable 
effects  by  an  action  on  the  peripheral  filaments  of  the  nerves  of  the 
iris,  and  not  on  its  muscular  fibers  ;  atropine  paralyzes  the  oculo-motor 
nerve  end-organs,  and  stimulates  those  of  the  sympathetic. 

The  cerebral  effects  of  belladonna  are  very  characteristic.  Head- 
ache, vertigo,  illusions,  hallucinations,  a  busy  delirium,  sometimes 
somnolence,  are  produced  by  large  doses.  The  vision  is  usually  lost, 
the  pupils  are  dilated  to  the  utmost,  the  eyes  are  brilliant  and  staring. 
Muscular  weakness,  inco-ordination,  and  complete  motor  paralysis  oc- 
cur ;  but  sensation  is  not  destroyed  ;  although  occupied  with  fancies 
and  illusions,  the  patient  may  be  indifferent  to  moderate  irritation. 
The  delirium  which  occurs  has  a  peculiar  character  :  it  may  be  gay 
and  laughing,  or  busy,  the  patient  being  incessantly  occupied  with  a 
single  object  or  idea  ;  or  it  may  be  noisy  and  furious,  the  patient  fight- 
ing and  striking  all  who  approach.  In  lethal  doses  convulsions  may 
occur,  or  profound  stupor  may  result  after  a  period  of  delirious  excite- 
ment. 

The  voluntary  muscles  are  not  affected  by  belladonna.  The  mus- 
cular paresis  which  results  from  the  administration  of  this  drug  is  due 
to  its  action  on  the  motor  nerves,  but  the  excitability  of  these  nerves 
is  diminished  only,  and  not  wholly  destroyed.  Both  the  motor-nerve 
trunks  and  the  end-organs  are  affected.  The  sensibility  of  the  sensory 
nerves  is  also  impaired,  but  is  not  diminished  to  the  same  extent  as  is 
that  of  the  motor  nerves. 

Although  the  action  of  belladonna  is  so  largely  paralyzant,  it  is 
not  exclusively  so,  and,  under  certain  circumstances,  a  tetanic  action 


526  EXCITO-MOTORS. 

very  similar  to  that  caused  by  strychnine  is  developed.  In  frogs,  a 
day  or  two  after  the  induction  of  paralysis  by  the  subcutaneous 
injection  of  atropine,  the  tetanic  state  occurs.  When  this  state  is 
reached,  although  the  frog  lies  perfectly  limp  and  motionless  if  un- 
disturbed, an  irritation  applied  to  the  periphery  will  at  once  cause 
general  tetanic  rigidity  a"nd  spasms.  The  author  was  the  first  to 
show  that  this  condition  of  the  nervous  system  is  attained  in  frogs 
an  hour  or  two  after  the  conjoined  administration  of  atropine  and 
physostigma  (eserine). 

Atropine,  by  virtue  of  the  greater  than  normal  transmission  of 
blood  through  the  tissues,  increases  metamorphosis,  and  the  results 
of  this  are  represented  in  an  increased  elimination  of  the  products 
of  waste. 

Atropine  is  eliminated  chiefly  by  the  urine,  and  the  urine  of  an 
atropinized  animal  will  dilate  the  pupil  of  another  animal. 

THERAPY. — In  mercurial  ptyalism,  and  the  ptyalism  of  the  preg- 
nant state,  a  few  drops  (five  to  ten)  of  the  tincture  of  belladonna, 
given  every  four  to  six  hours,  or  a  corresponding  quantity  of  atropine, 
will  cause  the  excessive  secretion  to  diminish,  and  even  dry  up,  and 
will  thus  relieve  a  very  disagreeable  symptom.  Gastralgia,  as  well  as 
the  pain  which  accompanies  gastric  ulcer,  is  often  happily  relieved  by 
atropine.  3  Atropinae  sulphatis,  gr.  j  ;  zinci  sulphatis,  3  ss ;  aquae 
destil.,  3  j.  M.  Sig.  :  From  three  to  five  drops  twice  or  thrice  a  day. 
A  similar  combination  is  very  effective  in  pyrosis,  chronic  gastric  ca- 
tarrh, and  irritative  dyspepsia.  Atropine  is  frequently  effective  in 
relieving  the  vomiting  of  pregnancy.  I£  Atropinse  sulphat.,  gr.  ij  ; 
aquae  destil.,  §  j.  M.  Sig.  :  Two  drops  in  water  before  meals.  It  is 
often  more  useful  when  applied  to  the  rectum  in  the  form  of  supposi- 
tory. It  sometimes  gives  great  relief  when  applied  to  the  epigastrium 
in  chloroformic  solution.  Jfr  Atropinae,  gr.  v  ;  chloroformi,  f  j.  M. 
Sig. :  A  piece  of  lint  to  be  moistened  with  the  solution  and  laid  on  the 
epigastrium. 

The  extract  of  belladonna  is  a  useful  addition  to  purgatives,  to  di- 
minish the  harshness  and  at  the  same  time  to  increase  the  effectiveness 
of  their  operation.  Belladonna  has  the  power  to  increase  the  peristal- 
tic movements  and  to  allay  irregular  or  spasmodic  movements.  It  is, 
therefore,  used  to  overcome  habitual  constipation.  A  pill  containing 
a  half -grain  of  extract,  taken  at  night,  will  sometimes  succeed,  but  it 
is  generally  better  to  combine  it  as  follows  :  $  Ext.  belladonnas,  ext. 
nucis  vomicae,  ext.  physostigmatis,  aa  gr.  iij.  M.  Ft.  pil.  no.  vj.  Sig.  : 
One  at  bed-hour.  An  addition  of  a  half-grain  of  aloin  will,  of  course, 
increase  the  action  of  this  pill,  and  may  be  added  when  there  are  great 
torpor  and  inaction  of  the  intestines. 

When,  in  affections  of  the  gastro-intestinal  apparatus,  acids  are  in. 
dicated  with  atropine,  they  may  be  combined  as  follows  :  R  Acid. 


BELLADONNA.  527 

muriat.  dil.,  §  j  ;  atropinse,  gr.  ss.  M.  Sig.  :  Five  drops  in  water 
before  meals.  Such  a  prescription  is  useful  in  heart-burn,  water- 
brash,  etc. 

Harley  advises  the  use  of  atropine  as  a  cardiac  stimulant  •  but  the 
fact  that  this  agent  exhausts  the  irritability  of  the  cardiac  ganglia 
after  a  period  of  excitement  requires  discrimination  in  its  use.  Not- 
withstanding this  objection,  atropine  may  be  given  to  counteract  a 
sudden  and  temporary  depression  in  the  heart's  action — as,  for  exam- 
ple, in  the  collapse  of  cholera,  in  which  it  has  been  employed  success- 
fully by  the  hypodermatic  method. 

Belladonna  is  a  remedy  of  great  efficacy  in  certain  acute  inflamma- 
tions of  the  air-passages.  No  remedy  gives  such  prompt  and  sustained 
relief  in  acute  nasal  catarrh  with  profuse  watery  secretion.  To  adults, 
the  best  method  of  administration  consists  in  giving  a  first  dose  of  five 
drops  of  the  tincture,  and  repeating  a  drop  or  two  drops  every  hour 
until  atropinism  is  produced.  This  remedy  is  also  very  admirably 
adapted  to  the  treatment  of  ordinary  sore-throat.  As  a  constant  phys- 
iological action  of  belladonna  is  redness  and  dryness  of  the  fauces,  its 
therapeutical  action,  in  sore-throat  with  increased  secretion,  is  anti- 
pathic or  substitutive  ;  or,  as  it  may  be  more  scientifically  expressed, 
the  action  of  belladonna  is  the  physiological  antagonist  of  the  disease- 
action.  When  there  is  much  fever  it  is  useful  to  combine  aconite  with 
belladonna.  $  Tinct.  aconiti  rad.,  3  j  ;  tinct.  belladonna,  3  ij.  M. 
Sig.  :  Four  drops  in  water  every  hour  or  two.  That  form  of  aphonia 
which  is  due  to  fatigue  of  the  vocal  cords  may  be  removed  very  speed- 
ily by  a  morning  and  evening  dose  (T^¥ — fa  of  a  grain)  of  atropine. 
Not  unfrequently  hysterical  aphonia  may  be  quickly  cured  in  the 
same  way. 

There  is  much  to  be  expected  from  the  use  of  belladonna  prepara- 
tions in  whooping-cough.  The  best  form  for  administration  is  a  solu- 
tion of  the  sulphate  of  atropine  (gr.  j —  f  j  of  water.  Dose,  til  ij — 
ni  iv).  This  remedy  is  not  adapted  to  all  cases,  and  is  most  effective  in 
the  spasmodic  stage.  In  order  to  be  curative,  physiological  effects 
must  be  produced.  The  good  results  of  atropine  in  whooping-cough 
are  most  obvious  in  those  cases  characterized  by  profuse  bronchial 
secretion. 

Belladonna  gives  great  relief  in  paroxysms  of  asthma,  and  in  the 
spasmodic  difficulty  of  breathing  which  accompanies  emphysema.  Ac- 
cording to  the  author's  observation,  when  the  bronchial  mucous  mem- 
brane is  deficient  in  secretion,  the  pulse  much  accelerated,  the  skin  dry 
and  hot,  belladonna  rather  adds  to  the  distress  ;  and  its  good  effects 
are  most  conspicuous  when  there  are  abundant  expectoration,  a  cool 
and  moist  skin,  and  a  quiet  pulse  of  low  tension.  In  asthma,  atropine 
may  be  injected  subcutaneously,  or  the  belladonna-leaves  be  used  by 
the  method  of  fumigation.  Belladonna-leaves,  dipped  in  a  saturated 


528  SXCITO-MOTORS. 

solution  of  niter  and  then  dried,  may  be  burned  in  a  close  apartment, 
the  patient  breathing  the  fumes  until  relief  is  obtained.  Pastiles  are 
made  of  belladonna,  stramonium,  poppy,  tobacco,  etc.  A  good  for- 
mula for  cigarettes  is  the  following  (Trousseau)  :  Belladonna,  grs.  v  ; 
stramonium  and  hyoscyamus,  of  each  grs.  iij  ;  extract  of  opium,  £  of 
a  grain ;  cherry-laurel  water,  a  sufficient  quantity.  The  leaves  are 
moistened  with  a  solution  of  the  opium  in  the  cherry-laurel  water,  and 
when  dry  made  into  a  cigarette.  Two  to  four  of  such  cigarettes  may 
be  smoked  daily.  When  the  paroxysms  of  asthma  occur  in  the  morn- 
ing, they  may  sometimes  be  prevented  by  the  one  sixtieth  of  a  grain 
of  atropine  at  bedtime. 

The  remarkable  similarity  in  the  symptoms  of  atropinism  and  of 
scarlatina  has  led  to  the  use,  by  homoeopathic  practitioners,  of  bella- 
donna as  a  prophylactic  against  this  disease.  The  points  of  resem- 
blance are  so  superficial,  and  the  differences  so  wide,  that  no  more 
striking  instance  could  be  adduced  of  the  uncertainty  in  the  applica- 
tion of  the  homo3opathic  dogma,  even  admitting  its  truth.  The  au- 
thor is  convinced  that  the  so-called  prophylactic  power  of  belladonna 
against  scarlatina  has  no  real  existence.  He  has  seen  too  many  cases 
of  scarlatina  occur  in  subjects  who  had  been  given  the  remedy  freely, 
to  permit  him  to  come  to  any  other  conclusion.  Belladonna  is  a  use- 
ful remedy  to  relieve  some  of  the  symptoms  in  scarlatina.  During 
the  stage  of  eruption  it  is  indicated  when  the  pulse  is  feeble,  the  bod- 
ily powers  are  depressed,  and  the  rash  is  imperfectly  evolved.  In  this 
condition  of  things — in  which  carbonate  of  ammonia  is  so  much  used — 
belladonna  also  renders  most  important  service  ;  but  it  should  not  be 
forgotten  that  these  agents  are  chemically  incompatible,  and  should 
not,  therefore,  be  prescribed  together. 

In  diphtheria,  when  there  is  much  depression,  belladonna  is  a  most 
excellent  remedy.  If  given  before  the  exudation  has  spread  and  con- 
solidated into  membranous  plaques,  and  when  a  few  patches  only  have 
appeared  on  the  tonsils,  or  soft-palate,  it  seems  to  have  the  power  to 
hinder  the  formation  of  the  exudation. 

There  is  no  doubt  that  belladonna  has  a  real  curative  power  in 
erysipelas.  It  is  especially  adapted  to  idiopathic  erysipelas,  notably 
to  facial  erysipelas,  and  is  less  serviceable  in  traumatic  erysipelas. 
Homceopathists  explain  this  on  the  doctrine  of  similars,  but  the  action 
is  really  one  of  antagonism,  or  substitution.  When  there  is  much 
fever,  digitalis  or  aconite  may  be  combined  with  belladonna  with  ad- 
vantage, and  when  there  is  much  depression,  quinine.  $  Quininae 
sulph.,  3  ss  ;  belladonnas  extract.,  grs.  iij .  M.  Ft.  pil.  no.  x.  Sig. : 
One  every  four  or  six  hours. 

Excellent  results  have  been  obtained  from  the  use  of  belladonna  in 
typhus  and  typhoid  fevers.  Graves  originally  suggested  an  indication 
for  its  use  in  fevers,  which  is  doubtless  serviceable,  viz.,  contracted 


BELLADONNA.  529 

pupils  ;  but  belladonna  has  been  used,  irrespective  of  this  sign,  by 
other  practitioners  with  great  success.  The  tincture  is  a  suitable 
preparation,  and  of  this  from  five  to  ten  drops  every  four  hours  is  a 
proper  dose.  According  to  the  author's  observation,  belladonna  is  in- 
dicated when  there  is  much  low,  muttering  delirium,  subsultus,  and 
stupor,  and  is  contraindicated  in  the  condition  of  delirium  ferox. 

Belladonna  has  important  application  in  the  treatment  of  certain 
disorders  of  the  nervous  system.  Sick-headache,  due  to  or  accom- 
panied by  spasm  of  the  arterioles — a  condition  manifested  by  pallor 
of  the  face,  vertigo,  and  tinnitus  auriuni — is  relieved  by  belladonna. 
At  first  the  distress  may  be  even  increased,  but  great  relief  presently 
follows.  This  remedy  is  injurious  in  the  congestive  form  of  sick- 
headache.  The  following  is  a  serviceable  combination  in  the  cases  of 
sick -headache  due  to  vaso-motor  spasm  :  $  Atropinae  sulph.,  gr.  ss  ; 
chinoidin,  3  j.  M.  Ft.  pil.  no.  Ix.  Sig. :  One  pill  twice  or  thrice  a 
day. 

Although  belladonna  in  the  physiological  state  induces  wakeful- 
ness  and  busy  delirium,  in  certain  morbid  states  of  the  brain  it  is  hyp- 
notic. The  indications  for  its  use  are  as  follows  :  prostration,  low 
state  of  the  arterial  tension,  languid  intra-cranial  circulation,  a  con- 
tracted pupil,  and  insomnia,  due  to  the  condition  of  the  brain  mani- 
fested by  these  objective  signs.  In  various  kinds  of  mental  disorder, 
in  which  the  foregoing  symptoms  are  present,  much  good  may  be  ex- 
pected from  the  use  of  belladonna  in  moderate  doses  ;  but  harm  only 
will  be  produced  by  it  when  there  is  much  vascular  excitement. 

Belladonna,  according  to  Trousseau  and  Pidoux,  is  a  more  efficient 
remedy  in  the  treatment  of  epilepsy  than  the  salts  of  silver,  copper,  or 
zinc.  They  insist  that  the  capital  condition  of  success  is  perseverance 
on  the  part  of  the  physician  and  patient,  that  belladonna  should  be 
given  steadily  for  a  year  in  gradually-increasing  doses,  and  that  if 
amendment  is  then  produced  it  should  be  continued  through  two, 
three,  or  even  four  years.  Belladonna  is  not  equal  to  bromide  of 
potassium  in  cases  of  diurnal  epilepsy,  in  epilepsy  accompanied  by 
cerebral  hyperaemia,  and  in  epileptiform  convulsions  due  to  coarse  or- 
ganic lesion  of  the  brain.  The  best  results  are  obtained  from  it  in 
nocturnal  epilepsy,  in  petit  mal,  and  in  pale,  delicate,  and  anemic  sub- 
jects, with  cold  hands  and  feet,  blue  skin,  and  weak  heart. 

In  neuralgia  belladonna  affords  relief,  although  not  equal  to  some 
other  agents.  Given  hypoder  medically  (see  post),  it  is  often  very  effec- 
tive. In  any  case,  its  use  must  be  persisted  in  ;  full  doses  are  neces- 
sary, and  physiological  effects  must  be  produced  and  maintained  for 
some  time.  A  solution  of  atropine  is  the  best  form  for  the  stomach 
administration.  Dysmenorrhoea,  when  neuralgic  in  character,  and 
ovarian  neuralgia,  may  be  permanently  removed  by  belladonna.  It 
is  useful  in  these  cases  to  combine  it  with  synergistic  remedies.  P> 
36 


530  EXCITO-MOTORS. 

Ext.  belladonnse,  grs.  iv  ;  ext.  stramonii,  grs.  v ;  ext.  hyoscyami,  grs. 
v;  quininse  sulphat.,  3ij.  M.  Ft.pil.no.  xx.  Sig. :  One  pitt  two  or 
three  times  a  day.  When  anaemia  exists,  iron  may  be  added  to  this 
formula. 

No  single  agent  has  been  as  uniformly  successful  in  the  treatment 
of  nocturnal  incontinence  of  urine  as  belladonna.  This  morbid  state 
is  due  to  several  conditions,  and  belladonna  is  not  equally  successful 
in  all  :  nocturnal  incontinence  may  be  due  to  an  excess  in  the  acidity 
of  the  urine,  which  renders  it  unduly  stimulating  ;  to  relaxation  of 
the  sphincter  vesicse  ;  to  an  irritability  of  the  mucous  membrane,  in 
consequence  of  which  erroneous  impressions  are  communicated  to  the 
brain.  Belladonna  gives  relief  in  the  two  last-named  conditions.  The 
atropine  dissolved  in  the  urine  acts  locally  on  the  nerves  of  the  mucous 
membrane,  diminishing  their  irritability  ;  the  sphincter  is  put  into  a 
state  of  tonic  contraction  by  reason  of  the  systemic  effect,  which 
includes,  of  course,  the  sympathetic  system.  The  error  is  often  com- 
mitted of  giving  too  little  of  the  remedy ;  systemic  effects  must  be 
produced,  and  children,  compared  with  adults,  are  insusceptible  to 
the  action  of  belladonna.  The  best  form  for  administration,  be- 
cause less  disagreeable  and  more  constant  in  effect,  is  a  solution  of 
atropine. 

Nocturnal  seminal  losses,  as  respects  mechanism  of  production, 
making  allowance,  of  course,  for  difference  of  seat,  have  a  strong 
analogy  with  nocturnal  incontinence  of  urine.  This  trouble  may  be 
considered  a  morbid  state,  only,  when  the  losses  are  frequent  and  affect 
the  health.  Bromide  of  potassium  best  relieves  spermatorrhoea,  so 
called,  when  it  is  largely  physiological  and  due  to  a  normal  plethora  ; 
belladonna  is  most  serviceable  when  the  genitalia  are  relaxed,  the 
emissions  flowing  without  force,  and  without  a  distinct  dream  and 
orgasm. 

Atropine  is  a  remedy  of  the  greatest  importance  in  the  practice  of 
ophthalmology.  As  it  dilates  the  pupil,  diminishes  the  intraocular 
pressure,  contracts  the  arterioles,  and  acts  topically  on  the  sentient 
nerves,  it  is  obvious  that  its  field  of  utility  is  wide,  and  its  therapeutic 
power  great. 

In  phlyctenular  keratitis  atropine  renders  the  greatest  service  ;  it 
diminishes  the  photophobia  and  blepharospasm,  and  lessens  the  blood- 
supply  by  contracting  the  vessels.  It  has  a  still  more  beneficial  action 
in  iritis ;  it  prevents  adhesions,  anterior  and  posterior,  and  by  dilata- 
tion of  the  pupil  so  compresses  the  vessels  as  to  jugulate  the  inflam- 
matory process.  When  the  cornea  is  perforated,  herniary  protrusion 
and  adhesion  of  the  iris  are  prevented  by  dilating  the  pupil.  For  these 
purposes  a  four-grain  solution  of  atropine  is  the  proper  strength  for  in- 
stillation into  the  eye.  When  it  is  desirable  to  suspend  the  power  of 
accommodation,  in  cases  of  hypermetropia  to  determine  the  refraction 


BELLADONNA.  531 

of  the  eye,  and  in  astigmatism  to  ascertain  the  difference  in  the  me- 
ridians, atropine  is  used.  A  weak  solution  only  is  employed,  to  dilate 
the  pupil  for  a  brief  period,  in  order  to  facilitate  the  examination  of 
the  fundus  of  the  eye.  Dilatation  of  the  pupil  with  atropine  is  also 
necessary  in  the  examination  of  cataract,  especially  in  the  early  stages 
of  its  formation.  It  should  be  remembered  that  strong  solutions  of 
atropine  instilled  into  the  eyes  may,  by  subsequent  absorption,  pro- 
duce atropinism,  and  to  such  an  extent  as  to  occasion  solicitude. 

In  certain  affections  of  the  skin  belladonna  is  useful — viz.,  in  the 
cutaneous  neuroses,  prurigo,  herpes  zoster,  erythema,  and  eczema,  etc. 
Cases  of  these  affections  which  resist  ordinary  treatment,  yield  to  bella- 
donna. The  tincture,  or  the  alkaloid,  in  suitable  doses,  may  be  given 
in  quantity  sufficient  to  maintain  a  slight  physiological  action.  Hyper- 
idrosis  (colliquative  sweating),  unilateral  sweating,  and  other  forms 
of  profuse  transpiration  through  the  skin,  are  arrested  by  the  internal 
and,  in  some  cases,  by  the  local  application  of  the  belladonna  prepara- 
tions, as  Ringer  has  shown. 

No  remedy  is  so  generally  effective  in  relieving  the  sweats  of 
phthisis  as  atropine.  The  one  sixtieth  of  a  grain  at  bedtime  usually 
suffices.  The  author  was  the  first  to  indicate  this  use  of  atropine  in  his 
"Prize  Essay."  Not  only  is  atropine  antagonistic  in  action  to  that 
condition  of  the  sudoriparous  glands  resulting  in  the  sweats  of  disease, 
but  it  equally  antagonizes  the  hyperidrosis  produced  by  such  drugs  as 
jaborandi. 

In  the  treatment  of  that  form  of  phthisis  known  as  caseous  pneu- 
monia, atropine  has  an  important  place,  quite  irrespective  of  its  power 
to  arrest  the  sweats.  As  Dr.  Fothergill,  of  London,  and  myself,  nearly 
simultaneously  ascertained,  it  has  an  influence  on  the  progress  of  these 
cases,  and  a  curative  effect  that  is  often  very  remarkable.  The  author 
has  observed  with  regret  that  some  of  those  who  have  found  this  rem- 
edy useless,  were  entirely  mistaken  as  to  the  character  of  the  cases  in 
which  atropine  has  proved  beneficial.  As  a  remedy  for  the  caseous 
inflammation,  without  regard  to  sweating,  the  period  when  the  degree 
of  benefit  above  referred  to  may  be  expected  from  it,  is  the  stage  of 
deposit  immediately  succeeding  the  stage  of  catarrhal  inflammation, 
and  before  softening  and  extrusion,  and  not  in  tuberculosis. 

HYPODERMATIC  USE  OF  ATROPINE. — The  solution  usually  employed 
for  this  purpose  is  two  grains  of  the  sulphate  of  atropine  to  an  ounce 
of  distilled  water,  the  dose  of  which  ranges  from  one  to  five  minims. 

There  are  two  forms  of  neuralgia  in  which  the  subcutaneous  use 
of  atropine  has  been  most  signally  useful :  tic-douloureux  and  sciatica, 
more  especially  the  latter.  Atropine  is  not  as  effective  in  the  treat- 
ment of  the  neuralgias  in  general  as  morphine,  and  the  systemic  effects 
of  the  former  are  much  more  unpleasant  than  those  caused  by  the  lat- 
ter. Nevertheless,  when  morphine  fails  or  disagrees  with  the  patient. 


532  EXCITO-MOTORS. 

atropine  may  be  used  with  confident  expectation  of  its  affording  re- 
lief. We  owe  to  Hunter  our  knowledge  of  the  fact  that  atropine  has 
a  very  special  utility  in  tic-douloureux  and  sciatica.  The  merely  sub- 
cutaneous injection  of  atropine  does  not  afford  the  same  degree  of 
relief  as  its  deep  injection  in  the  neighborhood  of  the  affected  nerve- 
trunk.  Furthermore,  a  decided  impression  must  be  made  on  the  cere- 
brum, in  order  to  obtain  the  best  results.  The  largest  doses  compati- 
ble with  the  safety  of  the  patient  must  be  used — generally  the  one 
fiftieth  of  a  grain  to  the  one  thirtieth.  If  the  remedy  is  employed  in 
sufficient  quantity,  and  well  inserted  into  the  tissues  above  the  nerve, 
decided  curative  results  may  be  expected  from  it  in  these  two  forms 
of  neuralgia.  When  relief  follows  the  injection  of  atropine,  it  is  apt 
to  be  more  permanent  than  when  the  same  degree  of  relief  is  obtained 
from  morphine.  We  have  the  high  authority  of  Dr.  Anstie  for  the 
assertion  that  atropine  is  exceptionally  serviceable  in  peri-uterine  and 
dysmenorrhoeal  neuralgia.  Dr.  Weir  Mitchell  asserts  that  atropine 
in  traumatic  neuralgias  is  "  simply  useless,"  and,  as  his  power  of  ac- 
curate observation  is  unquestioned,  and  his  clinical  opportunities  vast, 
we  may  accept  this  conclusion  as  final. 

Muscular  cramp,  from  injuries  to  the  nerve-trunk,  are  often  remark- 
ably relieved  by  injections  of  atropine  into  the  substance  of  the  affected ' 
muscles.  The  so-called  "late  rigidity,"  as  the  result  of  which  the 
members  may  be  put  into  very  injurious  positions,  is  occasionally  re- 
moved or  diminished  by  the  same  expedient — viz.,  injecting  a  small 
quantity  of  atropine  (-j-^-g-  of  a  grain)  into  the  contracted  muscles. 
This  result  does  not  ameliorate  the  condition  of  the  patient  to  any 
greater  extent  than  that  of  affording  relief  to  an  inconvenient  de- 
formity. 

The  insomnia  of  mental  disorders,  and  of  delirium  tremens,  may  be 
overcome  by  the  hypodermatic  injection  of  atropine  when  the  follow- 
ing indications  for  its  use  are  present  :  Coma  vigil,  great  restlessness, 
weak  action  of  the  heart,  coldness  of  the  surface,  cyanosis,  clammy 
sweat.  When  there  is  a  condition  of  hypersemia  of  the  cerebro-spinal 
centers,  excitement  with  elevated  pulse-rate  and  increase  of  arterial 
tension,  atropine  can  only  do  harm. 

The  treatment  of  asthma  by  belladonna,  administered  by  the  stom- 
ach and  in  the  form  of  fumigation,  has  already  been  referred  to.  The 
hypodermatic  injection  of  atropine  is  much  more  effective.  From  y^ 
to  ^5-  of  a  grain  may  be  used  for  this  purpose  ;  but,  as  the  relief  comes 
from  the  systemic  effect,  it  is  not  necessary  to  inject  the  solution  in  the 
neighborhood  of  the  pneumogastric,  as  practiced  by  Courty.  In  order 
to  procure  the  greatest  relief,  the  injection  should  be  made  at  the  be- 
ginning of  the  asthmatic  paroxysm,  and  succeeding  attacks  should  be 
anticipated  by  inducing  atropinism  at  the  first  warning  of  a  seizure. 

Vomiting  of  pregnancy,  when  obstinate  and  resisting  other  means, 


BELLADONNA.  533 

is  sometimes  arrested  promptly  and  permanently  by  the  subcutaneous 
injection  of  atropine  in  small  quantity  (y^  of  a  grain).  Sea-sickness 
is  relieved  in  the  same  way.  In  these  maladies,  it  is  better  to  insert 
the  injection  in  the  epigastrium. 

Cramp  of  the  hollow  muscular  organs — hepatic,  intestinal,  uterine, 
and  renal  colic — may  all  be  relieved  by  the  subcutaneous  injection  of 
atropine,  but  the  most  satisfactory  results  are  produced  by  the  com- 
bined use  of  atropine  and  morphine. 

EXTERNAL  APPLICATION  or  BELLADONNA  PREPARATIONS.  —  The 
chloroformic  solution  of  atropine  is  an  excellent  external  application  to 
relieve  pain  in  nerves  superficially  situated.  1J  Chloroformi,  spts.  vini 
rect.,  aa  3  ss  ;  atropinae,  grs.  v.  M.  Sig. :  Apply  on  lint  to  painful  part, 
and  cover  with  oiled  silk.  The  same  application  to  the  epigastrium 
sometimes  arrests  obstinate  vomiting,  cerebral  or  reflex,  as,  for  example, 
the  vomiting  of  pregnancy,  sea-sickness,  etc.  A  belladonna-plaster  is 
an  excellent  application  to  relieve  the  chest-pains  of  phthisis,  to  allay 
irritability  of  an  over-excited  heart,  to  diminish  the  pains  and  soreness 
of  lumbago,  myalgia,  etc. 

Excessive  siceating  of  a  part,  as,  for  example,  unilateral  sweating  of 
the  head,  may  be  removed  by  brushing  over  the  affected  surface  a 
solution  of  atropine  (grs.  iv —  3  j). 

There  is  no  doubt  that  belladonna  has  the  power  to  arrest  the  secre- 
tion of  milk,  in  the  same  way  that  it  stops  the  cutaneous  transpira- 
tion, for  the  milk-gland  is  only  an  enlarged  sebaceous  gland  whose 
function  is  differentiated  from  that  of  other  sebaceous  glands  of  the 
body.  When  it  is  desirable  to  arrest  the  secretion  of  milk,  the  gland 
may  be  enveloped  by  a  belladonna-plaster,  or  the  ointment  of  bella- 
donna may  be  carefully  rubbed  into  the  integument.  These  are  rather 
disagreeable,  sticky  applications,  which  soil  the  clothing.  A  much 
more  elegant  method  of  applying  this  treatment  is  to  envelop  the 
breast  in  lint  wet  with  a  solution  of  atropine,  four  grains  to  the 
ounce  of  rose-water.  As  systemic  effects  may  be  produced  by  such  an 
application,  when  the  pupils  dilate  and  the  mouth  becomes  dry,  it 
should  be  removed.  Inflamed  breasts  may  be  treated  in  the  same  way. 
The  mode  of  action  of  the  belladonna  preparations  is  quite  obvious  : 
the  irritability  of  the  terminal  filaments  of  the  nerves  is  allayed  by  the 
direct  action  of  the  atropine,  and  the  arterioles  are  made  to  contract, 
thus  diminishing  the  blood-supply  to  the  inflamed  tissue. 

Other  superficial  inflammations  are  subdued  by  the  same  treatment, 
as,  for  example,  abscesses,  boils,  carbuncles.  A  plaster  made  of  bella- 
donna extract  may  be  kept  in  contact  with  the  inflamed  tissue,  or  the 
solution  of  atropine,  above  recommended,  may  be  used. 

Pruritus  of  the  vulva,  vaginismus,  fissure  of  the  anus,  are  some- 
times relieved,  as  if  by  magic,  by  the  use  of  the  atropine  solution 
above  recommended. 


534  EXCITO-MOTOBS. 

Whenever  atropine  is  used  locally  for  the  relief  of  inflammatory 
t>ain  and  swelling,  the  efficiency  of  the  application  is  much  increased 
by  the  addition  of  morphine,  or  morphine  and  chloral,  according  to  for- 
mulae to  be  given  hereafter  in  the  article  on  the  latter  drug. 

SECONDARY  PRODUCTS  OF  ATROPINE. — Some  remarkable  products 
have  lately  been  obtained  from  atropine  by  chemical  processes.  The 
first  step  consisted  in  the  discovery,  by  Kraut  and  Lossen,  simultane- 
ously, that  atropine  may  be  split  up  into  tropine  and  tropic  acid.  Sub- 
sequently, Prof.  Ladenburg  succeeded  in  the  synthesis  of  atropine  by  a 
combination  of  these  two  secondary  products.  If  the  salts  of  tropine 
are  treated  with  dilute  hydrochloric  acid,  alkaloids  are  produced,  to 
which  Ladenburg  has  given  the  name  tropeins.  Homatropine  is  an 
alkaloid  obtained  from  the  amygdalate  of  tropine.  The  artificial  atro- 
pine, prepared  as  above  described,  has  precisely  the  same  effects  as  the 
original  alkaloid. 

Effects  of  Homatropine. — The  preparation  of  this  base  now  used 
is  the  hydrobromate.  The  physiological  action  of  this  new  salt  has 
been  studied  by  Ringer  and  Tweedy,  among  others.  Ringer  finds  that, 
like  atropine,  homatropine  paralyzes  and  tetanizes,  but  the  tetanizing 
effect,  which  follows  in  forty-eight  hours  or  more  in  the  former,  occurs 
at  once  in  the  latter.  The  paralyzing  action  is  not  in  the  nerves  or 
muscles,  for  they  respond  to  electrical  stimulation,  but  in  the  cord, 
which  is  also  the  case  with  atropine.  Homatropine,  like  atropine,  in- 
creases the  action  of  the  heart  by  paralyzing  the  intra-cardiac  inhibi- 
tory apparatus,  and  it  also  antagonizes  muscarine.  In  man  there  is  a 
marked  distinction  as  regards  the  action  of  atropine  and  homatropine 
on  the  heart :  while  the  former  accelerates  the  heart  considerably,  the 
latter  retards  the  beat  from  ten  to  twenty  per  minute,  and  also  makes 
the  action  irregular.  Homatropine  also  antagonizes  the  action  of  pilo- 
carpine,  but  it  requires  relatively  more  than  of  atropine  to  accomplish 
this  result.  Ringer  sums  up  his  observations  with  the  remark,  "  Ho- 
matropine, then,  appears  to  possess  many  of  the  properties  of  atropine, 
but  in  a  weaker  degree." 

Tweedy  remarks  that,  as  regards  the  action  of  atropine  and  ho- 
matropine relatively  on  the  eye,  the  effect  of  homatropine  on  the 
iris  and  ciliary  muscle  is  really  very  powerful  while  it  lasts.  It 
widely  and  fixedly  dilates  the  pupil  in  from  fifteen  to  twenty  min- 
utes, and  it  acts  on  the  accommodation  in  an  equally  rapid  manner. 
Its  effects  pass  off  rapidly,  and  in  twenty-four  hours  the  accommo- 
dation is  restored,  although  the  pupil  is  yet  a  little  dilated.  The 
application  of  homatropine  solution  to  the  eye  is  entirely  unirritat- 
ing.  For  these  reasons  homatropine  becomes  a  valuable  substitute 
for  atropine  in  ocular  therapeutics,  but  it  can  not  be  substituted  for 
atropine  in  the  general  diseases  in  which  the  latter  has  been  found 
useful. 


STRAMONIUM,  535 

Authorities  referred  to  : 

BARTHOLOW,  DR.  R.  Prize  Essay  of  the  American  Medical  Association,  1869.  The 
Physiological  Effects  and  Therapeutical  Uses  of  Atropia  and  its  Salts. 

IBID.     Manual  of  Hypodermatic  Medication,  fourth  edition,  1882. 

BEZOLD  UND  BLOEBAUM.  Untersuchungen  aus  phys.  Laborat.  in  Wurzburg.  Quoted 
by  Still6. 

BOTKIN,  DR.  S.     Vir  chow's  Archiv,  vol.  xxiv,  p.  86. 

DONDERS.  On  the  Anomalies  of  Accommodation  and  Refraction  of  the  Eye,  Sydenham 
Society  edition. 

EULENBURG,  DR.  ALBERT.  Lehrbuch  der  functionellen  Nervenkrankheiten,  Berlin,  1871, 
p.  168. 

FLUCKIGER  AND  HANBURT.     Pharmacographia,  pp.  407,  411. 

FRASEK,  DR.  THOMAS  R.  An  Investigation  into  some  Tetanic  Symptoms  produced  by 
Atropia  in  Cold-blooded  Animals.  From  "  Transactions  of  the  Royal  Society  of  Edin- 
burgh," vol.  xxv. 

NOTE. — Other  references  omitted  for  lack  of  space,  but  they  are  to  be  seen  in  all  edi- 
tions previous  to  the  fourth. 

Stramonium. — Leaves  and  seed  of  Datura  stramonium  Linne  (Nat. 
Ord.  Solanacece).  Stramoine,  Fr.  ;  Stechapfel,  Ger. 

Stramonii  Folia. — Stramonium-leaves. 

Stramonii  Semen. — Stramonium-seed. 

Extractum  Stramonii  Seminis.  —  Extract  of  stramonium-seed. 
Dose,  gr.  ^ — gr.  ss. 

Tinctura  Stramonii  Seminis.  —  Tincture  of  stramonium-seed. 
Dose,  TTIV —  3  ss. 

Extractum  Stramonii  Seminis  Fluidum. — Fluid  extract  of  stra- 
monium-seed. Dose,  nij — flLv. 

COMPOSITION. — The  alkaloid  of  stramonium — daturine — is  chemi- 
cally and  physiologically  nearly  identical  with  atropine.  It  is  contained 
in  the  seeds  in  the  proportion  of  about  one  tenth  per  cent,  and  in  the 
leaves  in  much  smaller  quantity.  It  exists  in  the  plant  in  combina- 
tion with  malic  acid.  The  seeds  contain  a  fixed  oil  in  considerable 
quantity. 

ANTAGONISTS,  INCOMPATIBLES,  and  STNEBGISTS,  are  the  same  as  for 
belladonna.  In  the  case  of  poisoning  by  stramonium,  which  is  not  un- 
common in  this  country,  the  seeds,  which  usually  are  taken  by  children, 
must  be  evacuated  by  an  emetic.  Unless  distinct  symptoms  follow,  no 
further  treatment  may  be  necessary  ;  if,  however,  marked  dilatation  of 
the  pupil,  hallucinations,  and  active  delirium  are  produced,  the  physio- 
logical antagonist  becomes  necessary.  Tincture  of  opium  should  be 
administered  until  some  contraction  of  the  pupil,  lessening  of  the  pulse- 
rate,  and  cessation  of  the  delirium,  occur.  If,  then,  normal  sleep  comes 
on,  the  pupil,  heart,  and  lungs  functionating  normally,  no  further  in- 
terference will  be  necessary.  In  cases  of  poisoning  in  children,  it  is 
particularly  desirable  to  employ  the  opium  with  caution,  since  opium 
narcosis  may  readily  be  substituted  for  stramonium-poisoning. 


536  EXCITO-MOTORS. 

Hyoscyamus, — The  leaves  and  flowering  tops  of  Hyoscyamus  niger 
Linne  (Nat.  Ord.  Solanacece),  collected  from  the  plants  of  the  second 
year's  growth.  Jusquiame,  Fr.  ;  J3ilsenkraut,  Ger. 

Extractum  Hyoscyami  Alcoholicum. — Alcoholic  extract  of  hyos- 
cyamus.  Dose,  gr.  £ — gr.  j. 

Extractum  Hyoscyami  Fluidum. — Fluid  extract  of  hyoscyamus. 
Dose,  TH,V —  3  ss. 

Tinctura    Hyoscyami.  —  Tincture    of    hyoscyamus.      Dose,   3  ss 

—  §SS. 

COMPOSITION. — Hyoscyamus  contains  two  active  principles — hyos- 
cyamine  and  hyoscine. 

Hyoscyamince  Hydrobromas. —  Hyoscyamine  hydrobromate.  A 
yellowish-white,  amorphous,  resin-like  mass,  or  prismatic  crystals.  Very 
soluble  in  water  (0'3  part)  and  in  alcohol  (2  parts).  Dose,  gr.  -fa — gr.  £. 

Hyoscycamince  Sulphas. — Hyoscyamine  sulphate.  In  white,  in- 
distinct crystals,  or  a  white  powder,  without  odor  and  having  a  bitter, 
acrid  taste.  Freely  soluble  in  water  (0'5  part)  and  in  alcohol  (2'5 
part).  Dose,  gr.  -fa— gr.  J. 

Hyoscince  Hydrobromas. — Hyoscine  hydrobromate.  In  colorlessr 
transparent,  rhombic  crystals,  odorless  and  having  an  acrid,  slightly 
bitter  taste.  Soluble  at  59°  Fahr.  in  1*9  parts  of  water  and  in  13  parts 
of  alcohol.  Dose,  gr.  -fa — gr.  -fa. 

ANTAGONISTS,  INCOMPATIBLES,  and  SYNERGISTS  are  the  same  as 
for  belladonna.  The  observation  of  Ladenburg,  that  hyoscyamine 
and  duboisine  are  identical,  is  important,  and,  if  confirmed,  will  facili- 
tate the  introduction  of  the  latter  into  practice.  As  hyoscyamine 
is  difficult  to  procure  and  very  expensive,  and  as  duboisine,  on  the 
other  hand,  will  probably  be  very  readily  procured  in  any  quantity, 
the  latter  may  be  substituted  for  the  former.  Clinical  facts  of  this 
kind  must  be  acted  on  with  caution.  Identity  of  chemical  consti- 
tution does  not  always  mean  identity  in  physiological  action  and  in 
therapeutical  power.  Differences  in  molecular  arrangement,  not  ap- 
preciable by  chemical  analysis,  may  influence,  to  a  great  extent,  the 
mode  of  action.  The  clinical  facts  do  not,  thus  far,  warrant  the 
adoption  of  the  view  that  hyoscyamine  and  duboisine  are  mutually 
convertible. 

PHYSIOLOGICAL  ACTIONS. — As  atropine,  daturine,  and  hyoscyamine 
are  similar  if  not  identical  in  chemical  composition  and  in  physiologi- 
cal action,  the  remarks  already  made  in  regard  to  the  actions  and  uses 
of  belladonna  are  applicable  to  stramonium  and  hyoscyamus. 

To  these  alkaloids  must  be  added  duboisine,  which  by  Ladenburg 
is  held  to  be  identical  with  hyoscyamine.  Studied  from  the  physio- 
logical standpoint,  daturine  and  hyoscyamine  are  regarded  as  identical 
in  their  effects  by  Oulmont  and  Laurent.  As  daturine  is  not  em- 
ployed, owing  to  its  scarcity,  and  as  hyoscyamine  has  been  the  subject 


HYOSCYAMUS.  537 

of  considerable  study  and  clinical  observation,  we  refer,  in  the  follow- 
ing remarks,  wholly  to  this  alkaloid. 

Hyoscyamine,  as  it  occurs  in  commerce,  prepared  chiefly  by  Merck, 
of  Darmstadt,  is  in  two  forms,  a  yellowish-white  crystalline  solid,  which 
is  represented  as  chemically  pure,  and  a  dark,  resinous  mass,  having  a 
strong,  mouse-like  odor,  which  is  rather  a  concentrated  extract,  but 
appears  to  be  little  if  at  all  inferior  to  the  pure  alkaloid,  and  consists, 
as  is  now  known,  for  the  most  part,  of  hyoscine,  and  is  necessarily  as 
active  as  any  salts  of  the  alkaloid.  It  may  be  administered  hypoder- 
matically  in  this  form.  As  now  the  salts  of  hyoscyamine  are  used, 
and  are  freely  soluble,  water  is  the  only  menstruum  employed  to 
make  solutions.  The  hydriodate  is,  however,  the  best  form  for  ad- 
ministration, as  it  is  freely  soluble  in  water.  The  great  variations  in 
the  dose  of  the  alkaloid  are  due  to  the  fact  that  much  of  the  supposed 
residual  extract  is  merely  the  uncrystallized  hyoscine.  The  dose,  by 
subcutaneous  injection,  ranges  from  one  sixtieth  of  a  grain  to  one 
fourth,  and  by  the  stomach  from  one  sixtieth  to  one  grain. 

Hyoscyamine  causes  the  same  dryness  of  the  mouth,  dilatation  of 
the  pupils,  flushing  of  the  face,  rapid  action  of  the  heart  and  of  the 
lungs,  the  busy  delirium  with  hallucinations  and  illusions,  which  are 
caused  by  atropine,  but  its  effects  in  these  directions  are  less  in  de- 
gree. In  the  various  observations  which  have  now  been  made  on  man, 
with  the  considerable  doses  which  have  been  found  necessary  in  some 
cases,  it  has  been  definitely  ascertained  that  hyoscyamine  has  some- 
what less  than  atropine  of  the  deliriant  action  and  much  more  hyp- 
notic effects.  As  regards  the  mechanism  of  its  action  on  the  pupil, 
on  accommodation,  on  the  heart  and  respiration,  there  is  no  actual 
difference  between  the  two  alkaloids. 

The  elaborate  investigations  of  MM.  Oulmont  and  Laurent  have 
conducted  them  to  the  following  conclusions  :  Hyoscyamine  and  datu- 
rine  act  especially  on  the  sympathetic  system,  in  small  or  moderate 
doses  stimulating  the  vaso-motor  fibers  and  raising  the  arterial  ten- 
sion, and  in  large  doses  paralyzing  the  vessels  and  lowering  the  arte- 
rial tonus.  These  effects  are  produced  after  section  of  the  vagi. 
The  alkaloids  differ  in  their  action  on  the  heart — hyoscyamine  render- 
ing the  cardiac  movements  more  regular,  and  daturine  causing  inter- 
mitteuce.  By  direct  contact,  both  alkaloids  slow  and  finally  stop  the 
heart's  action.  Both  accelerate  the  respiratory  movements.  In  mod- 
erate quantity  both  increase  the  intestinal  movements  ;  in  large  doses 
arrest  them.  As  regards  the  nervous  system  of  animal  life,  they  are 
both  without  action  on  the  motor  functions,  but  in  toxic  doses  they 
blunt  the  cutaneous  sensibility.  They  do  not  affect  the  contractility 
of  muscular  fiber.  Their  action  in  dilating  the  pupil  is  due  to  stim- 
ulation of  the  sympathetic,  and  not  to  paralysis  of  the  third  nerve. 
The  various  phenomena  arising  from  the  administration  of  these  alka- 


538  EXCITO-MOTORS. 

loids  are  referred  by  Oulmont  and  Laurent  to  the  circulatory  disturb- 
ances— to  the  increased  distribution  of  blood.  The  action  is  soon 
ended,  the  alkaloids  being  eliminated  by  the  urine  rapidly. 

Notwithstanding  the  freedom  with  which  hyoscyamus  and  its  alka- 
loid, hyoscyamine,  are  given,  rarely  are  there  any  unpleasant  effects. 
Empis,  however,  has  reported  some  cases  in  which  toxic  symptoms 
happened  from  medicinal  doses.  These  must  have  been  examples  of 
idiosyncrasy,  for  in  the  discussion  which  ensued,  Joffroy,  Damaschino, 
and  others,. expressed  themselves  strongly  against  the  probability  of 
serious  effects  from  doses  within  safe  limits. 

THERAPY. — The  possession  of  decided  hypnotic  qualities  has  led  to 
the  use  of  hyoscyamine  and  hyoscine  in  the  treatment  of  various  mental 
disorders  (Prideaux,  Lawson,  and  others).  Prideaux  makes  the  impor- 
tant practical  distinction,  that  it  acts  with  different  degrees  of  rapidity 
and  potency  under  varying  conditions  of  insanity.  In  acute  mania 
with  depression,  one  sixteenth  of  a  grain  will  have  a  marked  effect, 
while  in  the  excitement  of  chronic  mania  large  doses  will  be  necessary. 
In  chronic  mania  with  exacerbations,  he  gives  one  quarter,  one  half,  and 
even  one  grain  by  the  stomach,  or  one  tenth  of  a  grain  subcutaneously. 
The  latter  mode  of  administration  he  regards  preferable  in  these  cases. 
In  cases  of  mania  with  great  motor  excitement,  and  of  a  destructive 
character,  Prideaux  regards  hyoscyamine  as  "  the  most  rapid  and  reli- 
able narcotic  we  possess."  In  the  epileptic  mania  of  the  epileptic 
status,  he  says,  it  diminishes  the  number  and  violence  of  the  attacks. 
In  delusional  insanity  he  finds  it  brings  about,  under  favorable  circum- 
stances, mental  restoration.  In  chronic  dementia,  with  destructive 
tendencies  and  sleeplessness,  improvement  is  sometimes  noted  from  the 
persistent  use  of  small  doses.  Reinhard  also  has  administered  this 
agent  in  the  dose  of  a  milligramme  (about  one  sixty-fifth  of  a  grain) 
subcutaneously  in  cases  of  mania  and  epilepsy,  with  distinctly  good 
results.  In  eight  of  fifteen  cases  of  mania,  calmative  effects  were  pro- 
duced and  permanent  good  was  accomplished ;  and  in  five  of  twelve 
epileptics  with  maniacal  attacks,  the  number  and  severity  of  the  seiz- 
ures were  lessened.  Drs.  Sapilli  and  Riva,  eminent  Italian  alienists, 
have  found  hyoscyamine  very  useful  in  recurrent  mania.  Gill,  Ringer, 
and  Lawson  have  also  had  good  effects  from  hyoscyamine,  in  suitable 
cases,  as  an  hypnotic. 

Stramonium  and  hyoscyamus  may  be  used  like  belladonna  for  the 
relief  of  painful  affections,  the  neuralgias. ;  but  they  possess  no  special 
advantages  over  their  more  powerful  congener.  Oulmont  has  used  the 
hypodermatic  injection  of  hyoscyamine  with  remarkable  success  in 
several  cases  of  neuralgia,  but  he  does  not  regard  it  as  more  conspicu- 
ous and  rapid  in  this  disease  than  are  opium  and  belladonna.  Stramo- 
nium is  used  with  advantage  in  the  treatment  of  dysmenorrhcea. 
ft  Ext.  stramonii,  ext.  hyoscyami,  ext.  opii,  aa  gr.  vj.  M.  Ft.  pil.  no. 


HYOSCYAMUS.  539 

xij.  Sig. :  One  pill  every  three,  four,  or  six  hours.  This  combination 
gives  great  relief  in  dysmenorrhcea,  and  may  also  be  serviceable  in 
neuralgia. 

In  affections  characterized  by  spasm,  as  asthma,  laryngeal  cough, 
hepatic,  intestinal,  renal,  and  uterine  colic,  stramonium  and  hyoscyamus 
may  be  given  with  advantage,  in  place  of  or  in  combination  with  bella- 
donna. The  hypodermatic  injection  of  hyoscyamine  or  daturine  is  an 
excellent  expedient  for  procuring  relief  in  these  cases,  but  these  alka- 
loids are  not  more  effective  than  atropine.  Hyoscyamus,  especially  in 
the  form  of  tincture,  is  frequently  prescribed  in  irritable  states  of  the 
bladder  due  to  the  presence  of  stone,  enlargement  of  the  prostate,  and 
in  catarrh  of  the  bladder  arising  by  transference  of  irritation  from  the 
urethra.  It  should  not  be  forgotten  that  liquor  potassae,  so  much  pre- 
scribed in  a  mixture  with  hyoscyamus,  is  incompatible. 

M.  Oulmont  refers,  in  terms  which  may  seem  to  be  exaggerated, 
to  the  great  efficiency  of  hyoscyamine  in  the  treatment  of  mercurial 
tremor,  senile  tremor,  paralysis  agitans,  locomotor  ataxia,  and  tetanus. 
In  mercurial  and  senile  tremor  cures  were  obtained,  but,  as  might  be 
expected,  only  amelioration  in  paralysis  agitans,  locomotor  ataxia,  and 
tetanus.  The  remarkable  benefit  obtained  from  this  remedy  in  paral- 
ysis agitans  is  testified  to  by  Empis,  Joffroy,  Charcot,  and  many  other 
observers.  The  dose  which  Oulmont  found  effective  was  the  one 
thirty-second  of  a  grain  of  hyoscyamine,  gradually  increased  to  the 
one  fifteenth  of  a  grain. 

The  hypnotic  quality  is  much  more  conspicuous  in  hyoscyamus  than 
in  belladonna  or  stramonium.  In  children  it  has  long  been  known  that, 
when  opium  is  not  well  borne,  hyoscyamus  is  an  efficient  substitute. 
Recent  experience  in  asylum  practice  has  shown  that  hyoscyamus  in 
large  doses  is  a  very  valuable  hypnotic.  According  to  Dr.  Campbell, 
two  and  a  half  drachms  of  the  tincture  are  equivalent  in  hypnotic  power 
to  thirty  grains  of  chloral  hydrate.  In  order  to  procure  efficient  hyp- 
notic effects,  from  two  drachms  to  an  ounce  of  the  tincture  is  neces- 
sary, and  this  large  quantity  appears  to  be  free  from  danger. 

Extract  of  hyoscyamus  is  used  in  combination  with  purgatives, 
with  the  object — which  abundant  clinical  observation  confirms — of 
rendering  their  operation  more  efficient,  no  doubt,  because  of  its 
action  on  the  muscular  layer  of  the  intestine. 

The  ointment  of  stramonium  is  a  favorite  application  to  irritable 
ulcers,  superficial  inflammations,  etc. 

HYOSCINE. — This  is  a  new  alkaloid  obtained  from  the  mother- 
liquor,  as  already  shown,  and  which  has  been  produced  synthetically 
by  Ladenburg.  It  forms  a  crystalline  combination  with  hydriodic 
acid,  and  an  amorphous  salt  with  hydrochloric.  These  salts  dissolve 
freely  in  water.  The  solution  employed  by  Edfelsen  for  administra- 
tion by  the  stomach  contained  about  -^  gr.  to  the  tablespoonf  ul,  and 


540  EXCITO-MOTORS. 


for  subcutaneous  injection,  y^  gr.  to  one  minim.  These  are  suitable 
doses  for  administration. 

The  physiological  effects  of  hyoscine  have  been  studied  by  Laden- 
burg,  the  discoverer  ;  by  Edfelsen,  and  others.  Generally  speaking, 
the  effects  of  this  agent  correspond  quite  closely  to  those  of  atropine, 
but  in  corresponding  doses  the  latter  is  more  powerful.  When  admin- 
istered subcutaneously,  hyoscine  acts  in  two  to  twelve  minutes  ;  by  the 
stomach  in  about  fifteen  minutes.  It  causes  more  drowsiness  and  sopor, 
and  less  delirium  than  atropine,  but  like  the  latter  dilates  the  pupil, 
increases  the  rate  of  the  cardiac  and  respiratory  movements,  and  red- 
dens the  skin.  According  to  Gnauck,  the  pulse  is  first  slowed  eight  to 
twenty  beats  per  minute,  and  after  ten  to  twenty  minutes  rises.  The 
same  phenomenon  is  observed  from  atropine  in  some  subjects,  but  is 
not  so  pronounced.  Dilatation  of  the  pupil  does  not  always  occur 
after  the  stomachal  administration.  Sleep  comes  on  in  twenty  to  thirty 
minutes,  preceded  by  a  feeling  of  lassitude,  and  is  deep  and  quiet,  but 
is  followed  by  headache  and  vertigo.  As  a  cerebral  sedative,  Bruce 
assigns  it  to  a  high  place,  but  a  period  of  excitement  prefaces  the 
decline  of  action,  and  hence  a  true  statement  of  its  powers  can  be 
made  when  both  stages  of  its  action  are  duly  accounted  for. 

Instilled  into  the  eye,  hyoscine  is  a  more  en  ergetic  mydriatic  than 
atropine,  dose  for  dose  (Emmert).  One  part  of  the  hydriodate  to  one 
thousand  of  water  is  the  solution  used  by  Emmert,  and  this  he  finds 
more  active  than  a  half-per-cent  solution  of  atropine. 

Hyoscine  has  been  employed  in  various  diseases  requiring  a  sopo- 
rific and  anodyne  agent.  In  general,  it  can  be  used  in  the  same  cases 
as  atropine,  but,  as  it  possesses  more  decided  antispasmodic  effects,  it 
may  prove  more  valuable.  By  Ladenburg  it  has  been  used  success- 
fully in  whooping-cough,  in  asthma,  and  in  enteralgia.  Half  the  cases 
of  whooping-cough  were  relieved,  and  all  of  the  cases  of  asthma  were 
more  or  less  benefited,  some  decidedly  so. 

In  ophthalmic  practice,  hyoscine  can  be  substituted  for  atropine. 
It  causes  more  prompt  and  decided,  but  less  persistent,  dilatation  of 
the  pupil,  and  it  is  less  poisonous  (Emmert).  It  is  applicable  to 
the  same  purposes  in  eye-diseases  as  those  in  which  atropine  is  now 
employed. 

Authorities  referred  to  : 

BCCKNILL  AND  TcKK.     Manual  of  Psychological  Medicine,  London,  1874,  p.  727. 

CAMPBELL,  DR.    Journal  of  Mental  Science,  No.  Ixxx,  1871. 

EDFELSEN  CND  ILLINO.  Ueber  die  therapeutische  Verwendung  des  Hyoscinum  hydrochlo. 
ricum  und  hydriodicum.  Centralblatt  /.  d.  med.  Wissensch.,  No.  23,  1881. 

EMMERT,  DR.  Correspondenz-Blatt,  January  15,  1882  ;  by  London  Medical  Record, 
February,  1882. 

EMPIS,  DR.  Hyoscyamine,  accidents  causes  par  son  emploi.  Butt.  Qen.  de  Therap., 
Juin  15,  1881. 


DUBOISLL  541 

FRONMULLER,  DR.  Klinische  Studien  uber  die  scMafmachende  Wirkung  der  narkotischen 
Arzneirnittel,  Erlangen,  1875,  p.  70. 

GNAUCK,  DR.  A.  Ueber  die  Wirkungen  des  Hyoscine.  Centralblatt  fur  die  rued.  Wis- 
tensch.,  No.  45,  1881. 

HUSEMAXX,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  1115,  et  seq. 

LADENBURG,  PROF.  DR.     Ibid.     No.  23,  1881. 

LACREXT,  M.  LK  DR.     De  F  Hyosciamine  et  de  la  Daturine.     These. 

OCLMONT,  M.  LE  DR.  De  F  Hyosciamine  et  de  son  Action  dans  les  Nevrotes.  Bulletin 
General  de  Therapeviique,  vol.  Ixxxiii,  p.  481. 

PRIDEAUX,  E.  The  Action  and  Uses  of  Hyoscyamine.  Lancet,  1879,  September  27, 
October  4  and  11. 

REINHARD,  DR.  C.     Archiv  fur  Pschy.  und  Nervenkrankh.,  Band  li,  p.  121. 

Duboisia. — Duboisia  myoporoides,  of  the  Solanacece. 

PREPARATIONS. — There  are  no  official  preparations  ;  but  the  fol- 
lowing can  be  employed  in  any  of  the  cases  requiring  it : 

Extractum  Duboisice.     Dose,  gr.  \  to  gr.  £. 

Duboisince  Sulphas,  or  Hydrobromas. — Dose,  gr.  y^  to  gr.  -fo. 

COMPOSITION. — The  important  constituent  is  an  alkaloid — duboi- 
sine — which  possesses  the  medicinal  powers  and  properties  of  the 
plant.  It  combines  with  acids  to  form  salts  which  are  freely  soluble 
in  water.  As  regards  its  chemical  relations,  duboisine  strongly  re- 
sembles atropine,  but  differs  in  some  particulars  ;  according  to  La- 
denburg,  duboisine  is  identical  with  hyoscyamine  ;  but  here  again 
we  have  an  illustration  of  the  important  fact  that  identity  of  compo- 
sition does  not  necessarily  imply  identity  of  physiological  action  and 
therapeutical  power.  The  dose  of  a  salt  of  duboisine  is  y^  to  -fo  of 
a  grain. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies  destroy 
the  active  principle,  and  consequently  prescriptions  containing  them 
will  be  inert,  except  as  to  the  effects  of  the  alkali.  The  physiological 
antagonists  are  the  same  as  those  of  atropine  ;  thus  physostigmine  and 
muscarine  counterbalance  the  action  of  duboisine  in  almost  the  entire 
range  of  power,  and  opium  in  a  limited  degree.  Duboisine  antagonizes 
pilocarpine,  as  respects,  at  least,  the  most  conspicuous  and  important 
properties  of  the  latter.  In  case  of  poisoning,  emetics  and  the  stom- 
ach-pump must  be  used,  and  the  systemic  effects  opposed  by  the  sub- 
cutaneous use  of  physostigma,  muscarine,  or  morphine,  cautiously,  and 
certainly  pilocarpine,  further  researches  having  proved  the  antagonism 
of  the  last  named. 

SYNERGISTS. — The  actions  of  duboisia  are  promoted  by  the  other 
agents  of  the  group,  especially  by  belladonna,  stramonium,  and  hy- 
oscyamus.  The  effects  of  atropine  and  duboisine  correspond  to  a 
remarkable  extent,  but  there  are  points  of  difference,  as  follows : 
Duboisine  is  twice  or  more  soluble  in  water  than  atropine ;  it  has 
stronger  basic  properties,  and  it  reacts  differently  to  sulphuric  acid 


542  EXCITO-MOTORS. 

and  bichromate  of  potassa  ;  it  is  less  irritating  to  the  conjunc- 
tiva, dilates  the  pupil  more  promptly,  and  its  effects  subside  earlier 
(Gerard). 

PHYSIOLOGICAL  EFFECTS. — Dryness  of  the  mouth,  thirst,  and  some 
difficulty  in  swallowing,  soon  follow  the  administration  of  duboisia, 
and  more  speedily  after  the  subcutaneous  injection  of  the  alkaloid. 
The  pulse  is  considerably  accelerated  ;  the  arterial  tension  rises,  the 
face  flushes,  the  pupil  dilates,  and  the  accommodation  is  paralyzed. 
Some  frontal  headache,  tinnitus  aurium,  giddiness,  and  restlessness, 
especially  in  sleep,  are  experienced.  Certain  motor  symptoms — uncer- 
tain gait,  awkwardness  of  movement  in  walking,  and  muscular  paresis 
— occur  (Gubler).  In  animals  mental  excitement  or  delirium  has  been 
noted,  but  no  confirmatory  or  opposing  observations  on  man  have  thus 
far  been  reported.  The  tetanic  symptoms  which  occur  after  some 
days  in  frogs  poisoned  by  atropine,  take  place  under  the  same  condi- 
tions from  duboisia. 

The  acceleration  of  pulse  and  rise  of  tension  first  produced  by 
duboisia  do  not  persist ;  the  pulse-rate  and  the  tension  fall  after 
some  hours,  the  excitement  subsides,  and  a  condition  of  stupor 
comes  on  which  is  not  sleep,  although  it  favors  sleep  (Gubler).  I 
can  confirm  these  important  observations  on  the  cerebral  effects  of 
duboisia. 

THEKAPY. — The  author  has  prescribed  duboisine  in  cases  of  puer- 
peral mania  with  excitement,  on  the  suggestion  of  M.  Gubler,  and 
with  entire  success.  There  is  an  increase  of  the  maniacal  excite- 
ment for  a  few  hours  after  the  hypodermatic  injection,  but  this  is 
followed  by  the  condition  of  stupor  and  mental  calm.  The  im- 
provement is  rapid,  and  follows  so  closely  the  administration  of 
the  remedy  that  he  could  not  doubt  it  was  propter  and  not  merely 
post  hoc. 

As  respects  its  use  in  ophthalmic  diseases,  it  may  be  stated  in  gen- 
eral that  duboisine  is  applicable  under  the  same  conditions  as  atropine, 
to  which  it  is  to  be  preferred,  in  many  cases,  it  is  probable. 

The  advantages  of  duboisine,  as  compared  with  atropine,  are  its 
greater  rapidity  of  action  in  effecting  dilatation  of  the  pupil  and  pa- 
ralysis of  accommodation,  the  less  irritation  of  the  conjunctiva,  and 
the  more  rapid  recovery  from  the  effects.  It  is,  therefore,  much  more 
useful  than  atropine  for  determining  the  refraction  of  the  eye,  and  for 
use  in  ocular  therapeutics  in  general. 

Some  unpleasant  cerebral  effects  have  been  observed  after  instilla- 
tion into  the  eye  (Seely).  The  author  was  given  the  opportunity, 
by  the  kindness  of  Dr.  Seely,  to  examine  the  patient — the  first  in- 
stance in  which  such  phenomena  were  observed — who  experienced 
faintness  and  strange  sensations  in  the  head  ;  but  they  were  entire- 
ly subjective  and  mental,  as  no  change  in  the  circulation  or  respi- 


SCOPOLAMINE.  543 

ration  was  to  be  seen.  Since  that  case  there  have  been  several 
examples  of  the  systemic  action  of  duboisine  after  its  instillation 
into  the  eye. 

To  relieve  the  night-sweats  of  phthisis  and  the  various  neuroses  of 
the  respiratory  organs,  and  to  stimulate  the  action  of  the  heart,  du- 
boisine may  take  the  place  of  atropine.  As  an  antagonist  to  mor- 
phine it  is  equally  as  effective  as  atropine,  but,  as  a  hypnotic  and 
anodyne,  superior  to  the  latter. 

Authorities  referred  to  : 

BANCROFT,  DR.  JOSEPH.     The  Lancet,  March  2,  1878. 

GERHARD,  MR.     London  Medical  Record,  vol.  vi,  1878,  p.  156. 

GUBLER,  PROF.  A.     Bull.  Gen.  de  Therap.,  vol.  xciv,  p.  426. 

LAUERSAU,  DE,  PROF.     Bull.  Gen.  de  Therap.,  supra,  p.  362. 

NORRIS,  PROF.  W.  F.  The  American  Journal  of  the  Medical  Sciences.  April,  1879,  pp. 
466,  et  seq.  Duboisia  as  a  Mydriatic,  etc. 

RINGER,  PROF.  SYDNEY.     Tlie  Lancet,  supra. 

SEELY,  PROF.  W.  W.  Lancet  and  Clinic  for  1879,  January,  February.  Various  arti- 
cles on  the  use  of  Duboisine. 

TWEEDY,  MR.  JOHN.  The  Lancet,  supra.  On  the  Mydriatic  Properties  of  Du- 
boisia, etc. 

WEEKER,  DR.  L.  Bull.  Gen.  de  TJierap.,  supra,  p.  337.  De  Vemploi  compare  de  Fese- 
rine,  de  Vatropine,  et  de  la  duboisine  en  therapeutique  oculaire. 

Scopolamine. — An  alkaloid  obtained  from  the  root  of  Scopolia  atro- 
pinoides,  a  member  of  the  Solanacece. 

Scopolamince  Hydrobromas. — Hydrobromate  of  scopolamine. 

There  is  also  a  hydrochlorate,  but  as  the  hydrobromate  is  more 
easily  obtained  in  a  pure  state  this  salt  is  now  preferred. 

The  dose  of  the  hydrobromate  is  -^^  grain  to  -fa  grain.  The  solu- 
tions employed  by  the  ophthalmologists  have  ranged  from  1  to  1,000, 
1  to  2,000  as  given  by  Raehlmann,  and  1  to  1,000,  2  to  1,000,  and  4  to 
1,000  according  to  Gutmann. 

ACTIONS  AND  USES. — Scopolamine  was  discovered  by  A.  Schmidt, 
of  Marburg.  Raehlmann  was  the  first  to  give  an  account  of  its  actions, 
based  on  clinical  investigations.  G.  Gutmann,  of  Berlin,  and  L.  Gross- 
mann,  of  Budapest,  subsequently  reported  on  its  effects,  also  based  on 
clinical  experience  in  their  respective  clinics.  As  a  member  of  the 
Solanacece,  it  was  a  priori  supposed  to  possess  mydriatic  qualities,  and 
the  investigations  of  different  observers  confirm  this  view.  In  its 
actions  and  uses  scopolamine  corresponds  closely  to  hyoscine  and  duboi- 
sine. In  their  clinical  observations  the  ophthalmologists  above  men- 
tioned compared  the  actions  of  the  new  remedy,  especially  with  atro- 
pine. It  was  found  that,  as  regards  the  eye  symptoms,  scopolamine 
acted  more  energetically  and  also  more  promptly  in  causing  dilatation 
of  the  pupil  than  atropine.  The  effects  are  shorter  in  duration,  so  that 
several  instillations  a  day  are  required  to  maintain  a  constant  action. 


544  EXCITO-MOTORS. 

It  also  affects  the  accommodative  apparatus  in  a  similar  manner  to 
atropine,  but  it  has  less  influence  on  the  intraocular  tension.  It  is 
more  efficient  than  atropine  in  inflammatory  states  of  the  eye,  which  is 
especially  true  of  iritis;  for  dilating  the  pupil  more  decidedly,  it  breaks 
up  adhesions  more  thoroughly.  As  respects  dryness  of  the  throat, 
dizziness,  and  hallucinations,  which  instillation  of  the  mydriatics  causes, 
these  untoward  symptoms  are  less  common,  and  by  no  means  so  promi- 
nent, from  the  use  of  scopolamine.  This  agent  acts  in  an  opposed 
manner  to  atropine  on  the  cerebral  cortex  ;  instead  of  excitement,  it 
induces  a  quiescent  state  of  the  mind  and  rather  disposes  to  sleep.  On 
the  cardiac  and  respiratory  functions  it  has  effects  different  from  atro- 
pine ;  instead  of  increased  action  of  the  heart,  and  more  frequent  re- 
spiratory movements,  it  lessens  both  and  tends  to  cause  death  by 
paralysis  of  respiration. 

The  testimony  of  ophthalmologists  who  have  published  their  obser- 
vations on  scopolamine  is  strongly  in  favor  of  this  remedy  in  most  of 
the  conditions  for  which  atropine  is  now  employed.  As  it  acts  so 
strongly  on  the  pupil,  and  the  time  of  the  action  is  so  brief,  it  is  espe- 
cially preferable  for  use  in  some  morbid  states  of  the  eye,  and  for  as- 
certaining errors  of  refraction.  As  it  affects  the  intraocular  tension 
little  or  not  at  all,  it  is  not  adapted  to  the  treatment  of  cases  in  which 
the  tension  needs  to  be  modified. 

Scopolamine  having  properties  not  unlike  hyoscine  and  duboisine, 
it  would  seem  to  be  indicated  in  mental  states  characterized  by  excite- 
ment, wakefulness,  and  active  delirium.  It  will  prove  valuable,  it  is 
probable,  in  cases  of  the  insomnia  of  neurasthenia,  in  such  spasmodic 
affections  as  chorea,  in  some  examples  of  epilepsy  and  allied  diseases. 

Authorities  referred  to  : 

GROSSMAN,  DR.  LEOPOLD.     Therapeutische  Monatshefte,  Berlin,  Marz,  1895. 
GUTMANN,  DR.  G.     Ibid.,  1894. 
RAEHLMANN,  PROF.  DR.  E.     Ibid.,  Mi,  1894. 


B.— AGENTS  EXCITING  THE   FUNCTIONAL  ACTIVITY  OF  THE   CEREBRUM. 

To  this  group  belong  those  remedies  usually  classed  together 
under  the  designation  of  antispasmodics.  They  are  to  a  slight  de- 
gree cardiac  stimulants  ;  they  increase  the  cutaneous  circulation 
and  promote  diaphoresis  ;  they  also  stimulate  the  bronchial  mucous 
membrane  and  favor  expectoration.  As  a  result  in  part  of  the 
increased  rapidity  of  the  circulation,  the  functions  of  the  brain  be- 
come slightly  more  active,  ideas  flow  more  freely,  irregular  mental 
excitement  and  muscular  hyperkinesis  are  moderated,  and  an  orderly 
feeling  of  well-being  is  experienced.  These  effects  are  probably  in 


CAMPHOR.  545 

part  due  to  a  direct  action  of  these  agents  on  the  gray  matter  of  the 
hemispheres,  but  our  knowledge  does  not  at  present  permit  an  exact 
statement  of  the  nature  of  this  impression.  These  agents  do  not  in 
any  quantity  suspend  the  functions  of  the  brain,  and  the  temporary 
increase  of  activity  which  they  produce  is  not  followed  by  manifest 
depression. 

Camphora. — Camphor.  Camphre,  Fr. ;  Campher,  Ger.  A  stea- 
ropten  derived  from  Cinnamomum  camphora  F.  Nees  et  Ebermaier 
(Nat.  Ord.  Lauracece),  and  purified  by  sublimation. 

Aqua  Camphorce. — Camphor-water.     Dose,  3  j —  1  j. 

Linimentum  Camphorce.  —  Camphor-liniment.  (Camphor,  200 
grm.  ;  cotton-seed  oil,  800  grm.) 

Linimentum  Saponis. — Soap-liniment.  (Soap,  camphor,  oil  of  rose- 
mary, alcohol,  and  water.) 

Spiritus  Camphorce. — Spirit  of  camphor.  (Camphor,  100  grm.  ; 
alcohol  to  make  1,000  c.  c.)  Dose,  fllv — TH.XX. 

Camphora  Monobromata. — Monobromated  camphor.  Dose,  grs. 
ij — grs.  x.  Colorless,  prismatic  needles  or  scales,  permanent  in  the 
air  and  unaffected  by  light,  having  a  mild  camphoraceous  odor  and 
taste,  and  a  neutral  reaction.  Almost  insoluble  in  water  ;  freely  solu- 
ble in  alcohol,  ether,  chloroform,  and  fixed  oils  ;  slightly  soluble  in 
glycerin. 

COMPOSITION  AND  PROPERTIES. — Camphor  is  found  in  colorless, 
translucent,  crystalline  masses.  One  part  dissolves  in  about  1,300 
parts  of  water,  but  it  is  freely  soluble  in  alcohol,  ethers,  oils,  chloro- 
form, bisulphide  of  carbon,  etc.  Its  odor  is  peculiar  and  characteristic. 
The  formula  for  camphor  is  the  following  :  C10H]6O.  By  distillation 
with  chloride  of  zinc  it  is  converted  into  cymol,  and  by  oxidizing 
agents  into  camphoric  and  camphretic  acids. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  addition  of  water  pre- 
cipitates camphor  from  its  spirituous  solution.  Alkaline  and  earthy 
salts,  for  example  sulphate  of  magnesium,  separate  from  its  solution 
the  small  quantity  of  camphor  contained  in  aqua  camphorse.  Coffee, 
the  arterial  sedatives,  cold,  and  depressing  causes  generally,  antago- 
nize its  physiological  action. 

SYNERGISTS. — All  the  remedies  of  this  group,  and  alcohol,  opium, 
and  narcotic  substances,  increase  the  effects  of  camphor. 

PHYSIOLOGICAL  ACTIONS. — Applied  to  the  skin,  camphor  produces 
redness,  heat,  and  superficial  inflammation,  if  the  contact  be  sufficiently 
prolonged  ;  to  an  open  wound  its  effects  are  still  more  severe.  Its 
taste  is  hot,  aromatic,  and  pungent.  In  the  stomach  it  causes  a  sensa- 
tion of  heat,  and  may  excite  in  large  doses  inflammation  and  ulcera- 
tion.  The  symptoms  common  to  irritant  poisons  may,  therefore,  be 
produced  by  camphor.  After  experimental  doses  in  animals  camphor 
37 


546  CEREBRAL   EXCITANTS. 

has  been  detected  in  the  blood  of  the  mesenteric  and  portal  vein,  but 
not  in  the  chyle  or  urine.  In  moderate  doses  (medicinal)  it  increases 
the  action  of  the  heart,  elevates  the  arterial  tension,  and  promotes 
cutaneous  transpiration  ;  it  also  produces  mental  exhilaration,  even  a 
gay  and  lively  intoxication,  and  allays  pain.  In  toxic  doses,  in  addi- 
tion to  the  local  irritant  action  on  the  gastro-intestinal  mucous  mem- 
brane, and  the  consequent  systemic  effects,  it  lowers  the  pulse,  the 
skin  becomes  pale,  and  the  surface  cold  and  moist,  stupefies,  dimin- 
ishes the  reflex  functions  of  the  spinal  cord,  and  causes  convulsions, 
insensibility,  and  death;  but  these  cerebral  phenomena  are  not  sepa- 
rable from  the  reflex  effects,  on  the  nervous  centers,  of  the  violent 
gastro-intestinal  disturbance.  Sometimes  dysuria  has  been  caused  by 
camphor,  and,  in  small  doses,  owing  doubtless  to  the  merely  stimulant 
effects  on  the  circulation,  it  increases  the  sexual  appetite  ;  but,  in  large 
doses,  it  is  antaphrodisiac. 

Camphor,  after  absorption,  is  eliminated  chiefly  by  the  skin  and 
bronchial  mucous  membrane,  hence  the  breath  and  sweat  of  those  using 
this  substance  smell  of  it  strongly  ;  but,  when  much  camphor  is  taken 
in  the  solid  form,  it  escapes  with  the  faeces. 

THERAPY. — Camphor  enters  into  the  composition  of  many  denti- 
frices. 

Camphor  is  contraindicated  in  all  inflammatory  affections  of  the- 
gastro-intestinal  mucous  membrane.  In  hysterical  vomiting  a  few 
drops  of  the  spirit  (two  to  five),  every  half -hour  or  hour,  will  often 
give  relief.  Camphor  is  an  efficient  remedy  in  summer  diarrhoea.  It 
is  usually  combined  with  opium  :  I£  Spirit,  camphorae,  tinct.  opii,  aa 
|  ss.  M.  Sig. :  Ten  to  thirty  drops  every  two,  three,  or  four  hours. 
IJ  Aqua  camphorse,  §  iij  ;  tinct.  lavendulse  comp.,  f  j  ;  tinct.  opii,  3  j 
—  3  ij-  M.  Sig. :  A  tablespoonful  every  hour  or  two.  This  is  an  ex- 
cellent formula,  omitting  the  opium,  tor  flatulence,  especially  hysterical 
flatulence  and  the  flatulent  colic  which  so  often  occurs  during  the  cli- 
macteric period.  For  the  preliminary  diarrhoea  of  Asiatic  cholera 
camphor  is  largely  used,  and  with  very  obvious  benefit.  A  drop  or 
two  of  the  saturated  tincture  (Rubini's),  or  five  to  ten  drops  of  the 
spirit,  may  be  given  with  a  little  laudanum  every  half-hour  or  hour. 
Oppolzer  gave  the  ethereal  tincture  with  opium  :  ]J  Camphorae,  §  j ; 
etheris,  §  vij  ;  tinct.  opii,  3  j.  M.  Sig.:  Twenty  to  forty  drops,  as 
necessary.  Camphor,  which  is  very  serviceable  in  the  summer  diar- 
rhoea of  children,  may  be  given  to  these  little  subjects  in  milk,  in 
which  it  is  soluble  in  the  proportion  of  one  drachm  to  four  ounces. 

Spirits  of  camphor,  in  the  form  of  vapor,  is  a  useful  inhalation  in 
the  incipiency  of  acute  catarrh.  Dr.  Beard  speaks  in  very  enthusias- 
tic terms  of  a  camphor  preparation  which  he  has  called  "  cold  powder." 
This  formula  is  as  follows  :  "  Camphor,  five  parts.  Dissolve  in  ether 
to  the  consistence  of  cream.  Then  add  carbonate  of  ammonium  four 


CAMPHOR.  547 

parts,  opium-powder  one  part."  The  dose  of  this  ranges  from  three 
to  ten  grains.  Dr.  Beard  finds  this  combination  of  "  great  value  in 
breaking  up  colds  when  taken  in  time,  and  in  modifying  their  force 
when  taken  late." 

Camphor  was  formerly  much  used  in  the  treatment  of  asthma,  but 
at  present  more  efficient  remedies  have  taken  its  place.  The  mono- 
bromide  of  camphor  has  proved  decidedly  beneficial  in  whooping-cough. 
Five  grains,  suspended  in  mucilage  and  sirup  of  tolu,  may  be  given  to 
a  child  three  or  four  times  a  day.  It  is  most  serviceable  in  the  spas- 
modic stage,  but  will  do  good  at  any  period. 

Camphor  will  allay  cough  and  promote  expectoration,  hence  its 
utility  in  chronic  bronchitis,  in  capillary  bronchitis  when  stimulants 
are  needed,  and  in  emphysema.  In  the  so-called  typhoid  pneumonia 
camphor  is  serviceable  as  a  stimulant,  in  small  and  frequently-repeated 
doses,  to  sustain  the  powers  of  life  during  the  period  of  deferves- 
cence. 

In  typhus  and  typhoid  fevers,  and  in  the  exanthemata  generally, 
camphor  is  used  to  accomplish  two  objects — to  quiet  delirium,  subsul- 
tus,  or  restlessness,  and  to  overcome  the  cardiac  depression.  When 
very  active  interference  is  unnecessary  the  following  can  be  used  :  IJ 
Aqua  camphorse,  liq.  ammonise  acetatis,  aa  §  ij.  M.  Sig. :  A  table- 
spoonful  every  two  hours. 

Attacks  of  nervousness  and  hysteria  are  relieved  by  camphor- julep, 
i.  e.,  camphor  rubbed  up  with  mucilage.  Some  cases  of  delirium  tre- 
mens  are  benefited  by  camphor,  but  it  is  impossible  to  indicate  the 
special  condition  requiring  it.  Maniacal  excitement,  melancholia,  and 
erotomania,  have  also  been  relieved  by  this  agent,  but  a  great  uncer- 
tainty exists  as  to  the  indications  for  its  employment.  Large  doses 
are  necessary  in  these  affections,  and  they  should  at  first  be  tentative, 
for  it  is  not  possible  in  the  present  state  of  our  knowledge  to  predict 
the  results  of  any  given  trial.  On  the  whole,  but  little  dependence  is 
to  be  placed  on  camphor  ;  besides,  more  certain  and  effective  remedies 
are  now  available  for  the  treatment  of  these  maladies. 

There  appears  to  be  a  satisfactory  clinical  experience  as  respects 
the  use  of  camphor  to  allay  sexual  excitement.  Large  doses  (from  ten 
to  twenty  grains)  diminish  the  venereal  appetite  and  the  vigor  of  the 
erections  ;  hence  the  use  of  camphor  in  priapism,  satyriasis,  nympho- 
mania,  chordee,  etc.  The  following  is  a  formula  of  Ricord  :  IJ  Cam- 
phorse, lactucarii,  aa  3  j.  M.  Ft.  pil.  no.  xxx.  Sig. :  One  or  two  pills, 
or  more,  as  necessary.  For  nocturnal  seminal  losses,  with  weakness 
and  relaxation  of  the  genitalia,  the  following  formula  is  useful :  $ 
Ergotae  ext.  (Squibb),  3ij  ;  camphorse,  3  j.  M.  Ft.  pil.  no.  xxx. 
Sig.  :  Two  at  bed-hour.  A  full  dose  of  camphor  will  often  arrest  the 
strangury  produced  by  blisters. 

Considerable  testimony  has  been  collected  showing  the  value  of 


548  CEREBRAL   EXCITANTS. 

camphor  as  a  remedy  in  senile  gangrene,  and  in  hospital  gangrene. 
Five  to  fifteen  grains  every  four  hours  may  be  given  in  an  emulsion, 
and  powdered  camphor  may  be  applied  freely  to  the  sloughing  sur- 
face. A  clyster  of  camphor  is  an  effective  remedy  against  ascarides. 

Camphor  was  a  favorite  remedy  with  Dewees  for  dysmenorrhcea. 
He  gave  ten  grains  in  a  mixture  with  mucilage  and  cinnamon-water, 
and  repeated  the  dose  in  an  hour  or  two  if  necessary.  For  after-pains, 
camphor  (ten  grains),  in  a  mixture  with  a  little  morphine  (one  eighth 
of  a  grain),  is  an  effective  remedy. 

EXTERNAL  USES. — A  cataplasm  of  camphor,  morphine,  and  flax- 
seed,  applied  to  the  cheek,  will  relieve  toothache.  Camphorated  oil  is 
a  mild  counter-irritant,  which  is  a  useful  external  application  for  the 
relief  of  internal  inflammations.  The  solution  of  camphor  in  ether  has 
been  applied  locally  with  benefit  in  erysipelas.  Myalgia,  lumbago, 
and  neuralgia  of  superficial  nerves,  may  sometimes  be  relieved  by 
frictions  with  camphorated  oil  or  soap-liniment.  Powdered  camphor, 
freely  sprinkled  over  the  surface,  is  one  of  the  means  resorted  to,  and 
sometimes  with  success,  to  prevent  pitting  of  the  face  from  variola. 

Camphor  and  chloral  triturated  together  form  a  clear  liquid, 
which  will  take  up  morphine,  atropine,  and  other  alkaloids,  in  large 
quantity.  The  solution  containing  the  alkaloids  can  be  mixed  with 
chloroform  without  precipitation.  This  constitutes  a  topical  applica- 
tion of  great  power,  which  can  be  utilized  in  the  treatment  of  pain 
and  inflammation,  painted  over  the  part  affected  by  a  camePs-hair 
brush,  or  by  means  of  absorbent  cotton  saturated,  covered  with  oil- 
silk,  and  kept  in  position  as  long  as  it  can  be  borne.  This  solution 
may  be  given  internally  also,  but,  as  it  is  irritating,  only  in  small 
doses,  and  after  meals. 

The  formula  used  by  the  author  is  :  Equal  parts  of  camphor  and 
chloral ;  after  it  is  liquefied  by  trituration,  morphine  and  atropine 
are  added,  and  then  some  pure  chloroform  mixed  in  drop  by  drop. 
Thus :  1J  CamphoraB,  chloral,  aa  f  ss.  Mix,  and  add  morphina? 
sulph.,  3j  ;  atropinae  sulph.,  gr.  v.  When  dissolved,  add  slowly, 
chloroformi,  3  ss. 

Authorities  referred  to  : 

BEARD,  DR.  GEORGE  M.    Archives  of  Electrology,  1874,  p.  272. 

FLUCKIGER  AND  HANBUKY.     Pharmacographia,  article  Camphora. 

GUBLER,  DR.  ADOLPHE.     Bulletin  General  de  Therapeutique,  December  30,  1871. 

HARLEY,  DR.  JOHN.  The  Physiological  Action  of  Camphor.  The  Practitioner,  voL 
ix,  p.  210. 

HUSEMANN,  DR.  THEODOR.  Handbuch  dcr  gesammten  Arzneimittellehre,  Berlin,  1875, 
zweiter  Band. 

Acidum  Camphoricum. — Camphoric  acid.  [Not  official.]  By  the 
oxidation  of  camphor  with  nitric  acid  camphoric  acid  is  produced.  As 
it  occurs  in  commerce  it  is  crystalline  in  structure,  whitish  in  color, 


ASAF(ETIDA.  549 

slightly  acid  to  the  taste  and  in  reaction,  and  it  is  without  odor.  It  is 
nearly  insoluble  in  cold  water,  freely  soluble  in  hot  water,  and  it  dis- 
solves in  alcohol,  ether,  oils,  etc.  The  best  menstruum  is  vaseline  oil, 
and  this  is  the  most  suitable  vehicle  for  hypodermatic  injection. 

The  dose  of  camphoric  acid  ranges  from  5  to  20  grains.  It  is  best 
administered  in  wafer  or  capsule,  but  may  also  be  prescribed  in  some 
alcoholic  tincture,  or  in  vaseline.  If  large  doses  are  to  be  given,  not 
more  than  two  should  be  ordered  in  twenty-four  hours. 

ACTIONS  AND  USES. — In  small  medicinal  doses  (2  to  5  grains) 
camphoric  acid  stimulates  digestion,  improves  the  appetite,  and  hastens 
peristalsis.  In  large  doses  (20  grains)  it  causes  a  sense  of  heat,  and 
eructations  are  apt  to  occur.  In  massive  (toxic)  doses  it  sets  up  gas- 
tro-intestinal  inflammation,  with  the  local  and  systemic  states  that 
belong  thereto.  It  is  a  very  diffusible  substance,  entering  the  blood 
and  diffusing  out  again  into  the  urine  quickly,  about  five  hours  being 
occupied  in  the  process  (Bohland). 

Camphoric  acid  has  considerable  antiseptic  power  ;  it  destroys  the 
germs  of  putrefaction,  and  is  actively  toxic  against  pathogenic  organ- 
isms. It  is  said  to  render  inactive  the  bacillus  tuberculosis,  and  when 
administered  as  an  antiseptic  in  tuberculosis  of  the  intestines  it  was 
found  to  be  effective  in  arresting  the  sweats  of  consumption.  In 
catarrh  of  the  bladder  and  putrefaction  of  the  urine  it  has  proved  to 
exert  a  decided  antiseptic  influence. 

The  most  important  uses  of  camphoric  acid  are  in  the  treatment  of 
the  gastro-intestinal  troubles  of  phthisis — tuberculous  diarrhoea — to 
arrest  the  sweats  of  phthisis,  and  as  an  antiseptic  and  topical  remedy  in 
catarrhal  states  of  the  genito- urinary  apparatus.  In  the  treatment  of 
gastro-intestinal  affections  medium  doses  (about  10  grains)  should  be 
given  three  times  a  day,  an  hour  or  two  after  meals.  To  arrest  the 
sweats  of  phthisis,  a  single  full  dose  (20  grains)  should  be  given  at 
bedtime.  As  it  is  excreted  in  five  hours  after  it  is  administered, 
should  the  sweats  occur  toward  morning  a  second  dose  may  be  neces- 
sary after  midnight.  When  used  to  act  on  the  genito-urinary  mucous 
membrane,  small  doses  (5  grains)  frequently  repeated  should  be  given. 
Of  the  quantity  taken  almost  all  appears  in  the  urine. 

AsafOBtida. — Asafcetida.  A  gum-resin  obtained  from  the  root  of 
Ferula  narthex  Boissier,  and  of  Ferula  fcetida  (Bunge)  Hegel  (Nat. 
Ord.  Umbelliferce).  Asafoetida,  Fr. ;  Teufelsdreck,  Ger. 

Fmulsum  Asafostidce. — Asafoetida-mixture.  (Asafcetida,  40  grm. 
to  1,000  c.  c.  of  water.)  Dose,  §  ss.  —  §  ij. 

Tinctura  Asafostidce, — Tincture  of  asafcetida.  (Asafoetida,  200 
grm.,  and  alcohol  sufficient  to  make  100  c.  c.)  Dose,  3  ss.  —  3  ij. 

PillulcB  Asafoetidce. — Pills  of  asafcetida.  (Asafoetida  and  soap.) 
Each  pill  contains  about  three  grains  of  asafcetida.  Dose,  1 — 4  pills. 


550  CEREBRAL   EXCITANTS. 

Pilulce  Aloes  et  Asafoetidce. — Pills  of  aloes  and  asafcetida.  (Asa> 
foetida,  aloes,  soap.)  Does,  1 — 4  pills. 

Pilulce  Galbani  Compositce. — Compound  pills  of  galbanum.  (Asa- 
fcetida, galbanura,  and  myrrh.)  Dose,  1 — 4  pills. 

COMPOSITION. — About  one  half  of  the  gross  constituents  of  asafcetida 
consists  of  resin.  This  is  not  wholly  soluble  in  chloroform  or  ether.  It 
contains  a  peculiar  acid  (ferulaic  acid}.  Asafcetida  also  contains  a 
sulphureted  and  phosphureted  volatile  oil,  in  the  proportion  of  from 
three  to  five  per  cent.  This  oil  is  at  first  neutral,  but  becomes  acid  by 
exposure  to  the  air,  and  evolves  sulphureted  hydrogen.  It  possesses 
in  a  high  degree  the  disagreeable  odor  of  the  drug. 

Asafcetida  also  contains  malic  acid,  and  acetic,  formic,  and  vale- 
rianic  acids  are  products  of  the  watery  distillation.  There  is  sufficient 
gum  present  also  to  form  an  emulsion  with  water. 

ANTAGONISTS  AND  INCOMPATIBLES. — Acids,  neutral  salts,  cold,  and 
arterial  sedatives,  oppose  the  action  of  asafcetida. 

SYNEEGISTS. — The  gum-resins,  the  balsams,  and  the  aromatics,  es- 
sential oils  containing  sulphur  and  phosphorus,  and  alcohol  and  ether, 
promote  the  physiological  and  therapeutical  activity  of  asafcetida. 

PHYSIOLOGICAL  ACTIONS. — Asafcetida  possesses  an  extremely  char- 
acteristic odor,  and  a  pungent,  rather  hot,  and  faintly  acrid  taste.  It 
excites  by  its  presence  in  the  fauces  an  increased  flow  of  saliva.  It 
stimulates  secretion  from  the  gastro-intestinal  mucous  membrane,  pro- 
motes the  appetite,  improves  digestion,  and  increases  peristalsis.  The 
faeces  are  somewhat  softer,  and  are  very  offensive  from  the  presence  in 
them  of  sulphur  and  phosphorus  compounds,  resulting  from  the  de- 
composition of  the  essential  oil.  In  large  quantity  asafcetida  causes 
nausea,  vomiting,  and  purging.  The  active  principle  (the  essential 
oil)  undoubtedly  slowly  diffuses  into  the  blood,  for  the  odor  of  it  is 
detectable  in  the  sweat  and  breath.  Increased  action  of  the  heart,  a 
higher  temperature  of  the  surface  (subjectively,  at  least),  more  or  less 
diaphoresis,  and  diuresis,  have  been  observed  to  follow  its  medicinal 
administration.  It  acts  as  a  gentle  stimulant  to  the  brain,  induces  a 
feeling  of  well-being,  increases  the  flow  of  ideas,  and  causes,  as  the 
author  has  observed  in  one  case,  certainly,  sufficient  exhilaration  of  a 
pleasant  kind  to  be  regarded  as  an  intoxicant. 

Asafcetida  is  eliminated  by  the  skin,  intestinal  and  bronchial  mu- 
cous membrane,  and  in  small  part  by  the  kidneys.  The  functions  of 
all  these  organs  are  increased  in  activity  by  the  local  stimulant  effect. 
Partly  due  to  the  general  rise  of  arterial  pressure  which  it  produces, 
partly  to  its  local  action  in  the  process  of  elimination,  and  partly  to  its 
phosphorus  compounds,  asafcetida  increases  the  menstrual  flux,  and,  in 
both  sexes,  the  venereal  appetite. 

THERAPY. — Asafcetida  is  used  in  the  country  of  its  habitat  as  a 
condiment.  A  little — very  little — rubbed  on  the  gridiron,  improves 


ASAFCETIDA.  551 

the  flavor  of  beefsteak.  If  it  were  not  for  its  intolerable  odor,  and  for 
the  horrible  eructations  which  follow  its  use,  even  when  disguised  in  a 
sugar-coated  pill,  it  would  be  much  employed  as  a  stomachic  tonic  in 
atonic  dyspepsia,  accompanied  by  torpor  of  the  intestines.  For  the 
flatulent  colic  of  infants  no  remedy  is  better  than  mistura  asafoetidoe, 
which  may  be  given  in  teaspoonful  doses.  It  is  especially  in  the  flatu- 
lence of  hysteria  and  hypochondriasis  that  this  remedy  is  serviceable. 
It  expels  the  flatus,  promotes  intestinal  secretion  and  digestion,  and 
relaxes  the  bowels.  In  this  way  the  mind  is  relieved,  for  the  action 
of  asafoetida  extends  beyond  this  improvement  in  the  state  of  the 
chylopoietic  viscera — it  induces  a  condition  of  mental  cheerfulness 
which  takes  the  place  of  the  abnormal  mobility  of  hysteria,  and  of 
the  gloom  of  hypochondriasis. 

The  official  pill  of  aloes  and  asafoetida  is  an  excellent  combination 
for  the  relief  of  constipation,  when  associated  with  amenorrhoea.  It 
is  adapted,  of  course,  to  those  cases  in  which  there  is  a  condition  of 
anoemia  rather  than  of  plethora,  and  in  which  there  exists  a  state  of 
torpor  of  the  ovaries,  as  well  as  of  the  intestinal  canal.  These  condi- 
tions existing,  the  combined  pill  of  aloes  and  asafoetida  is  indicated 
whether  hysteria  be  present  or  not. 

The  chronic  scaly  eruptions,  chronic  eczema,  etc.,  especially  when 
the  skin  is  dry  and  harsh,  are  much  improved  by  the  persistent  use  of 
asafoetida. 

Bronchorrhcea,  bronchitis  after  the  acute  symptoms  have  subsided, 
the  cough  maintained  by  habit  which  may  succeed  the  whooping-cough, 
and  the  sympathetic  cough  of  mothers  whose  children  are  experiencing 
whooping-cough,  are  greatly  benefited  by  asafoetida.  I£  Mist,  asaf  oeti- 
dse,  3  iv  ;  ammonii  muriat.,  3  j-  M.  Sig.  :  A  tablespoonful  as  neces- 
sary. 

Asafoetida,  which  was  formerly  much  prescribed  in  asthma,  whoop- 
ing-cough, and  other  neuroses  of  the  respiratory  organs,  has  been  sup- 
planted by  more  efficient  remedies. 

The  disagreeable  odor  of  asafoetida,  which  is  a  bar  to  its  employ- 
ment in  many  of  the  diseases  to  the  treatment  of  which  it  is  very  well 
suited,  is  not  an  objection  to  its  use  in  hysteria,  hypochondriasis,  and 
epilepsy.  The  moral  effect  of  its  repulsive  odor  is  not  without  influence 
in  the  psychic  realm.  But  the  effect  of  asafoetida  is  not  simply  on  the 
imagination  of  the  patient ;  it  has  constituents  of  very  positive  quality, 
which  impress  the  brain.  Hence  the  utility  of  asafoetida  to  arrest  the 
hysterical  paroxysm,  and  to  relieve  the  numerous  maladies  in  which 
the  hysterical  constitution  disports  itself.  The  remarks  already  made 
in  regard  to  the  action  of  asafoetida  on  the  digestive  functions  in  hypo- 
chondriacal  subjects,  render  it  unnecessary  to  speak  more  at  length  on 
the  use  of  this  remedy  in  hypochondriasis.  Asafoetida  is  no  longer 
employed  in  the  treatment  of  epilepsy,  except  in  the  so-called  hystero- 


552  CEREBRAL   EXCITANTS. 

epilepsy.  The  convulsions  of  childhood,  from  reflex  irritation,  are 
sometimes  relieved  by  this  remedy,  but  it  is  entirely  without  utility  in 
convulsions  arising  from  renal  or  cerebral  disease. 

Ammoniacum.— Ammoniac.  A  gum-resin  obtained  from  Dorema 
ammoniacum  Don  (Nat.  Ord.  Umbelliferce).  Gomme  ammoniaque, 
Fr.  ;  Ammoniakgitmrni,  Ger. 

Emplastrum  Ammoniaci. — Ammoniac-plaster. 

Emplastrum  Ammoniaci  cum  Hydrargyro. — (Ammoniac,  mercury, 
diluted  acetic  acid,  and  lead-plaster.) 

Emulsum  Ammoniaci. — Ammoniac-mixture.  (The  resin  is  sus- 
pended by  the  gum  in  water.)  Dose,  §  ss —  §  j. 

COMPOSITION. — Ammoniac  contains  a  volatile  oil,  which  differs  from 
the  asafoetida  oil  in  not  containing  sulphur.  It  has  the  odor  of  the 
drug.  Ammoniac  also  contains  gum  and  resin,  the  latter  in  the  pro- 
portion of  about  seventy  per  cent. 

ANTAGONISTS,  INCOMPATIBLES,  and  SYNERGISTS,  same  as  for  asa- 
foetida. 

PHYSIOLOGICAL  ACTIONS. — The  effects  of  ammoniac  are  similar  to 
those  of  asafoetida,  but  it  is  much  less  active,  owing  to  the  fact,  chiefly, 
that  its  volatile  oil  does  not  contain  sulphur  and  phosphorus  com- 
pounds. 

THERAPY. — Ammoniac  may  be  used  for  the  same  purposes  as  asa- 
foetida, but  it  is  much  less  efficient  than  the  latter.  At  present  its  use  is 
almost  entirely  restricted  to  chronic  bronchial  affections,  in  which  the 
mistura  is  prescribed  usually  with  the  carbonate  or  chloride  of  ammo- 
nium. Ammoniac-plaster  is  sometimes  used  as  a  discutient  to  indo- 
lent glandular  and  inflammatory  swellings. 

Authorities  referred  to  : 

FLUCKIGER  AND  HANBURY.     Pharmacographia. 

GUBLER,  DR.  A.     Commentaires  Therapeutiques. 

HUSEMANN,  DR.  THEOD.     Handbuch,  etc.,  zweiter  Band,  p.  987. 

KOHLER,  DR.  HERMANN,     ffandbuch,  etc.,  erste  Halfte,  p.  392. 

STILLE,  DR.  ALFRED.     Therapeutics  and  Materia  Medico,  fourth  edition. 

TROUSSEAU  ET  PIDOUX.     Traite  Therap.  et  Mat.  Med.,  vol.  ii. 

Valeriana. — Valerian.  The  rhizoma  and  rootlets  of  Valeriana  offi- 
cinalis  Linne  (Nat.  Ord.  Valerianaceae).  Valeriane,  Fr.  ;  Baldrian- 
wurzel,  Ger. 

Extractum  Valeriance  Fluidum. — Fluid  extract  of  valerian.    Dose, 

3  88 —  |  88. 

Tinctura  Valeriance. — Tincture  of  valerian  (200  grm.  to  1,000  c.  c.). 
Dose,  3  ss —  3  ij- 

Tinctura  Valeriance  Ammoniata. — Ammoniated  tincture  of  vale- 
rian (200  grm.  of  valerian  and  aromatic  spirit  of  ammonia  to  make 
1,000  c.  c.). 


•VALERIAN.  553 

Ammonii  Valerianas. — Valerianate  of  ammonia.  Is  a  white  salt, 
in  the  form  of  quadrangular  plates,  having  the  disagreeable  odor  of 
valerianic  acid,  and  a  sharp,  sweetish  taste.  It  deliquesces  in  a  moist 
air,  but  effloresces  in  a  dry  one,  and  is  very  soluble  in  water  and  in 
alcohol.  It  is  decomposed  by  potassa,  with  evolution  of  ammonia,  and 
by  the  mineral  acids  with  separation  of  valerianic  acid,  which  rises  to 
the  surface  in  the  form  of  oil. 

Oleum  Valeriance. — Oil  of  valerian.     Dose,  TTJ,  ij — TTJ,  iv. 

COMPOSITION. — Valerian  contains  from  one  to  two  per  cent  of  an 
essential  oil,  which,  if  distilled  from  the  perfectly  fresh  plant,  has  but 
little  odor.  In  the  process  of  drying  of  the  root,  or  on  exposure  to  the 
air  of  the  oil  distilled  from  fresh  roots,  valerianic  acid  is  formed. 
As  obtained  from  the  dried  root,  the  oil  of  valerian  consists  of  valeri- 
anic acid,  a  camphor,  valerene,  and  valerol. 

An  acid  strongly  resembling  valerianic  is  obtained  by  the  oxida- 
tion of  amylic  alcohol ;  but  the  two  acids  are  not  identical.  The 
valerianic  acid  of  pharmacy  is,  however,  obtained  in  this  way,  and  the 
various  valerianates  are  products  of  the  combination  of  the  acid  formed 
from  ainylic  alcohol  with  bases. 

ANTAGONISTS  AND  INCOME ATIBLES. — Quinine,  digitalis,  ergot,  and 
remedies  acting  similarly,  antagonize  the  actions  of  valerian. 

SYNEEGISTS. — All  the  agents  of  this  group,  opium,  alcohol,  ether, 
etc.,  increase  the  action  of  valerian. 

PHYSIOLOGICAL  ACTIONS. — Valerian  and  its  preparations  have  a 
hot,  pungent  taste,  and  a  peculiar  and  disagreeable  odor.  A  sensation 
of  warmth  at  the  epigastrium  follows  when  it  is  taken  into  the  stom- 
ach. In  large  doses,  nausea,  hiccough,  eructations  of  the  drug,  vomit- 
ing, and  diarrhoea,  may  be  produced.  In  small  doses  no  appreciable 
physiological  effects  are  observed  ;  but  in  considerable  doses  the  action 
of  the  heart  is  increased,  the  temperature  of  the  surface  rises,  and  dia- 
phoresis occurs.  As  respects  the  nervous  system,  headache,  vertigo, 
exhilaration  of  mind,  spectral  illusions,  hallucinations,  have,  it  is  said, 
been  produced  by  valerian  ;  but  these  results  are  by  no  means  constant 
phenomena.  According  to  Von  Grisar  (Kohler),  oil  of  valerian  re- 
duces the  reflex  excitability,  motility,  and  sensibility,  and  antagonizes 
the  tetanizing  action  of  brucine. 

The  odorous  principle — valerianic  acid — appears  in  the  sweat, 
breath,  and  also  the  urine. 

THERAPY. — The  flatulence  of  the  hysterical  and  hypochondriacal 
is  quickly  relieved  by  the  tincture  or  fluid  extract  of  valerian. 

It  sometimes  happens  that  a  mild  attack  of  spasmodic  asthma  may 
be  relieved  by  valerian,  but  this  by  no  means  efficient  remedy  quickly 
loses  its  effect.  Whooping-cough,  laryngismus  stridulus,  and  other 
neuroses  of  the  respiratory  organs,  may  be  occasionally  modified  by 
this  agent  ;  but  it  is  by  no  means  equal  to  many  other  remedies  now 
available. 


554  CEREBRAL   EXC[TANT$ 

The  chief  therapeutic  use  of  valerian  is  in  the  treatment  of  nerv- 
ousness, hysteria,  and  hysterical  disorders  generally.  There  can  be 
no  difference  of  opinion  as  to  its  great  value  in  these  cases  ;  but 
as  respects  epilepsy,  chorea,  paralysis  agitans,  etc.,  in  which  it 
was  formerly  used,  it  must  suffice  to  say  that  it  is  now  never  pre- 
scribed. 

Under  the  impression  that  the  physiological  and  therapeutical  ac- 
tivity of  valerian  depends  on  valerianic  acid,  various  valerianates  have 
been  introduced  into  practice.  The  only  one  which  requires  notice 
here  is  the  valerianate  of  ammonia,  which  in  the  form  of  elixir  is  fre- 
quently prescribed  in  hysterical  affections.  Fluid  extract  of  valerian 
has  been  used  with  advantage  in  diabetes  insipidus  and  also  in  saccha- 
rine diabetes,  but  the  results  are  not  permanent.  It  diminishes  the 
amount  of  urinary  water  in  both,  and  lessens  the  excretion  of  sugar 
in  the  latter,  but  these  effects  continue  only  while  the  remedy  is 
given. 

Authorities  referred  to  : 

FLUCKIGER  AND  HANBURY.     Pharmacographia. 

HUSEMANN,  DR.  THEODOR.     Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band. 

HUSEMANN,  DRS.  AUG.  UND  THEO.     Die  Pflanzenstoffe. 

KOHLER,  DR.  HERMANN.    Handbuch  der physiologischen  Therapeutik,  etc.,  erste  Halfte. 

TROUSSEAU  ET  PIDOUX.     Traite  de  TTierapeutique  el  de  Mat.  Med.,  huitifcme  edition. 

Cannabis  Indica. — Indian  cannabis.  The  flowering  tops  of  the 
female  plant  of  Cannabis  sativa  Linne  (Nat.  Ord.  Urticacece,  Canna- 
binece),  grown  in  the  East  Indies.  Chanvre  Indient  Fr. ;  Han/kraut, 
Ger. 

PREPARATIONS. — Extractum  Cannabis  Indicce. — Extract  of  canna- 
bis Indica.  Dose,  gr.  £ — gr.  ij  or  more. 

Extractum  Cannabis  Indicce,  IFluidum. — Fluid  extract  of  canna- 
bis Indica.  Dose,  TTJ,  ij —  3  ss. 

Tinctura  Cannabis  Indicce. — Tincture  of  cannabis  Indica.     Dose, 

m  v—  3  j. 

Cannabinum  Tannicum. — Dose,  gr.  j — gr.  x. 

COMPOSITION. — The  most  important  constituent  of  hemp  is  a  pecul- 
iar resin,  cannabin,  which  possesses  the  active  powers  of  the  plant. 
By  distillation  of  the  leaves  and  stems,  a  peculiar  volatile  oil  is  ob- 
tained ;  and  this  is  divisible  into  cannabene,  a  very  light  hydrocarbon, 
and  hydride  of  cannabene,  a  solid  crystalline  substance. 

An  impure  resin,  collected  in  an  imperfect  and  crude  way  from  the 
leaves  and  stems,  is  known  as  charas  or  churrus.  Bhang  consists  of 
the  dried  leaves  and  stalks  made  into  a  confection  with  preserved  fruits 
and  aromatics,  and  in  this  form  constitutes  the  well-known  hashish. 
Gunjah  is  the  female  flowering  plant,  dried,  from  which  the  resin  has 
not  been  extracted.  There  are  important  differences  of  opinion  as  to 
the  active  constituents.  According  to  Roux,  the  new  preparation— 


CANNABIS  INDICA.  555 

the  tannate  of  cannabin — has  no  obvious  effects,  is  in  fact  inert.  The 
volatile  oil,  which  Personne  thinks  is  the  true  active  principle,  has  also 
been  shown  to  have  no  special  power.  The  alcoholic  extract  is  inert, 
and  Duquesnel's  proved  to  be  no  more  active.  The  resin,  it  seems  to 
be  demonstrated,  is  the  active  part,  or  contains  it.  The  petroleum 
(rhigolene  or  benzine  ?)  extract  has  excitant  and  convulsive  property, 
and  is  distinctly  toxic. 

No  arbitrary  rules  for  the  dose  can  be  laid  down.  In  beginning 
the  use  of  any  newly-made  preparation,  it  is  safer  to  commence  with 
the  minimum  dose.  Having,  by  gradually  increasing  the  quantity, 
ascertained  the  physiological  activity  of  that  particular  specimen,  it 
may  then  be  pushed  according  to  the  necessities  of  the  case. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies,  the  acids, 
strychnine,  and  induction  electricity,  oppose  the  actions  of  hemp.  In 
cases  of  poisoning,  the  stomach  should  be  evacuated,  and  symptoms  be 
combated  as  they  arise.  Strychnine  may  be  injected  hypodermatical- 
ly,  and  the  respiration  be  maintained  by  faradization  of  the  respiratory 
muscles.  As,  however,  hemp  possesses  but  feeble  toxic  power,  cases 
of  acute  poisoning  have  never  been  reported. 

SYNEEGISTS. — Alcohol,  ether,  nitrous  oxide,  the  mydriatics — bella- 
donna, hyoscyamus,  etc. — opium,  and  the  cerebral  stimulants  general- 
ly, promote  the  actions  of  hemp. 

PHYSIOLOGICAL  ACTIONS. — The  resin  of  hemp  is  a  soft  solid  ;  is 
soluble  in  alcohol  and  in  ether,  in  the  fixed  and  volatile  oils,  and  in 
the  fats.  It  has  a  balsamic  taste,  but  is  bitter  and  acrid.  It  promotes 
the  appetite  and  the  digestion  somewhat.  The  most  important  actions 
are  those  referable  to  the  nervous  system.  There  is  a  distinction  to 
be  made  between  the  effects  on  the  nervous  system  of  the  inhalation 
of  the  fumes  of  hashish  and  those  effects  which  follow  the  stomach 
administration.  Inattention  to  this  point  has,  probably,  given  rise  to 
most  of  the  confusion  regarding  the  physiological  actions  of  this  rem- 
edy. When  inhaled  it  produces  a  singular  muscular  erythism  and  agi- 
tation, a  great  desire  for  muscular  activity  and  motion,  an  entire  absence 
of  the  sense  of  fatigue  ;  but  these  sensations  are  followed  by  exhaus- 
tion, even  by  syncope.  Hallucinations  occur,  but  they  are  not  usually 
agreeable  ;  they  are  often  painful,  and  are  replaced  by  stupor. 

By  the  stomach,  and  in  moderate  doses,  hashish  is  an  excitant  of 
the  nervous  system,  increasing  intellectual  and  motor  activity.  In 
large  doses,  it  lowers  the  tactile  sense  and  the  sense  of  pain — in  other 
words,  it  is  analgesic  and  anaesthetic — and  it  induces  a  cataleptic  state, 
in  which  the  muscles  maintain  any  position  in  which  they  may  be 
placed.  The  mental  intoxication  is  ordinarily  of  an  agreeable  kind  ; 
the  ideas  flow  more  easily,  are  highly  pleasurable,  and  are  usually  ac- 
companied by  bursts  of  gay  laughter.  Not  unfrequently  the  excite- 
ment t9,kes  the  form  of  a  furious  delirium,  in  which  acts  of  violence 


556  CEREBRAL  EXCITANTS. 

are  committed — whence  the  name  "  haschaschins,"  or  assassins,  applied 
to  the  unfortunate  hashish-eater  who,  under  the  influence  of  the  drug, 
commits  murder.  It  has  been  maintained,  and  probably  rightly  enough, 
that  the  form  which  the  delirium  takes  represents  the  mental  and  moral 
condition  of  the  individual  in  his  normal  state  :  those  who  are  amiable 
and  gay  become  more  so  under  the  influence  of  hashish  ;  and  those 
possessed  of  evil  and  malignant  dispositions  enact  deeds  of  violence. 

Under  the  influence  of  hashish  the  knowledge  of  time  is  lost  ;  such 
are  the  number  and  variety  of  the  images  which  occupy  the  mind, 
that  a  few  minutes  appear  to  be  hours,  days,  or  even  years.  After  the 
effects  of  the  drug  have  passed  off,  the  hashish-eater  is  usually  uncon- 
scious of  the  events  that  have  transpired.  Sleep  or  coma,  according 
to  the  dose,  ends  the  effects  of  the  drug. 

Dilatation  of  the  pupil,  and  disorders  of  vision,  which  contribute  to 
the  hallucinations  by  the  distortion  of  external  objects,  are  produced 
by  hemp.  Aphrodisiac  effects  are  said  to  follow  the  use  of  hashish  ; 
but  impotence,  which  is  common  in  hashish-eaters,  doubtless  results 
from  the  repeated  over-stimulation  of  the  sexual  organs. 

It  is  not  known  by  what  organs,  or  in  what  form,  hashish  is  elimi- 
nated. The  effects  of  a  large  dose  are  not  entirely  expended  in  twenty- 
four  hours,  and  those  who  have  taken  it  by  way  of  experiment  have 
suffered  vertigo,  headache,  and  other  cerebral  symptoms,  for  some  time 
subsequently.  It  does  not  increase  any  of  the  secretions,  except  it  may 
be  the  urinary,  somewhat ;  and  it  does  not  stimulate  into  increased 
activity  any  organs  except  the  cerebro-spinal  and  the  sexual.  The 
sleep  or  stupor  which  it  produces,  and  which  comes  on  after  the  stage 
of  excitement,  is  not  followed  by  after  nausea  and  depression,  as  in  the 
case  of  opium. 

THEKAPY. — The  extract  of  cannabis  Indica  enters  into  the  compo- 
sition of  chlorodyne,  a  nostrum  which  has  had  a  great  reputation  as  an 
anodyne  and  hypnotic.  In  cholera  morbus  and  diarrhoea  this  remedy 
has  been  used  successfully,  but  we  now  possess  more  efficient  ones. 

Before  the  days  of  anaesthesia,  and  in  very  remote  times,  the  fumes 
of  hashish  were  employed  to  stupefy  and  to  render  painless  surgical 
operations.  It  was  also  employed  to  relieve  pain,  and  as  a  substitute 
for  opium  in  neuralgia,  and  as  an  hypnotic.  In  migraine  it  has  been 
used  with  decided  success  by  Seguin,  Williams,  and  others.  Good  re- 
sults have  been  obtained  from  it  in  epilepsy  by  Sinkler  and  others,  and 
it  deserves  further  consideration  in  this  disease.  In  chorea,  and  in 
delirium  tremens,  it  is  strongly  urged  by  De  Cavaillon,  and  in  senile 
trembling  and  paralysis  agitans  it  has  afforded  relief.  About  one  half 
of  the  cases  of  tetanus,  for  which  hemp  was  much  prescribed  a  few 
years  ago,  got  well  under  its  use  ;  but  more  accurate  knowledge  of 
the  natural  history  of  this  disease  has  shown  that  many  cases  tend  to 
recovery  without  the  aid  of  medicines. 


OOCA.  557 

It  is  well  established  that  hemp  has  the  power  to  promote  uterine 
contractions.  It  can  not  initiate  them,  but  increases  their  energy  when 
action  has  begun.  It  may  be  given  with  ergot.  In  consequence  of 
this  power  which  it  possesses  to  affect  the  muscular  tissue  of  organic 
life,  hemp  is  used  successfully  in  the  treatment  of  menorrhagia.  It  is 
said  to  be  especially  useful  in  that  form  of  menorrhagia  which  occurs 
at  the  climacteric  period  (Churchill).  It  has,  more  recently,  been  shown 
to  possess  the  power  to  arrest  hcemorrhage  from  any  point,  but  it  is 
chiefly  in  menorrhagia  that  much  good  is  accomplished. 

There  can  be  no  doubt  that  cannabis  Indica  is  a  useful  remedy  in 
cases  of  impotence.  It  need  hardly  be  stated  that  it  is  adapted  to  the 
functional  disorder.  It  may  be  advantageously  combined  with  ergot 
and  nux  vomica  in  this  malady  ;  for  example  :  $  Ext.  cannabis  Indi- 
cae,  gr.  x  ;  ergotin  (aq.  ex.),  3ij  ;  ext.  nucis  vom.,  gr.  x.  M.,  ft.  piL 
no.  xx.  Sig.  :  One  morning  and  evening. 

This  agent  has  also  been  used  with  success  in  the  treatment  of 
gonorrhoea.  It  diminishes  the  local  inflammation,  allays  chordee,  and 
lessens  the  pain  and  irritation,  with  the  accompanying  restlessness. 

Authorities  referred  to  : 

Bulletin  General  de  Tlierapeutique.     Various  articles,  1870,  '74,  '76. 
FLUCKIGER  AND  HANBCEY.     Pharmacographia,  p.  491. 
SEGUIN,  DR.  E.  C.     New  York  Medical  Record,  vol.  xii,  p.  774. 
WILLIAMS,  DR.  S.  W.    London  Medical  Record,  vol.  i,  p.  407. 

Coca. — Coca.  The  leaves  of  ErytJiroxylon  coca  Lamarck  (Nat. 
Ord.  Linece). 

PREPARATION. — Extractum  Cocce  Fluidum.  —  Fluid  extract  of 
coca.  Dose,  3  ss —  3  ij. 

COMPOSITION. — The  effects  of  coca  depend  on  the  presence  of 
a  peculiar  alkaloid — cocaine.  It  contains  also  an  aromatic  oil  which 
gives  it  the  special  aroma  and  taste,  and  it  possesses  considerable 
astringency,  due  to  the  presence  of  a  tannic  acid.  The  odor,  taste, 
and  appearance  of  the  infusion  are  comparable  to  those  of  tea.  Co- 
caine has  decided  basic  properties,  and  combines  with  acids  to  form 
salts.  It  crystallizes  in  prisms  in  the  smaller  rhombic  system  (Huse- 
mann),  which,  when  pure,  are  transparent  and  colorless.  It  is  very 
slightly  soluble  in  water  and  in  alcohol,  but  dissolves  freely  in  ether. 
It  has  a  bitter  taste,  and  the  salts  are  more  bitter  than  the  alkaloid 
itself. 

Cocaince  Hydrochloras. — Cocaine  hydrochlorate.  Colorless,  trans- 
parent crystals,  or  a  white  crystalline  powder,  without  odor,  slightly 
bitter  taste,  and  producing  on  the  tongue  a  tingling  sensation,  followed 
by  numbness  of  some  minutes'  duration.  Soluble  at  59°  Fahr.  (15°  C.) 
in  0'48  part  of  water  and  in  3*5  parts  of  alcohol. 

Tropacocaine  (benzoylpseudotropein)  is  an  alkaloid  of  the  small- 


558  CEREBRAL   EXCITANTS. 

leaved  coca  of  Java.  This  was  first  extracted  from  the  plant  by  Gie- 
sel,  and  it  was  made  synthetically  by  Liebermann,  who  proved  its 
identity  with  pseudotropein  of  hyoscyamus. 

PHYSIOLOGICAL  ACTIONS. — The  historical  notes  of  Sir  R.  Christi- 
son  show  that  the  peculiar  properties  of  cuca-leaves  have  long  been 
known  to  the  inhabitants  of  Peru.  The  leaves  have  a  strong,  tea-like 
odor,  and  the  infusion  resembles  ordinary  tea  in  taste.  The  volatile 
oil  and  the  active  principle  are  readily  diffusible,  and  enter  the  blood 
with  facility.  A  momentary  depression  of  the  pulse  and  diminution 
of  the  blood-pressure  take  place,  but  these  effects  are  quickly  over- 
come, and  a  considerable  increase  in  the  action  of  the  heart  and  of  the 
blood-pressure  follows  (Ott).  A  feeling  of  contentment  and  of  well- 
being  takes  possession  of  the  mind,  the  sense  of  fatigue  is  removed, 
drowsiness  is  experienced  for  a  brief  period,  but  it  is  soon  succeeded 
by  wakefulness  and  increased  mental  activity.  It  has  long  been 
known  to  the  mountaineers  of  the  Peruvian  Andes  that  chewing  cuca- 
leaves  increases  the  respiratory  power,  and  removes,  or  lessens,  the 
sense  of  fatigue.  The  celebrated  pedestrian,  Weston,  having  learned 
this  fact,  was  detected  in  the  use  of  cuca  during  one  of  his  extraordi- 
nary feats  in  London  (Thompson). 

Although  erythroxylon  (coca  or  cuca)  had  been  the  subject  of  in- 
vestigation and  its  power  to  suspend  the  functions  of  the  sensory 
nervous  system  recognized,  the  character  of  its  local  action  was  not 
suspected.  It  was  reserved  for  Dr.  Roller,  of  Vienna,  to  discover  its 
analgesic  effects  when  applied  directly  to  the  mucous  membrane,  and 
this  great  fact  he  demonstrated  before  the  Ophthalmological  Congress 
at  Heidelberg.  It  happened  that  the  distinguished  ophthalmologist 
of  New  York,  Prof.  Dr.  Noyes,  was  in  attendance  on  the  Congress, 
and  he  sent  to  the  New  York  "  Medical  Record  "  a  letter  giving  the 
facts  of  the  discovery,  and  this  proved  to  be  the  first  statement  in  the 
English  language  of  Roller's  demonstration.  As  the  possibilities  of 
the  future  utility  of  cocaine  as  a  local  anaesthetic  was  then  recog- 
nized, it  created  a  profound  impression,  and  in  an  incredibly  short 
time  this  remarkable  discovery  became  the  common  interest  and  the 
common  possession.  Everywhere  cocaine  was  investigated  by  physio- 
logical and  clinical  methods,  and  the  results  confirmed  the  statements 
of  Roller.  By  no  one  on  this  side  of  the  ocean  was  the  investigation 
of  the  properties  and  powers  of  cocaine,  more  especially  from  the  stand- 
point of  the  ophthalmologist,  more  carefully  conducted  than  by  Rnapp, 
of  New  York,  who  confirmed  the  results  attained  by  Roller.  Before 
the  Congress  of  Ophthalmologists  Roller  exhibited  the  effect  of  a  four- 
per-cent  solution  applied  to  the  conjunctiva — such  a  degree  of  anaes- 
thesia being  induced  by  it  that  this  delicate  membrane  bore  cutting, 
pinching,  and  tearing  without  any  manifestation  of  pain  and  without 
exciting  reflex  action.  It  was  also  shown  that  the  local  action  of  co- 


COCA.  559 

caine  included  a  condition  of  anaemia  of  the  parts  due  to  an  active 
contraction  of  the  arterioles.  Only  the  mucous  membrane  is  rendered 
anaesthetic.  The  skin  is  not  penetrated  unless  an  abrasion  or  some 
punctures  permit  the  solution  to  pass  through. 

It  was  early  observed  that  idiosyncrasy  influences  greatly  the  ef- 
fects of  cocaine.  A  few  drops  instilled  into  the  eye  and  through  the 
vessels  of  the  nares  entering  the  circulation  have  caused  sudden  and 
severe  depression  of  the  vital  powers,  great  weakness  of  the  heart's 
action,  slow  and  shallow  respiration,  and  convulsive  jerkings  of  the 
muscles.  Similar  and  more  severe  symptoms  have  accompanied  the 
hypodermatic  injection  of  a  small  dose  (an  eighth  of  a  grain),  and 
death  has  ensued  suddenly  from  heart-failure  in  not  a  few  instances 
when  moderate  doses  have  been  administered  in  this  way. 

The  character  of  the  action  of  cocaine  is  much  influenced  also  by  the 
amount  administered,  and  the  several  stages  of  its  action  differ  be- 
cause the  immediate  and  primary  effect  is  necessarily  opposed  to  the 
condition  of  reaction  which  seeks  to  restore  the  normal.  When  a  suffi- 
ciently active  dose  is  given,  the  first  effect  is  stimulation  ;  the  heart- 
beats are  accelerated  ;  the  respiration  becomes  more  frequent ;  the 
reflexes  respond  to  a  distant  irritation  more  promptly  ;  the  mind  ex- 
periences a  grateful  sense  of  well-being  and  of  activity,  and  ideation  is 
ready,  acute,  and  comprehensive. 

The  stage  of  excitement  continues  for  an  hour  or  two,  and  is  suc- 
ceeded by  depression,  which  is  at  the  same  time  physical,  mental,  and 
moral.  The  pulse  may  continue  quick,  but  its  force  declines,  and 
some  irregularity  of  the  rhythm  may  occur  ;  the  skin  grows  moist  or 
profuse  sweating  comes  on  ;  the  body  temperature  declines  a  little, 
possibly  ;  the  appetite  is  lost,  and  nausea  and  vomiting  increase  the 
feelings  of  physical  wretchedness  and  moral  distress.  These  are  the 
conditions  which  impair  nutrition.  Observations  made  on  those  un- 
fortunates addicted  to  the  use  of  morphine  and  cocaine  have  proved 
misleading.  The  decline  in  the  weight  of  the  body  is  for  the  most 
part  due  to  the  gastro-intestinal  derangement  and  to  the  complete 
anorexia  which  is  a  result  of  the  withdrawal  of  the  morphine.  No 
doubt  cocaine  contributes  to  the  wasting  to  some  extent.  Although 
cocaine  is  not  actively  toxic,  and  may  be  taken  in  enormous  doses, 
some  persons  are  highly  susceptible  to  its  action,  and  are  profoundly 
depressed  by  a  minute  quantity.  On  the  one  hand,  we  find  that  Dr. 
Hammond,  who  reports  taking  eighteen  grains  at  a  single  dose,  has 
experienced  only  disturbed  sleep  and  severe  headache  as  a  consequence ; 
on  the  other  hand,  a  susceptible  woman,  who  is  made  faint,  nauseated, 
and  seriously  depressed  by  the  minute  quantity  that  has  passed  into 
the  nares  from  an  instillation  into  the  eye. 

In  the  smaller  medicinal  doses  (-£  to  ^  grain)  cocaine  stimulates  the 
nerve-functions,  gives  clearness  and  power  to  the  tones  of  the  voice^ 


560  CEREBRAL   EXCITANTS. 

heightens  the  reflexes,  and  raises  the  arterial  tension.  Large  doses  act 
briefly  in  the  stimulating  way  above  described,  but  the  depression 
stage  quickly  succeeds,  then  the  mental  activity  declines,  memory  is 
impaired,  and  a  sense  of  weariness  comes  on.  During  this  period 
there  is  more  or  less  sweating,  sometimes  profuse,  and  a  tingling  and 
pricking  sensation  accompany  it. 

Cocaine  pursues  a  certain  order  in  its  action  on  the  brain  and  nerv- 
ous system  :  first  the  hemispheres,  then  the  lower  motor  and  co-ordi- 
nating centers  and  the  reflex  centers,  including  respiration  and  also  the 
vaso-motor  center.  The  sensory  paralysis  includes  the  posterior  col- 
umns ;  but  it  is  held  by  the  principal  authorities  that  it  begins  in  the 
peripheral  nerves,  and  thence  extends  to  the  sensory  tract  in  the  spinal 
cord.  Cocaine  has  a  distinctly  convulsant  action  in  animals,  as  has 
been  experimentally  shown  by  many  observers.  These  convulsions 
are  clonic  in  character.  Similar  results  occur  in  man  from  large  doses, 
and  have  been  especially  observed  in  the  subjects  of  its  habitual  use, 
when  suddenly  acted  on  by  massive  doses.  The  convulsive  movements 
are  accompanied  by  irregular  action  of  the  heart,  by  sighing  and  shal- 
low respiration,  and  by  hallucinations  of  vision  and  hearing. 

Cocaine  first  stimulates  and  afterward  paralyzes  the  pneumogastric 
nerve,  and  the  respiration  is  first  increased  and  afterward  paralyzed, 
failure  of  respiration  being  the  mode  of  dying. 

The  utility  of  cocaine  was  first  demonstrated  in  ophthalmological 
practice.  The  manner  of  its  action  on  the  eye  has  been  carefully 
worked  out  as  a  basis  for  its  therapeutical  applications.  When  in- 
stilled into  the  eye,  anaesthesia  is  first  induced  in  the  conjunctiva  and 
cornea,  and  this  effect  may  be  accomplished  by  a  solution  having  the 
strength  of  2  to  100  ;  but  stronger  solutions  (5  to  100)  act  more 
quickly  and  efficiently.  When  the  deeper  parts  of  the  eye  are  to  be 
acted  on,  the  stronger  solutions  are  made  use  of,  and  the  contact  must 
be  sufficiently  prolonged.  Wounds  of  the  eyes  and  incisions  made 
are  utilized  to  secure  the  diffusion  of  the  anaesthetic  to  the  deeper 
parts  of  the  organ.  A  simple  congestion  of  the  conjunctiva  does  not 
hinder  the  effects  of  cocaine  ;  but  chronic  changes  in  the  structures  of 
the  organ  have  a  retarding  influence.  Some  dilatation  of  the  pupil 
begins  in  about  fifteen  minutes  after  an  instillation,  but  the  pupil  re- 
mains sensitive  to  light  (Roller).  Accommodation  is  somewhat  af- 
fected, but  not  sufficiently  so  to  be  an  interference.  The  mydriasis 
reaches  its  maximum  in  about  an  hour,  and  subsides  in  three  or  four 
hours  afterward. 

Cocaine  is  eliminated  by  the  kidneys  and  may  be  detected  in  the 
urine.  The  excretion  takes  place  in  a  short  time,  in  a  few  hours. 

Therapy. — The  preparations  of  coca,  especially  the  wine,  are  much 
employed  as  stomachic  tonics.  The  consumption  of  wine  of  coca  (a 
solution  of  cocaine  in  wine)  must  be  enormous,  for  numerous  prepara- 


COCA.  561 

tions  are  on  the  market.  They  are  advertised  in  the  most  lavish 
manner,  and  so  freely  dispensed  to  physicians  in  the  form  of  trial 
specimens  that  only  large  sales  with  immense  profits  can  justify  the 
expenditure.  The  author  has  observed  that  clergymen,  and  men 
with  scruples  and  high  moral  character,  take  this  wine  freely,  and 
not  without  a  devout  appreciation  of  its  grateful  action  in  time  of 
need. 

To  illustrate  :  a  clergyman  of  character,  attainments,  and  rhetorical 
skill,  informed  me  that  he  always  took  a  small  wine-glassful  of  the 
wine  of  coca  before  his  Sunday  morning  service.  He  had  found  that 
it  banished  fatigue,  gave  a  resonant  tone  to  his  voice,  and  freed  his 
intellect  from  the  trammels  of  a  written  discourse,  and  gave  scope  and 
power  to  his  sermon.  Those  who  at  first  experienced  this  grateful 
addition  to  their  resources  came  after  a  time  to  that  melancholy  stage 
of  its  action  when  the  dose  taken  must  be  larger,  and  consequently  an 
increasing  depression  with  its  baleful  associations  continually  succeeds 
to  the  shortening  stage  of  agreeable  excitation. 

In  various  neuroses  of  the  respiratory  organs,  asthma,  whooping- 
cough,  singultus,  etc.,  there  can  be  no  doubt  respecting  its  curative 
power,  and  small  doses  are  more  useful  than  large  ones  in  these  cases. 
The  effects  are  more  decided  when  the  remedy  is  thrown  under  the 
skin,  and  a  single  dose  may  give  more  relief  than  weeks  of  other 
treatment.  In  the  case  of  neurotic  individuals  with  the  irritable  and 
impressionable  nervous  system  characteristic  of  the  type,  cocaine,  more 
especially  when  administered  hypodermatically,  has  acted  in  a  way  to 
indicate  serious  danger.  We  have  already  pointed  out  how  it  is  that 
such  an  idiosyncrasy  may  endanger,  even  take,  life  by  sudden  failure 
of  respiration  or  of  circulation. 

The  topical  action  of  cocaine  in  hay-fever  has  proved  to  be  a  valu- 
able expedient.  The  solution,  four  to  ten  per  cent,  in  spray  or  ap- 
plied by  the  brush  to  the  whole  surface  of  the  nasal  and  faucial  mu- 
cous membrane,  lessens  congestion  and  secretion,  and  prevents  the 
passage  to  the  respiratory  center  of  the  peripheral  irritation.  Better 
than  with  a  solution  the  parts  affected  are  easily  acted  on  by  the  slow 
solution  of  a  compressed  pellet  placed  conveniently  in  the  anterior 
nares  behind  the  cartilages.  Numerous  reports  have  been  made  of  the 
complete  relief  afforded  by  this  mode  of  application. 

Most  remarkable  have  been  the  successes  obtained  by  the  local  ap- 
plications of  cocaine  to  abate  inflammation,  to  stop  or  to  relieve  pain. 
It  must  not  be  forgotten  that  swallowing  during  and  immediately 
after  local  applications  to  the  nares  and  fauces  may  cause  systemic 
effects.  Cases  have  occurred  in  which  a  small  quantity  thus  entering 
the  system  has  brought  on  the  most  alarming  syncope.  The  small 
quantity  escaping  by  the  tear-duct  into  the  nose,  thence  into  the  resoph- 
agus,  has  also  in  a  few  instances  caused  faintness. 
38 


562  CEREBRAL  EXCITANTS. 

Cocaine  is  a  remedy  of  the  highest  value  in  chorea.  The  author 
has  repeatedly  cured  cases  in  which  all  the  ordinary  and  some  ex- 
traordinary remedies  had  been  used  in  vain.  The  whole  amount  given 
daily  has  rarely  exceeded  one  half  a  grain.  Paralysis  agitans,  alco- 
holic tremors,  and  senile  trembling,  are  more  favorably  affected  by 
cocaine  than  by  any  other  remedy.  Large  doses  and  frequent  admin- 
istration are  unnecessary,  and  if  carefully  attended  to  the  special  influ- 
ence of  the  remedy  on  consciousness  need  not  be  developed  to  a  suffi- 
cient extent  to  form  a  habit. 

Combined  with  atropine,  cocaine  becomes  a  valuable  hypnotic  ;  for 
example  :  $  Cocainae  hydrochlor.,  gr.  xv  ;  atropinse  sulphat.,  gr.  ss. 
M.,  ft.  pil.  no.  Ix.  Sig. :  One  or  two  at  bed-hour. 

The  enormous  value  of  cocaine  as  a  local  anaesthetic  in  ophthal- 
mology is  fully  conceded,  and  no  less  useful  has  it  proved  to  facilitate 
manipulations  and  to  render  them  painless  in  laryngological,  genito- 
urinary, obstetrical,  and  gynaecological  and  rectal  surgery.  It  would 
be  a  labor  of  supererogation  to  enlarge  on  this  topic.  It  has  been  suc- 
cessful in  a  remarkable  degree  in  the  treatment  of  vaginismus,  pruri- 
tus, and  cutaneous  maladies  in  which  itching  is  the  most  troublesome 
symptom.  The  solution  used  for  these  purposes  should  have  a  strength 
of  five  to  ten  per  cent. 

COMBINATIONS— ANTAGONISTIC   AND   SYNERGLSTIC— OF   COCAINE. 

4 

With  Atropine. — Attention  was  called  to  the  actions  of  atropine  and 
cocaine  at  the  time  an  attempt  was  made  to  float  into  prominence  a 
fraudulent  remedy  composed  of  a  mixture  of  the  two.  As  the  ac- 
tions of  the  supposed  new  remedy  were  studied  by  some  who  are  emi- 
nently qualified  for  the  task,  and  as  new  facts  were  thus  ascertained, 
it  is  clear  that  sufficient  merit  was  found  in  the  combination  to  justify 
some  notice  of  it  here  in  this  form. 

ACTIONS  AND  USES. — A  two-per-cent  solution  of  the  compound 
applied  to  the  conjunctiva,  or  mucous  membrane  of  any  part,  induces 
anaesthesia  in  about  five  minutes.  If  applied  to  the  conjunctiva,  the 
anaesthesia  is  accompanied  by  a  mydriasis  of  the  maximum  extent,  the 
dilatation  beginning  in  ten  to  fifteen  minutes,  and  reaching  its  greatest 
extent  in  twenty  minutes,  but  remaining  in  that  condition  for  twelve 
to  twenty-four  hours,  and  not  entirely  disappearing  for  three  days. 
The  accommodative  apparatus  is  acted  on  quite  vigorously,  becomes 
paretic  in  ten  to  fifteen  minutes,  and  completely  paralyzed  within  a 
half-hour.  The  anaesthetic  effect  is  induced  when  the  solution  is  ap- 
plied to  the  mucous  membrane  in  any  situation — the  fauces,  nares, 
urethra,  etc.  In  some  subjects  such  a  degree  of  susceptibility  to  its 
action  exists  that  the  absorption  of  a  minute  quantity  causes  nausea, 
pallor,  vertigo,  and  rapid  action  of  the  heart.  In  this  respect,  as  in 
the  anaesthetic  action,  it  more  resembles  cocaine  :  in  its  mydriatic 


COCAINE   COMBINATIONS.  563 

action  and  paralyzing  effect  on  the  accommodative  apparatus  more 
atropine.  In  the  rapidity  of  the  action  on  the  pupil,  in  the  degree 
of  dilatation,  and  in  the  persistency  of  the  mydriatic  effects,  it  has 
more  the  action  of  atropine,  but  is  more  powerful  and  also  more 
enduring. 

Injected  subcutaneously,  very  soon  convulsions  of  a  tetanic  char- 
acter are  produced  ;  trembling  precedes  the  tonic  spasms,  and  occurs 
also  between  them,  while  paresis,  quickly  passing  into  paralysis,  re- 
sults from  the  exhaustion  of  over-stimulation.  In  respect  to  the 
behavior  of  the  tetanic  convulsions,  they  more  resemble  those  of 
picrotoxin  than  of  strychnine. 

When  the  mixture  was  first  brought  forward  it  was  asserted  that 
it  affected  cutaneous  sensibility  in  the  same  way  that  it  does  that  of 
the  mucous  membranes.  Knapp  was  unable  to  verify  this  observa- 
tion, and  such  a  claim  has  not  been  made  since. 

The  therapeutical  applications  of  the  combination  can  be  deduced 
from  the  physiological  actions.  Thus  far  the  course  of  the  investiga- 
tions has  been  limited  to  the  uses  of  the  new  mixture  in  ophthalmic 
practice ;  but  indications  are  thus  furnished  to  guide  its  applications 
in  diseases  in  general. 

The  conclusions  of  Knapp,  based  on  Dr.  Claiborne's  and  his  own 
observations,  are  as  follows  : 

In  cases  of  iritis,  the  combination  of  cocaine  and  atropine  is  supe- 
rior to  cocaine  alone,  and  should  also  be  preferred  to  atropine  alone 
when  pain  is  suffered,  and  when  a  tendency  to  glaucoma  exists.  On 
the  other  hand,  when  the  mydriasis  is  an  objection — as  in  the  case  of 
most  of  the  operations  on  the  eye — cocaine  should  be  preferred. 
When  paralysis  of  the  accommodative  apparatus  is  desirable,  the 
compound  acts  as  efficiently  as  atropine,  and  is  preferable,  because  its 
effect  is  shorter  in  duration. 

Small  doses,  rapidly  absorbed,  may  cause,  as  does  cocaine,  some 
general  disturbance,  which  consists  in  sudden  pallor,  cold  sweats, 
vertigo,  stupor,  faintness,  etc.,  and  large  doses,  approaching  lethal  in 
strength,  bring  on  tetanic  spasms,  trembling,  rapid  action  of  the  heart, 
and  failure  of  respiration. 

Inducing  complete  anaesthesia  of  the  mucous  membrane  at  any 
point,  surgical  procedures  of  all  kinds  may  be  carried  on  without  any 
sensation  of  uneasiness.  In  all  the  morbid  states  in  which  cocaine 
has  hitherto  been  used  alone,  the  combination  may  be  substituted, 
unless  the  dilatation  of  the  pupil  constitute  an  objection. 

With  Chloral  and  Urethan. — It  has  long  been  known  that  chloral 
has  the  power  to  liquefy  various  agents,  as  camphor,  urethan,  and 
others.  The  combination  of  chloral  and  urethan  being  effected,  co- 
caine will  dissolve  in  it  to  anv  desirable  extent.  Thus  :  I£  Chloral. 


564  CEREBRAL   EXCITANTS. 

hyd.,  urethan,  aa  3  ij-  M.  Solve.  To  the  solution  add  cocain. 
hydrochlorat.,  gr.  ij  vel  gr.  iv.  M.  Dose,  til  x — in,  xx  vel  3  ss.  As 
this  will  mix  with  water  without  separating,  it  becomes  a  convenient 
and  powerful  anodyne  and  anaesthetic. 

Under  the  name  Uralia  this  preparation  has  been  brought  forward 
recently  as  new,  and  extravagant  praise  given  it  as  an  anodyne. 

Tropacocailie,  Hydrochlorate. — Benzoyl  pseudotropeine.  A  substi- 
tute for  cocaine.  Locally  applied  in  3-per-cent  solution,  in  a  6-per- 
cent solution  of  common  salt.  It  is  far  less  toxic  than  cocaine,  and 
the  anaesthesia  caused  by  it  comes  on  more  rapidly  and  lasts  longer. 
In  ophthalmic  work  it  is  preferred  to  cocaine  because  it  does  not  cause 
hypenemia,  and  does  not  dilate  the  pupil.  It  may  be  used  in  Schleich's 
method  as  a  substitute  for  cocaine,  and,  indeed,  supplant  the  latter  in 
all  cases. 

Caffeina. — Caffeine.  A  feebly  basic,  proximate  principle,  obtained 
from  the  dried  leaves  of  Camellia  sinensis  Linne  (Nat.  Ord.  Tern- 
stroemiacece),  or  from  the  dried  seeds  of  Caffea  arabica  Linne  (Nat. 
Ord.  .RuMacece),  and  found  also  in  other  plants. 

Caffeina  Citrata. — Citrated  caffeine.  A  white,  odorless  powder, 
having  a  purely  acid  taste  and  an  acid  reaction.  Dose,  gr.  ij  to  gr.  x. 

Caffeina   Citrata  Effervescent.  — Effervescent    citrated    caffeine. 
This  contains,  with  caffeine  and  citric  acid,  the  materials  for  efferves-* 
cence — sodium  bicarbonate  and  tartaric  acid.     Dose,  a  teaspoonf  ul  in 
two  or  more  ounces  of  cold  water,  and  drunk  while  effervescing. 

The  salt  of  caffeine  most  worthy  of  consideration  is  the  hydrobro- 
mate.  This  should  not  be  confounded  with  certain  proprietary  com- 
pounds— more  truly,  mixtures — that  consist  of  caffeine  and  bromides. 

Some  new  salts  of  caffeine  have  been  lately  brought  forward 
and  are  probably  improvements  on  those  heretofore  available.  They 
consist  of  sodio-salicylate,  sodio-benzoate,  and  sodio-cinnamate  of  caf- 
feine. These  are  soluble  combinations,  and  can  be  given  subcutane- 
ously  without  causing  local  irritation.  The  dose  for  stomachal  ad- 
ministration ranges  from  gr.  ij  to  gr.  xv. 

Ethoxy-caffeine  is  a  substitution  product  of  considerable  promise 
— ethyl  replacing  one  atom  of  hydrogen  in  caffeine.  According  to 
Dujardin-Beaumetz,  this  is  an  excellent  hypnotic  and  calmative.  It 
is  crystalline,  has  basic  properties,  and,  although  insoluble  in  water, 
its  salts  can  be  dissolved  with  readiness.  The  following  formula  is 
a  convenient  one  for  extemporaneous  use  :  1$  Etboxy-caffeinae,  gr. 
iv ;  sodii  salicylat.,  gr.  iv  ;  aquae  lauro-cerasi,  3  jss  ;  syrupi,  1  ss.  M. 
Sig.  :  A  tablespoonful  as  required.  The  addition  of  one  and  a  half 
grain  of  cocaine  is  recommended  by  Dujardin-Beaumetz  to  increase 
its  hypnotic  action. 

The  so-called  "  citrate  of  caffeine  "  is  not  a  chemical  combination, 


CAFFEINE.  565 

but  a  mere  mixture,  and  is  recognized  by  the  present  Pharmacopoeia 
as  "  citrated  caffeine." 

PROPERTIES. — Caffeine  crystallizes  in  needle-shaped  crystals  and 
in  prisms.  It  is  bitter  in  taste,  soluble  in  water  and  in  alcohol.  It  is 
remarkable  for  the  quantity  of  nitrogen  it  contains,  surpassing  in  this 
respect  all  other  alkaloids. 

Caffeine  in  small  quantity  acts  as  a  stomachic  tonic,  and  rather 
improves  than  lessens  appetite  when  administered  in  diseased  states. 
It  is  feebly  laxative,  owing  probably  to  its  action  in  stimulating  the 
glands  of  the  mucous  membrane,  thus  increasing  secretion. 

The  most  important  function  is  its  action  on  the  heart  and  circu- 
lation. We  owe  more  especially  to  Dr.  Huchard  and  Professor  S6e 
the  modern  experience  in  regard  to  its  place  as  a  cardiac  remedy. 
It  has  not  usually  been  given  in  quantity  sufficient  to  produce  the 
appropriate  effects,  and  until  recently  its  powers  as  a  substitute  for 
digitalis  were  not  appreciated.  For  making  a  satisfactory  impres- 
sion on  the  organs  of  circulation  not  less  than  five  grains  at  a  dose, 
and  fifteen  to  twenty  grains  in  twenty-four  hours,  are  required.  In 
sufficient  quantity  caffeine  slows  the  heart,  lengthens  the  interval, 
and  increases  the  power  of  the  muscular  contraction.  It  also  raises 
somewhat  the  arterial  tension  by  stimulating  contraction  of  the  arte- 
rioles,  and  it  has  distinct  and  available  diuretic  property.  Excessive 
and  too  frequent  administration  of  caffeine  will  bring  on  toxic  effects, 
in  which  the  heart  becomes  weak  and  irregular,  the  pressure  falls, 
and  respiration  fails,  death  being  due  to  paralysis  of  the  respiratory 
muscles. 

As  regards  the  action  of  caffeine  on  the  brain,  it  may  be  stated 
that,  at  first,  drowsiness  occurs  ;  but  this  is  soon  followed  by  wakeful- 
ness,  excitement,  muscular  trembling,  confusion  of  mind,  hallucina- 
tions, and  delirium.  The  cerebral  effects  terminate  in  deep  sopor,  but 
this  is  probably  the  result  of  exhaustion.  Rise  of  temperature,  con- 
vulsions, general  paralysis,  occur  when  toxic  doses  are  administered 
to  animals  ;  but  the  temperature  declines  when  paralysis  supervenes 
(Leven,  Schmiedeberg,  Bennett,  and  others). 

THERAPY. — Caffeine  is  a  useful  stomachic  tonic.  In  convalescence 
from  acute  maladies  it  is  in  a  high  degree  serviceable,  given  to  pro- 
mote the  constructive  metamorphosis.  Chronic  catarrh  of  the  stomach, 
with  occasional  attacks  of  migraine,  is  a  combination  of  maladies  in 
which  caffeine  is  especially  useful.  Paullinia  or  coca  may  be  used 
instead. 

In  the  diarrhoea  of  phthisis,  in  ordinary  atonic  diarrhoea,  in  cholera 
infantum,  and  in  cholera  morbus,  produced  by  agencies  affecting  the 
nervous  system,  the  remedies  of  this  group,  especially  caffeine,  are 
often  extremely  useful.  When  the  vital  powers  are  depressed,  and 
when  there  is  at  the  same  time  an  abnormal  excretion  of  urea — a 


566  CEREBRAL   EXCITANTS. 

condition  of  things  which  exists  in  incipient  phthisis,  associated  with 
indigestion — caffeine,  coca,  and  paullinia  are  in  a  high  degree  service- 
able. They  increase  the  appetite  and  the  digestive  power,  and  dimin- 
ish tissue-waste. 

Black  coffee,  or  caffeine,  increases  the  action  of  the  heart  and  raises 
the  arterial  tension,  and  is  therefore  useful  when  the  circulation  is  de- 
pressed from  various  causes. 

An  important  use  of  caffeine,  at  present,  is  in  the  treatment  of  head- 
ache. It  is  adapted  especially  to  the  relief  of  migraine,  the  so-called 
nervous  headache,  accompanied  with  or  without  stomach-derangement. 
In  this  disorder  we  may  administer  a  grain  of  caffeine  every  half -hour, 
until  the  headache  is  relieved  ;  or  the  bromhydrate  of  caffeine  may  be 
given  in  an  effervescent  draught.  Elegant  and  useful  are  the  granu- 
lar, effervescent  preparations  of  caffeine.  They  may  be  prepared  ex- 
temporaneously by  adding  caffeine  to  the  materials  for  effervescence 
— sodium  bicarbonate  and  tartaric  acid. 

Caffeine  has  proved  very  useful  in  cardiac  dropsy  /  and  in  renal 
dropsy  in  inverse  ratio  to  the  amount  of  damage  suffered  by  the  kid- 
neys, for,  as  Brackenridge  has  shown,  this  remedy  does  not  increase 
the  flow  of  urine  when  the  renal  epithelium  is  destroyed.  It  may  be 
used  with  advantage  in  ascites  when  any  diuretic  will  prove  service- 
able. It  has,  within  the  past  two  years,  been  much  employed  by  the 
French  therapeutists,  in  place  of  digitalis,  in  the  treatment  of  certain 
cardiac  affections.  According  to  Huchard,  caffeine  acts  more  rapidly 
than  digitalis,  causing  free  diuresis  in  twenty-four  hours.  It  slows 
the  pulse  and  raises  the  arterial  tension,  thus  effecting  a  better  distri- 
bution of  the  blood.  To  bring  about  these  desirable  effects,  Huchard 
rapidly  increases  the  dose,  so  that  on  the  third  day  he  gives  a  gramme 
(15£  grs.)  hypodermatically. 

The  author  can  confirm  the  observations  of  Dr.  Huchard,  by  his 
own  experience  in  the  use  of  caffeine  in  cases  of  mitral  incompetence 
with  general  dropsy.  Having  the  same  kind  of  action  on  the  heart, 
not  cumulative,  and  unirritating  as  digitalis,  he  has  obtained  as  good 
results,  and  with  far  less  discomfort  to  the  patient,  with  caffeine. 

Guarana. — A  dried  paste,  prepared  from  the  crushed  or  ground 
seeds  of  Paullinia  sorbilis  Martius  (Nat.  Ord.  Sapindacece). 

Extractum  Gruarance  Fluidum. — Fluid  extract  of  guarana.    Dose, 

m  x—  3  ij. 

COMPOSITION. — It  contains  a  principle  which  has  been  entitled 
ffuaranine,  and  which  subsequent  researches  have  proved  to  be  iden- 
tical with  caffeine. 

ACTIONS  AND  USES.  —  The  physiological  effects  of  paullinia  are 
due  to  its  alkaloid,  chiefly  ;  and,  as  this  is  the  same  as  caffeine,  the 
observations  already  made  on  the  latter  are  equally  applicable  to  the 


THEOBROMINE.  567 

former.  One  instance  has  come  under  the  author's  observation,  in 
which  the  use  of  guarana  had  become  a  habit.  Every  morning  the 
lady  took  a  considerable  dose  of  the  paste  before  appearing  to  the 
world.  Quite  a  serious  effort  was  required  to  wean  her  from  it.  As 
is  the  usual  result,  the  accustomed  stimulus  withdrawn,  digestion  and 
assimilation  became  feeble,  and  loss  of  flesh  occurred  ;  but,  after  re- 
covery, all  was  regained  that  had  been  lost. 

The  special  use  of  paullinia  is  in  the  treatment  of  sick-headache 
or  migraine.  It  is  adapted  to  the  so-called  nervous  form  of  sick- 
headache,  and  is  less  efficient  when  the  attacks  are  due  to  stomachal 
troubles.  As  it  possesses,  directly  or  indirectly,  restorative  powers,  it 
may  be  employed  to  promote  constructive  metamorphosis.  Adminis- 
tered with  this  view,  it  may  be  given  with  advantage  in  the  conva- 
lescence from  acute  maladies,  in  incipient  phthisis,  and  in  the  wasting 
diseases  generally. 

Authorities  referred  to : 

AMORT,  DR.  R.     Boston  Medical  and  Surgial  Journal,  1868,  p.  17. 

AUBERT,  M.     Physiological  Action  of  Caffeine.     Centralblatt,  1873,  p.  124. 

BENNETT,  DR.  ALEXANDER.  Physiological  Actions  of  Theine,  Caffeine,  Guaranine, 
Cocaine,  and  Theobromine.  Pamphlet,  1873. 

H0CHARD,  DR.  HENRI.  De  la  Cafeine  dans  les  Affections  du  C<xur.  Journal  de  Thera- 
peutic, September  10,  1882. 

LEVEN,  M.     Archiv  de  Physiologic,  1868,  pp.  179,  470. 

PRATT,  DR.     Boston  Medical  and  Surgical  Journal,  vol.  ii,  1868,  p.  6. 

SCHMIEDEBERG,  PROF.  0.  Ueber  die  Verschiedenheit  der  Caffeinwirkung  an  Ratio,  tern- 
poraria  L.  und  Rana  esculenta  L.  Arch.f.  exper.  Path.  u.  Phar.,  1874,  p.  63. 

Theobromine. — An  alkaloid  obtained  from  Theobroma  cacao.  It 
is  crystallizable,  volatile,  and  is  closely  related  in  character  and  in 
molecular  arrangement  to  caffeine.  It  combines  with  acids  to  form 
salts,  is  very  slightly  soluble  in  water,  and  has  a  bitter  taste. 

Diuretin  is  the  proprietary  designation  of  a  combination  of  salicyl- 
ate  of  soda  and  theobromine.  Theoretically,  it  is  a  salicylate  of  theo- 
bromine  and  sodium,  and  should  contain  54  per  cent  of  theobromine, 
but  it  falls  short  of  this  as  it  occurs  in  commerce,  containing  usually 
not  more  than  40  per  cent. 

Under  the  name  Uropherin,  a  combination  of  theobromine  and  sali- 
cylate of  lithium  has  been  made  by  Merck,  of  Darmstadt,  and  its  physi- 
ological action  studied  by  Yon  Gram.  Heintz  and  Liebrecht  have 
also  lately  reported  on  a  compound  salt  of  caffeine  and  salicylate  of 
lithium  and  strontium.  These  preparations  practically  agree  in  the 
mode  and  character  of  their  effects.  In  the  remarks  to  follow,  diuretin 
is  the  agent  under  consideration. 

ACTIONS  AND  USES. — Theobromine,  a  congener  of  caffeine,  has  been 
shown  to  possess  similar  properties,  except  that  its  influence  on  the 
heart  is  less  and  on  the  kidneys  greater.  Gram  found  the  combination 
with  salicylate  of  sodium  to  be  very  effective  as  a  renal  stimulant,  act- 


568  CEREBRAL   SEDATIVES. 

ing  especially  on  the  secreting  structure,  but  without  any  irritant 
effects.  By  Von  Pawinski  it  is  considered  to  raise  the  arterial  tension 
and  improve  the  tone  of  the  heart,  as  shown  by  Bach's  sphygmo- 
graph.  The  diuretic  effect,  he  maintains,  is  due  both  to  the  action  on 
the  renal  epithelium  and  to  the  increased  power  imparted  to  the  heart, 
together  with  higher  blood  pressure.  He  holds,  therefore,  that  diu- 
retin  is  especially  indicated  in  cases  of  cardiac  dropsy.  The  formula 
proposed  by  him  is  the  following:  IJ  Diuretin,  3  j  to  3iv;  aquae 
menth.  pip.,  f  3  iij  ;  aquas  destil.,  f  §'ij  ;  syr.  simplicis,  f  1  j.  M.  Sig.: 
A  tablespoonful  every  three  hours. 

Diuretin  has  also  been  used  with  much  success  in  scarlatinal  dropsy. 
Indeed,  it  is  held  by  some  to  be  especially  adapted  to  the  treatment  of 
renal -dropsies  and  in  their  acuter  manifestations. 

Diuretin  is  not  without  ill  effects  if  used  in  rather  large  doses.. 
Gastro-intestinal  disorder,  headache,  dizziness,  and  other  unpleasant 
symptoms,  according  to  Hdhne,  followed  the  exhibition  of  full  me- 
dicinal doses  ;  but  it  is  supposed  that  such  disturbance  must  be  due 
largely  to  idiosyncrasy.  The  amount  which  may  be  given  daily  ranges 
from  3j  to  3  j,  according  to  age,  the  individual  doses  being  from  3  to 
10  grains. 

Authorities  referred  to  : 

COHXSTEIX,  DR.     Berliner  klin.  Woch.,  No.  4,  1894. 
GRAM,  PROF.  DR.     Centralblatt  f.  d.  gesammte  Theraple,  1894. 
HEINTZ  UND  LIEBRECHT.     Therapeutische  Monatshefte,  1894. 
PAWINSKI,  DR.     Ibid.,  April,  1894. 


REMEDIES  WHICH  DIMINISH  OR  SUSPEND  THE 
FUNCTIONS  OF  THE  CEREBRUM  AFTER  A  PRE- 
LIMINARY STAGE  OF  EXCITEMENT. 

To  this  group  belong  the  so-called  narcotics,  the  anaesthetics,  and 
some  of  those  usually  classed  as  antispasmodics.  They  all  agree  in 
these  respects  :  their  effects  are  expended,  chiefly,  on  the  nervous  sys- 
tem ;  they  first  stimulate  the  functions  of  the  brain,  but  this  stage  of 
excitement,  which  may  be  of  shorter  or  longer  duration,  is  followed  by 
sopor,  coma,  and  complete  insensibility. 

Alcohol. — Alcohol.  A  liquid  composed  of  91  per  cent  by  weight 
(94  per  cent  by  volume)  of  ethyl  alcohol,  and  9  per  cent  by  weight  (6 
per  cent  by  volume)  of  water.  Specific  gravity,  0-820  at  60°  Fahr. 
A  transparent,  colorless,  mobile,  and  volatile  liquid  of  a  characteristic, 
pungent,  and  agreeable  odor,  and  a  burning  taste. 

Alcohol  Dilutum. — Diluted  alcohol.  A  liquid  composed  of  41 
per  cent  by  weight  and  48'6  per  cent  by  volume  of  absolute  ethyl 
alcohol. 


ALCOHOL.  569 

Alcohol  Absolutum. — Absolute  alcohol.  Ethyl  alcohol  containing 
not  more  than  1  per  cent  by  weight  of  water. 

Alcohol  Deodoratum. — Deodorized  alcohol.  A  liquid  composed  of 
about  92*5  per  cent  by  weight,  or  95*1  per  cent  by  volume,  of  ethyl 
alcohol,  and  about  7'5  per  cent  by  weight  of  water. 

Alcohol  Amylicum. — Amylic  alcohol.     Fusel-oil. 

A  peculiar  alcohol,  obtained  from  fermented  grain  or  potatoes, 
by  continuing  the  process  of  distillation  after  the  ordinary  spirit  has 
ceased  to  come  over.  An  oily,  nearly  colorless  liquid,  having  a  strong,, 
offensive  odor,  and  an  acrid,  burning  taste. 

Spiritus  Frumenti. — Whisky.  An  alcoholic  liquid,  obtained  by 
the  distillation  of  fermented  grain  (usually  corn,  wheat,  or  rye),  and 
at  least  two  years  old.  Whisky  has  an  amber  color,  a  distinctive  taste 
and  odor,  and  a  specific  gravity  not  above  0*930  nor  below  0*917,  cor- 
responding approximately  with  an  alcoholic  strength  of  44  to  50  per 
cent  by  weight,  or  50  to  58  per  cent  by  volume. 

Spiritus  Vini  Gallici. — Brandy.  An  alcoholic  liquid  obtained  by 
the  distillation  of  fermented  grapes,  and  at  least  four  years  old. 
Brandy  has  a  pale,  amber  color,  a  distinctive  taste  and  odor,  and  a 
specific  gravity  not  above  0.941  nor  below  0.925,  corresponding  ap- 
proximately with  an  alcoholic  strength  of  39  to  47  per  cent  by  weight,, 
or  45  to  55  per  cent  by  volume. 

There  is  a  close  correspondence  in  the  alcoholic  strength  of  whisky 
and  brandy,  especially  when  they  conform  to  the  official  standard. 
Brandy  differs  from  whisky  in  that  it  contains  oenanthic  and  other 
ethers  peculiar  to  the  grape. 

COMPOSITION. — A  large  number  of  bodies  have  been  classed  under 
the  generic  term  of  alcohols.  A  list  of  the  most  important  of  these  is 
subjoined  : 

Methylic  alcohol CH40. 


Ethylic 

Propylic 

Butylic 

Amylic 

Caproic 


CaHeO  or  C 
C8H80  or  CH40-r2(CHs). 
C4H100  or  CH40  +  3(CHa). 
C5H,,0  or  CH40  +  4(CH.,). 
C6Hj40  or  CH40  +  5(CHa). 


These  alcohols  are  called  "  homologous,"  because  they  are  closely 
related  to  each  other,  and  differ  by  the  common  multiple  CH,.  Ethylic 
is  the  common  or  ordinary  alcohol,  and  amylic  is  an  impurity  existing 
in  certain  alcoholic  beverages — for  example,  whisky,  in  which  it  oc- 
curs in  consequence  of  the  cupidity  of  distillers  in  carrying  on  the 
process  after  all  the  ethylic  alcohol  has  distilled  over.  Absolute  alco- 
hol should  be  entirely  free  from  any  odor  except  its  native  ethereal 
odor,  and  no  products  but  carbonic  acid  and  water  should  result  from 
its  combustion. 

Whisky  is  a  solution  of  alcohol  in  water  (48  to  56  per  cent),  but 


570  CEREBRAL   SEDATIVES. 

contains  various  odorous  principles  and  ethers  which  impart  to  it  its 
peculiar  physical  properties.  The  best  specimens,  doubtless,  contain 
traces  of  fusel-oil,  and  acetic,  butyric,  and  sometimes  valerianic  acids 
are  present  in  it.  The  reactions  of  these  acids  with  the  alcohol  result 
in  the  formation  of  various  ethers,  and  hence  old  whisky  is  more  fra- 
grant, and  therefore  more  highly  prized,  than  the  recent  product  of 
the  still. 

Brandy  is  also  a  solution  of  alcohol  in  water  (48  to  56  per  cent). 
It  has  a  wine-like  odor,  and  a  hot,  astringent  taste.  It  contains  a 
volatile  oil,  an  ether  peculiar  to  wines  (renanthic  ether),  coloring-mat- 
ters, tannic  acid,  aldehyde,  and  acetic  ether.  The  color  is  usually  fac- 
titious :  in  pale  brandy,  the  color  is  derived  from  the  cask  ;  in  dark 
brandy,  from  caramel.  Brandy  is  made  artificially  from  high-wines 
by  the  addition  of  an  ether  (cognac,  acetic  or  nitric),  of  coloring- 
matter  (burnt  sugar),  and  an  astringent  to  give  it  the  necessary  rough- 
ness of  taste  (logwood,  catechu,  etc.). 

PHYSIOLOGICAL  ACTIONS. — Alcohol  in  prolonged  contact  with  the 
skin,  evaporation  being  prevented,  excites  a  sense  of  heat  and  super- 
ficial inflammation.  It  coagulates  albumen  and  hardens  the  animal 
textures.  The  epithelium  of  the  mouth  is  corrugated  by  it — a  result 
due  to  the  abstraction  of  water  and  condensation  of  the  albumen.  In 
the  stomach  alcohol  causes  a  sense  of  warmth,  which  diffuses  over  the 
abdomen,  and  is  quickly  followed  by  a  general  glow  of  the  body.  In 
moderate  quantity  it  induces  a  superficial  congestion  of  the  mucous 
membrane — a  dilatation  of  the  arterioles — and  this  increased  blood- 
supply  enables  the  mucous  follicles  and  the  gastric  glands  to  produce 
a  more  abundant  secretion.  The  increased  formation  of  the  stomach- 
juices  is  doubtless  somewhat  determined  by  the  stimulation  of  the 
mouths  of  the  glands,  in  accordance  with  a  well-known  physiological 
law.  The  excitation  of  the  gastric  mucous  membrane,  when  habitual, 
results  in  important  changes  ;  a  gastric  catarrh  is  established — for  the 
mucous  follicles,  under  the  influence  of  repeated  stimulation,  pour 
forth  a  pathological  secretion.  The  gastric  glands  at  first  simply  pro- 
duce an  increased  amount  of  gastric  juice,  but  abnormal  stimulation 
results  in  pathological  changes  in  this  secretion.  The  increased  blood- 
supply  to  the  mucous  membrane  sets  up  an  irritation  of  the  connective 
tissue,  which  undergoes  hyperplasia  ;  the  proper  secreting  structure 
is  encroached  upon,  and  the  glands  suffer  atrophic  changes  which  re- 
sult in  still  more  important  modifications  of  the  gastric  juice.  Alco- 
hol also  affects  directly  the  constitution  of  the  gastric  juice  by  precipi- 
tating the  pepsin  from  its  solution  and  by  arresting  the  activity  of  this 
ferment. 

In  small  doses,  not  too  frequently  repeated,  alcohol  increases  the 
digestive  power  by  stimulating  the  flow  of  blood  and  soliciting  a 
greater  supply  of  the  stomach- juices.  Large  doses  impair  digestion 


ALCOHOL.  571 

directly  by  precipitating  the  pepsin,  an  albuminoid  ferment.  That  a 
small  quantity  does  not  produce  the  same  results  in  a  comparative  de- 
gree, is  simply  due  to  the  fact  that  it  is  too  far  diluted,  by  the  quan- 
tity of  fluid  present  in  the  stomach,  to  act  on  the  pepsin. 

The  structural  alterations  induced  by  the  habitual  use  of  alcohol, 
and  the  action  of  this  agent  on  the  pepsin,  seriously  impair  the  diges- 
tive power.  Hence  it  is  that  those  who  are  habitual  consumers  of 
alcoholic  fluids  suffer  from  disorders  of  digestion — gastric  catarrh.  The 
abnormal  mucus  which  is  elaborated  in  great  quantity,  acts  the  part  of 
a  ferment,  and  the  starchy,  saccharine,  and  fatty  elements  of  the  food 
undergo  the  acetic,  lactic,  and  butyric  fermentations.  Acidity,  heart- 
burn, pyrosis,  regurgitation  of  food,  and  a  peculiar  retching  in  the 
morning  (morning  vomiting  of  drunkards),  are  produced. 

As  alcohol  is  a  very  diffusible  substance,  it  enters  the  blood  with 
great  facility,  and  probably  almost  all  of  that  taken  into  the  stomach 
passes  into  the  blood  from  this  organ,  and  does  not  reach  the  small 
intestine.  The  liver  is  consequently  the  first  organ,  after  the  stomach, 
to  be  influenced  by  the  ingested  alcohol.  The  blood  of  the  portal 
vein,  rendered  more  highly  stimulating  by  the  presence  of  alcohol,  in- 
creases for  the  time  being  the  functional  activity  of  the  liver-cells, 
and,  as  is  the  case  with  the  stomach,  a  more  abundant  glandular  secre- 
tion follows.  Frequent  stimulation  and  consequent  over-action  result 
in  impairment  or  loss  of  the  proper  function  of  the  part,  as  is  the  uni- 
versal law.  The  hepatic  cells,  over-stimulated,  produce  an  imperfect 
product  ;  they  are  affected  by  fatty  and  atrophic  changes,  and  shrink 
in  size  ;  and  the  connective  tissue  of  the  liver  undergoes  hyperplasia. 
The  first  result  of  the  structural  alterations  is  an  increase  in  the  size 
of  the  organ  ;  but  with  the  shrinking  of  the  hepatic  cells,  and  the  con- 
traction of  the  newly-formed  connective  tissue,  the  liver  becomes 
smaller,  nodulated,  and  hardened.  To  this  change  the  term  cirrhosis 
has  been  applied.  It  is  essentially  a  slowly-developing  and  chronic 
malady,  and  long  indulgence  in  alcoholic  liquids  is  necessary  to  its  pro- 
duction. 

In  small  doses,  alcohol  increases  the  action  of  the  heart  and  the 
cutaneous  circulation  ;  a  slight  general  rise  of  temperature  is  observed  ; 
and  all  of  the  functions  are,  for  the  time  being,  more  energetically 
performed.  If  a  considerable  dose  be  taken,  the  phenomena  of  exhila- 
ration, of  excitement,  of  slight  intoxication  ensue.  A  still  larger  quan- 
tity causes  loss  of  muscular  power,  impaired  co-ordination  of  voluntary 
movements,  and  rambling  incoherence.  When  a  toxic  dose  is  taken,  the 
stage  of  excitement  is  of  short  duration  ;  profound  insensibility,  with 
stertorous  breathing  and  complete  muscular  resolution,  quickly  follow. 

As  respects  the  action  of  alcohol  on  the  nervous  system,  it  is  ob- 
vious that  its  first  effect  is  to  increase  the  functional  activity  of  the 
orain  ;  the  ideas  flow  more  easily,  the  senses  are  more  acute,  the  muscu' 


572  CEREBRAL   SEDATIVES. 

lar  movements  are  more  active.  These  effects  are  coincident  with  the 
increased  action  of  the  heart,  the  slight  rise  of  temperature,  and  the 
greater  activity  of  the  functions  of  the  organism  in  general.  With 
the  increased  action  of  the  alcohol  on  the  cerebrum  the  excitement 
becomes  disorderly,  the  ideas  incoherent  and  rambling,  the  muscular 
movements  uncontrolled  and  inco-ordinate  (over-stimulation  of  the 
cells  of  the  gray  matter).  With  an  excessive  quantity,  the  functions 
of  the  cerebrum  are  suspended,  and  complete  unconsciousness  ensues  ; 
the  reflex  movements  cease  ;  the  functions  of  organic  life  are  performed 
feebly  ;  and,  by  an  extension  of  the  toxic  influence  to  the  centers  pre- 
siding over  these  movements,  respiration  and  circulation  are  finally 
arrested. 

That  these  effects  on  the  intra-cranial  organs  are  due  to  the  direct 
action  of  the  alcohol  has  been  shown.  Alcohol  has  been  discovered  in 
the  fluid  contained  in  the  ventricles,  and  has  been  distilled  from  the 
cerebral  matter  ;  and  Hammond  has  demonstrated  that  it  has  a  special 
affinity  for  nervous  matter,  being  found  in  the  cerebro-spinal  axis  and 
in  the  nerves,  in  greater  quantity  than  in  other  tissues  of  the  body. 
As  a  result  of  the  direct  contact,  chiefly,  but  in  part  also  from  the  va- 
riations in  the  intra-cranial  blood-current,  important  structural  altera- 
tions are  gradually  wrought  in  the  cerebral  matter.  The  cells  of  the 
gray  matter  become  more  or  less  fatty  and  shrunken,  the  neuroglia 
undergoes  hyperplasia,  shrinking  and  condensation  of  the  whole  cere- 
brum ensue  (sclerosis),  and  the  cerebro-spinal  fluid  relatively  increases. 
The  objective  evidences  of  these  pathological  changes  are  seen  in  the 
impaired  mental  power,  the  muscular  trembling,  the  shambling  gait,  of 
the  drunkard. 

In  some  subjects  from  sudden  excess  of  a  periodical  kind,  in  others 
from  a  failure  of  the  stomach  to  dispose,  not  only  of  aliment,  but  of 
the  accustomed  stimulus,  a  peculiar  morbid  state,  known  as  delirium 
tremens,  is  produced.  Peculiarity  of  the  nervous  system — idiosyncra- 
sy— is  an  important  factor  in  the  causation  of  this  condition,  and 
probably  also  the  use  of  alcoholic  beverages  rich  in  fusel-oil — for  Rich- 
ardson has  shown,  and  the  author  has  repeatedly  confirmed  the  obser- 
vation, that  amylic  alcohol  causes  tremors  and  muscular  twitching 
"  identical  with  the  tremors  observed  in  the  human  subject  during  the 
alcoholic  disease  known  as  delirium  tremens." 

The  long-continued  action  of  alcohol  on  the  nervous  system  pro- 
duces other  disorders  besides  delirium  tremens.  Hemi-anaesthesia, 
epilepsy,  paraplegia,  amaurosis,  etc.,  have  been  observed  to  result  from 
alcoholic  excess,  and  mental  alienation,  as  the  asylum  statistics  prove, 
has  in  the  same  agent  its  most  influential  cause. 

It  is  necessary  now  to  consider  what  becomes  of  the  alcohol  after 
its  introduction  into  the  human  body,  and  the  influence  which  it  exerts, 
if  any,  in  the  metamorphosis  of  tissue.  The  results  of  experiment  on 


ALCOHOL.  573 

these  points  have  been  remarkably  contradictory  ;  and  the  questions 
involved  are  by  no  means  settled.  It  would  require  a  volume  to  make 
a  satisfactory  analysis  of  the  various  memoirs  and  papers  which  have 
been  published  on  the  actions  of  alcohol.  The  author,  therefore, 
merely  presents  the  conclusions  to  which  he  himself  has  come,  after  a 
careful  consideration  of  all  the  more  important  contributions  to  the 
literature  of  the  subject. 

A  small  quantity  of  alcohol,  in  a  subject  not  accustomed  to  its  use, 
causes,  as  has  been  already  stated,  increased  activity  in  all  the  bodily 
functions,  and  slight  elevation  of  temperature.  Habit,  as  is  the  case 
with  a  great  many  drugs,  modifies  in  a  remarkable  manner  the  physio- 
logical activity  of  alcohol,  and  hence  these  results  are  not  perceived  in 
the  habitual  consumers  of  this  substance.  Considerable  doses  of  alco- 
hol cause  a  decline  in  the  temperature  of  the  body,  which  is  even  more 
marked  in  pyrexia  than  in  the  normal  state.  As  respects  this  effect, 
the  influence  of  habit  is  equally  great,  for  in  old  topers  a  decline  in 
temperature  does  not  follow  the  use  of  alcohol  in  doses  short  of  lethal. 
In  animals  the  reduction  of  the  body-heat  is  more  marked  than  in 
man.  To  what  cause  is  the  decline  in  temperature,  produced  by  alco- 
hol, attributable  ?  This  is,  doubtless,  referable  to  the  diminished  rate 
of  tissue  metamorphosis — for  it  has  been  ascertained  that  the  excretion 
both  of  urea  and  of  carbonic  acid  is  lessened  by  alcohol.  The  combus- 
tion of  the  nitrogen  and  carbon  foods  is,  therefore,  retarded.  This 
action  is  represented,  objectively,  by  an  increase  in  the  body- weight 
and  the  embonpoint  of  those  who  take  stimulants  moderately. 

The  disposition  of  alcohol  in  the  organism  is  a  subject  which  has 
gone  through  several  revolutions  of  opinion.  At  present  the  weight  of 
authority  and  the  deductions  of  experiment  are  in  favor  of  that  view 
which  maintains  that,  within  certain  limits  (one  ounce  to  one  and  a 
half  ounce  of  absolute  alcohol  to  a  healthy  man),  alcohol  is  oxidized 
and  destroyed  in  the  organism,  and  yields  up  force  which  is  applied  as 
nervous,  muscular,  and  gland  force.  The  amount  of  alcohol  ingested, 
in  excess  of  this  oxidizing  power  of  the  organism,  is  eliminated  as  alco- 
hol by  the  various  channels  of  excretion — by  the  lungs,  skin,  kidneys, 
etc.  As  alcohol  checks  tissue  metamorphosis,  and  thus  diminishes  the 
evolution  of  heat  and  force,  it  might  be  expected  that  the  products  of 
its  own  oxidation  would  supply  the  deficiency,  but  this  is  not  the  case. 
Alcohol  is  a  useful  food  in  the  small  quantity  which  increases  but 
does  not  impair  digestion,  which  quickens  the  circulation  and  gland 
secretion  but  does  not  over-stimulate,  and  which  is  within  the  limit  of 
the  power  of  the  organism  to  dispose  of  by  the  oxidation  processes. 
This  amount  has  been  pretty  accurately  shown,  as  stated  above,  to  be 
one  ounce  to  one  ounce  and  a  half  of  absolute  alcohol  for  a  healthy 
adult  in  twenty-four  hours.  All  excess  is  injurious.  North -pole 
voyages,  military  expeditions  (experiences  in  India  and  the  Ashantee 


574  CEREBRAL   SEDATIVES. 

march),  and  the  diminished  power  of  resistance  to  cold  shown  by 
drunkards,  have  conclusively  demonstrated  that  alcohol  does  not  sup- 
ply the  place  of  other  foods  ;  and  that  those  habituated  to  its  use, 
damaged  as  they  are  in  their  vital  organs,  do  not  possess  the  same 
endurance  of  fatigue  and  the  same  power  of  resistance  to  external 
morbific  influences  as  do  the  healthy.  Furthermore,  clinical  expe- 
rience has  amply  proved  that  topers  do  not  bear  chloroform  well,  that 
they  succumb  more  quickly  to  injuries  and  surgical  operations,  and 
that  they  possess  much  less  power  of  resistance  than  the  temperate  to 
the  inroads  of  acute  diseases.  While  these  facts  rest  upon  the  soundest 
basis,  it  is  equally  true  that  alcohol  is,  within  certain  limits,  a  food,  and 
that  the  organism  may  subsist,  for  a  variable  period,  on  it  exclusively. 

It  is  an  important  clinical  fact  that  the  physiological  effects  of  alco- 
hol differ  in  different  conditions  of  the  system.  In  convalescence  from 
acute  diseases,  in  the  sudden  depression  of  the  powers  of  life  caused  by 
the  bites  of  venomous  snakes,  or  from  loss  of  blood,  or  from  serious 
injury,  quantities  which  would,  in  the  state  of  health,  cause  profound 
intoxication,  are  taken  with  impunity.  The  extremes  of  life — infancy 
and  old  age — bear  considerable  quantities  of  alcohol  well,  and  are  often 
remarkably  benefited  by  them.  Habitual  use  modifies  still  more  de- 
cidedly the  immediate  influence  of  this  agent  on  the  functions  of  calor- 
ification, of  circulation,  and  of  the  nervous  system. 

The  differential  diagnosis  of  acute  alcoholism  (lethal  dose),  of  opium 
narcosis,  concussion  of  the  brain,  cerebral  haemorrhage,  and  haemor- 
rhage into  the  pons  or  medulla,  is  by  no  means  easy.  In  the  absence 
of  the  history,  in  any  given  case,  it  may  be  impossible  to  determine. 
The  odor  of  the  breath  (of  opium  or  alcohol)  ;  the  state  of  the  pupil 
(contracted  from  opium,  unequal,  or  contracted  or  dilated  from  intra- 
cranial  haemorrhage,  contracted  or  dilated  from  alcoholic  intoxica- 
tion) ;  the  muscular  resolution  (common  to  all  these  states)  ;  the  slow, 
sighing,  irregular,  or  stertorous  respiration  (may  occur  in  either)  ;  the 
abolition  of  reflex  movements  (a  final  symptom  in  all),  are  in  the  nature 
of  things  fallacious.  A  man  who  has  received  a  concussion  of  the  brain, 
or  had  an  intra-cranial  haemorrhage,  may  have  taken  opium  or  alcoholic 
stimulants  in  quantity  sufficient  to  impart  a  distinct  odor  to  his  breath, 
without  otherwise  being  distinctly  affected  by  it.  The  other  signs  are 
not  sufficient  in  themselves  to  enable  a  decision  to  be  reached.  Hence 
the  importance  of  an  attentive  examination  of  the  surrounding  circum- 
stances. In  the  absence  of  a  trustworthy  history,  it  were  better  to 
suspend  opinion  until  the  further  developments  of  the  case  enable  an 
exact  diagnosis  to  be  made.  The  numerous  examples  of  errors  fallen 
into  by  most  competent  observers  should  make  the  physician  hesitate 
before  pronouncing  an  opinion  of  "  drunk "  or  "  dying,"  in  the  sensa- 
tional language  by  which  some  of  these  cases  of  mistake  have  been 
characterized. 


ALCOHOL.  575 

The  treatment  of  acute  alcoholism  consists  in  the  evacuation  of 
the  stomach  by  the  stomach-pump  of  any  unabsorbed  alcohol ;  the 
cautious  inhalation  of  ammoniacal  gas  ;  cold  affusion  to  the  head  ; 
faradism  of  the  muscles  of  respiration,  external  warmth,  etc. 

As  respects  the  post-mortem  appearances  the  following  have  been 
observed  :  intense  hyperaemia  of  the  gastric  mucous  membrane  ;  dis- 
tention  of  the  right  cavities  of  the  heart,  and  of  the  great  venous 
trunks  ;  hyperaemia  of  the  cerebral  meninges,  and  serous  effusion  into 
the  ventricles  and  subarachnoid  spaces. 

THERAPY. — Alcohol  in  small  doses  is  a  useful  stomachic  tonic.  It 
is  best  taken  for  this  purpose  after  or  with  meals.  It  is  specially  ser- 
viceable in  the  feeble  digestion  of  old  people,  the  atonic  dyspepsia  of 
the  sedentary,  and  in  the  slow  and  inefficient  digestion  of  convales- 
cence from  acute  diseases.  It  should  be  prescribed  with  caution  in 
these  cases,  especially  in  the  atonic  dyspepsia  of  women  and  of  seden- 
tary men,  because  of  the  danger  that  an  alcohol  habit  may  be  formed. 
When  it  is  prescribed  in  the  convalescence  of  acute  diseases,  the  stimu- 
lant should  be  withdrawn  at  the  earliest  period. 

Excellent  results  are  obtained  from  the  use  of  brandy  in  the  apep- 
sia  of  infants.  The  summer  diarrhoea,  both  of  children  and  adults, 
may  be  arrested  by  a  full  dose  of  brandy.  Irritating  matters  and  un- 
digested food  should  be  removed  before  the  brandy  is  administered. 
The  vomiting  of  cholera-morbus  and  of  cholera  may,  frequently,  be 
arrested  by  small  doses  of  iced  brandy  (a  teaspoonful  in  pounded  ice 
every  half -hour),  or  tablespoonful  doses  of  iced  champagne.  Other 
forms  of  vomiting,  when  due  to  irritation  or  inflammation  of  the 
stomach — as,  for  example,  the  vomiting  of  pregnancy — can  sometimes 
be  promptly  cured  by  the  same  remedy.  It  not  unfrequently  happens 
that,  in  delirium  tremens,  nothing  is  retained  by  the  stomach,  and  the 
life  of  the  patient  is  put  into  imminent  danger,  by  reason  of  the  failure 
of  the  food-supply  to  the  blood.  A  little  brandy  and  ice  will  some- 
times settle  the  stomach  under  these  circumstances,  and  enable  the 
patient  to  take  and  digest  the  much-needed  aliment. 

Notwithstanding  the  theoretical  objections  which  may  be  urged 
against  this  practice,  clinical  experience  is  strongly  in  favor  of  the  use 
of  alcoholic  stimulants  to  counteract  the  depressing  influence  of  certain 
agents  on  the  action  of  the  heart — as,  for  example,  aconite,  veratrum 
viride,  conium,  digitalis,  and  the  poison  of  venomous  snakes.  Before 
commencing  the  inhalation  of  chloroform,  an  ounce  or  two  of  whisky 
or  brandy  should  be  given  the  patient.  This  serves  a  double  purpose  : 
it  sustains  the  heart  and  prolongs  the  chloroform  narcosis. 

Alcohol  in  some  form  is  constantly  prescribed  in  low  conditions  in 
fevers,  acute  inflammations,  and  depressing  maladies  of  all  kinds.  It 
is  serviceable  in  these  diseases  when  it  lessens  the  pulse  rate,  but  in- 
creases the  contractile  power  of  the  heart  and  elevates  the  arterial 


576  CEREBRAL   SEDATIVES. 

tension.  It  does  harm  when  the  pulse  becomes  more  rapid  and  the 
blood-pressure  is  lowered  by  it.  It  does  good  when  the  tongue,  be- 
fore dry,  becomes  moister  under  its  use,  and  harm  when  the  dryness 
of  the  tongue  is  increased.  It  does  good  when  the  temperature  is  re- 
duced, the  delirium  and  subsultus  lessened,  and  the  sleep  becomes 
more  continuous  and  refreshing  ;  and  does  harm  when  it  increases 
fever,  exaggerates  the  delirium,  and  induces  coma  vigil.  The  chief 
utility  of  alcohol  in  these  forms  of  disease  is  not  as  a  stimulant,  but 
as  a  food.  It  furnishes  material,  easily  oxidizable,  which  can  be  ap- 
plied as  nervous,  muscular,  and  gland  force.  Furthermore  it  stimulates 
digestion,  and  enables  more  food  to  be  taken  and  disposed  of,  and 
thus  contributes  indirectly  to  the  maintenance  of  the  powers  of  life. 
It  follows  from  these  considerations,  that  alcohol  should  be  given  in 
these  low  conditions  of  the  organism,  with  milk,  eggs,  broth,  and 
other  suitable  aliment. 

Undoubtedly  the  stimulant  treatment  of  adynamic  states  is  often 
carried  to  great  excess.  The  large  doses  of  alcoholic  substances  ad- 
ministered, disorder  the  stomach  and  suspend  digestion  ;  and  thus  the 
condition  of  things  which  they  are  intended  to  relieve  is  only  made 
worse.  Furthermore,  stimulants  are  excessively  used  in  these  disor- 
ders, from  a  wrong  notion  of  their  therapeutic  action,  and  a  conviction 
that  diseases  characterized  by  depression  are  best  treated  by  arterial 
stimulants.  The  reaction  which  has  set  in  against  the  antiphlogistic 
methods  is  in  part  answerable  for  the  great  freedom  with  which  alco- 
hol is  now  used  in  fevers  and  inflammations. 

As  respects  its  action  on  the  nervous  system,  alcohol  is  a  narcotic. 
It  may  be  used  to  relieve  pain,  to  promote  sleep,  and  to  quiet  delirium. 
The  various  neuralgia  may  be  temporarily  alleviated  by  intoxicating 
doses  of  alcohol,  but  such  a  prescription  is  dangerous  to  the  moral 
health  of  the  patient.  The  subjects  of  neuralgia,  or  those  who 
possess  the  neurotic  temperament,  have  as  a  rule  an  inherited  or 
acquired  weakness  of  constitution,  and  a  mobility  of  the  nervous 
system,  which  render  the  effects  of  alcoholic  stimulants  peculiarly 
grateful. 

When  waJcefulness  is  due  to  a  condition  of  cerebral  ancemia,  a  full 
dose  of  some  alcoholic  fluid,  whisky  or  brandy,  will  procure  sound 
and  refreshing  sleep.  In  some  subjects  a  glass  of  ale  or  beer  answers 
better.  Some  cases  of  delirium  tremens  are  greatly  benefited  by  alco- 
holic stimulants.  When  the  delirium  is  the  result  of  sudden  excess 
and  of  the  direct  action  of  the  alcohol  on  the  cells  of  the  gray  matter, 
the  use  of  this  agent  will  only  add  to  the  existing  disorder  ;  but  when, 
as  is  so  frequently  the  case,  the  attack  is  determined  by  the  failure  of 
the  stomach  to  appropriate  not  only  the  stimulant  but  the  food  also, 
the  careful  administration  of  alcoholic  stimulants  with  suitable  aliment 
renders  an  incontestable  service. 


ALCOHOL.  577 

As  alcohol  stops  waste,  promotes  constructive  metamorphosis  by 
increasing  the  appetite  and  the  digestive  power,  and  favors  the  depo- 
sition of  fat,  it  is  directly  indicated  in  chronic  wasting  diseases,  espe- 
cially in  phthisis.  Clinical  experience  is  in  accord  with  physiological 
data  :  alcohol  is  an  important  remedy  in  the  various  forms  of  pulmo- 
nary phthisis.  It  is  frequently  given  with  cod-liver  oil,  or  an  ounce 
or  two  of  whisky  may  be  taken  with  some  bitter  or  aromatic  imme- 
diately after  meals.  If  alcohol  disagrees,  if  it  does  not  improve  but 
lessens  the  appetite,  it  will  do  harm  in  phthisis.  It  is  an  interesting 
fact  that  an  intractable  form  of  phthisis  is  induced  by  alcoholic  excess. 

EXTERNAL  APPLICATIONS  OF  ALCOHOL. — Equal  parts  of  alcohol  and 
water  is  an  excellent  evaporating  lotion  for  the  relief  of  superficial  in- 
flammations— bruises,  inflamed  joints,  orchitis,  etc.  Alcohol  is  an  ex- 
cellent hcsmostatic  for  restraining  oozing  from  a  large  surface.  For 
suppurating  wounds  alcohol  is  an  efficient  antiseptic  dressing — it  de- 
stroys germs,  removes  fetor,  and  stimulates  the  tissues  to  more  healthy 
growth.  It  favors  the  cicatrization  of  open  wounds  by  coagulating 
the  albumen  and  thus  making  an  impermeable  covering.  It  is  a  useful 
practice  to  wash  the  parts  threatened  with  bed-sores  with  whisky  or 
alcohol ;  it  hardens  the  cuticle,  and  prevents  ulceration.  Sore  nipples 
may  be  prevented  by  washing  them  with  brandy  after  the  child  nurses, 
and  then  dusting  them  with  bismuth  carbonate.  Brandy-and-water  is 
an  excellent  lotion  for  mercurial  and  other  forms  of  stomatitis  requir- 
ing stimulant  applications.  Brandy-and-water  is  one  of  the  thousand 
injections  used  in  gonorrhoea. 

Authorities  referred  to  : 

ANSTIE,  DR.  FRANCIS  E.  Stimulants  and  Narcotics,  and  various  papers  in  The  Prac~ 
titioner. 

BAKE,  DR.  A.  Der  Alcokolismus,  seine  Verbreitung  und  seine  Wirkung,  etc.  Berlin, 
1878,  A.  Hirschwald,  pp.  621. 

BINZ,  PROF.  DR.  C.     Virchovfs  Archiv,  voL  li,  p.  153. 

IBID.     The  Practitioner,  vol.  iii,  1869,  and  vol.  v,  1870. 

DUPRE,  A.,  PH.  D.  The  Practitioner,  vol.  viii,  pp.  148,  224.  The  Elimination  of 
Alcohol. 

JONES,  DR.  C.  HANDFIELD.     The  Practitioner,  vol.  vii,  p.  331. 

LALLEMAND,  PERRIN  ET  DCROY.  Du  Role  de  VAlcool  et  des  Ancesthetiques  dans  POr- 
ganisme,  Paris,  1860. 

LOMBARD,  DR.  J.  S.     New  York  Medical  Journal,  June,  1865. 

MURCHISON,  DR.  CHARLES.     A  Treatise  on  Fevers,  second  edition,  p.  230. 

NICOL,  DR.  PATRICK.  The  British  and  Foreign  Medico- Chirurgical  Review,  vol.  1, 
p.  203. 

PARKES,  DR.  E.  A.,  AND  COUNT  GIF.  WOLLOWICZ.  Experiments  on  the  Effects  of  Alco- 
hol (ethyl  alcohol)  on  the  Human  Body. 

RABOW,  DR.  S.  Berliner  klinische  Wochenschrift.  Beobachtungen  uber  die  Wirkung 
des  Alkohol  auf  die  Korper temper atur,  1871,  p.  257,  et  seq. 

RICHARDSON,  DR.  B.  W.     The  Medical  Times  and  Gazette,  December  18,  1869,  p.  70S- 

RINGER  AND  RiKARD.     Th«  Lancet,  August  26,  1866,  p.  208. 
39 


578  CEREBRAL   SEDATIVES. 

Vinum. — Wine. 

Vinum  Album. — White  wine.  A  pale,  amber-colored  or  straw- 
colored  alcoholic  liquid,  made  by  fermenting  the  unmodified  juice  of 
the  grape,  freed  from  seeds,  stems,  and  skins.  .  .  .  White  wine  should 
contain  not  less  than  ten  per  cent  nor  more  than  twelve  per  cent  by 
weight  of  absolute  alcohol. 

Vinum  Rubrum. — Red  wine.  An  alcoholic  liquid,  made  by  fer- 
menting the  juice  of  fresh  colored  grapes  in  presence  of  their  skins, 
A  deep  red  liquid,  having  a  pleasant  odor,  free  from  yeastiness,  and  a 
fruity,  moderately  astringent  taste  without  excessive  sweetness  or 
acidity. 

The  U.  S.  Pharmacopoeia  for  1890  recommends  that  when  wines, 
white  or  red,  are  prescribed,  the  domestic  product,  in  the  absence  of 
special  instruction,  be  employed. 

Sparkling  Wines.  (Champagne,  sparkling  catawba,  etc.) — These 
are  wines  which  have  been  bottled  before  the  stage  of  fermentation 
has  been  completed,  hence  they  are  lively,  or  sparkling,  in  consequence 
of  being  charged  with  carbonic  acid.  A  considerable  portion  of  the 
grape-sugar  has  not  been  converted  into  alcohol ;  they  are  sweet  wines, 
therefore,  and  the  quantity  of  absolute  alcohol  which  they  contain  is 
relatively  low  (eight  to  twelve  per  cent).  Sparkling  hock  is  a  lighter 
wine  than  champagne,  and  contains  less  sugar.  Sparkling  catawba 
more  nearly  resembles  hock  than  champagne. 

A  sophistication  now  much  practiced  consists  in  adding  to  still 
wines  carbonic-acid  gas,  by  pressure,  in  the  same  manner  that  carbonic- 
acid  water  is  manufactured. 

Dry  Acid  Wines. — The  best  specimens  of  this  group  are  the  Ger- 
man Rhine  and  Moselle  wines,  California  hock,  and  Ohio  and  Kelly- 
Island  catawba.  The  German  varieties  are  very  numerous,  and  are 
remarkable  for  their  flavor,  for  the  completeness  of  the  fermentation 
(absence  of  sugar),  and  for  their  permanence.  The  most  important 
of  the  varieties  are  the  following  :  Dflrkheimer,  Ungsteiner,  Hoch- 
heimer,  Deidesheimer,  Forster,  Rudesheimer,  Johannisberger,  Lieb- 
frauenmilch,  etc.  The  French  wines  are,  as  a  rule,  rather  acid.  The 
best  known  are  the  clarets,  but  these  are  more  properly  classed  with 
the  red  wines. 

Sweet  Wines. — In  this  group  are  contained  burgundy,  still  cham- 
pagne, muscatel,  malaga,  Hungarian  tokay,  and  angelica,  madeira, 
etc.  The  alcoholic  strength  of  these  wines,  unless  fortified,  is  rela- 
tively low,  because  the  sugar  has  not  been  consumed  by  the  fermen- 
tation. 

Light  Red  Wines. — The  French  clarets,  the  red  Rhine  wines,  the 
American  Ives's  seedling,  and  Concord  and  Hungarian,  are  members 
of  this  group.  They  contain  a  large  proportion  of  the  coloring-matter 
of  the  grape,  and  considerable  tannic  acid. 


WINE.  579 

Heavy  Red  Wines. — Port  is  the  principal  representative  of  this 
group,  but  it  is  not  a  natural  wine  ;  during  the  process  of  manufacture 
spirit  is  added,  and  its  alcoholic  strength  is  raised  to  thirty  or  forty 
per  cent.  California  port  when  fortified,  as  it  probably  frequently  is, 
should  be  classed  in  this  division. 

Dry  Spirituous  Wines. — The  most  important  member  of  this  group 
is  sherry. 

COMPOSITION  AND  PROPEBTIES. — The  composition  of  wine  is  ex- 
tremely complex.  The  constituents  ascertainable  by  chemical  analysis 
do  not  represent  all  of  the  peculiar  qualities  which  render  various 
wines  desirable.  Bouquet  and  flavor  can  not  be  determined  by  the 
most  expert  chemist,  and  elude  all  other  means  of  investigation  but 
the  tongue  and  nose  of  the  "  wine-taster." 

A  wine  is  a  solution  of  alcohol  in  water,  mixed  with  various  con- 
stituents of  the  grape.  The  proportion  of  alcohol  ranges  from  six  to 
forty  per  cent — the  largest  quantity  being  found  in  the  artificial  wines, 
such  as  port  and  sherry.  The  proportion  of  sugar  varies  greatly — 
from  three  to  twenty-five  per  cent.  The  acids  are  fixed  (tartaric)  and 
volatile  (acetic).  The  relation  between  these  several  constituents  is 
nearly  as  follows  :  Port  contains  about  fifty-three  parts  by  weight  of 
alcohol  to  one  part  of  acid,  and  twelve  parts  of  sugar  to  one  part  of 
acid.  The  average  of  sherry  is  thirty-nine  of  alcohol  and  1*5  of  sugar 
to  one  of  acid.  In  the  sweet  wines,  the  average  is  about  thirty  parts 
of  sugar  to  one  part  of  acid  and  fifteen  parts  of  alcohol.  In  the  acid 
wines,  the  average  proportion  of  alcohol  to  acid  is  as  eighteen  to  one, 
while  the  sugar  is  almost  absent,  and  in  some  of  the  best  is  entirely  so. 
Those  are  dry  wines  which  are  free  from  sugar.  Besides  tartaric  and 
acetic  acids,  wines  contain,  in  much  smaller  quantity,  malic,  tannic, 
and  carbonic  acids.  Wines  containing  less  than  three  hundred  grains 
of  acid  to  the  gallon  are  wanting  in  flavor  ;  on  the  other  hand,  an  ex- 
cess of  acid  over  five  hundred  grains  to  the  gallon  is  too  sour  to  be 
agreeable.  The  coloring-matter  of  wine  varies  greatly,  and  the  dis- 
tinction between  "  white  "  and  "  red  "  depends  on  the  quantity  present 
in  these  different  varieties.  The  red  wines  are  more  astringent,  due  to 
the  larger  proportion  of  tannin  which  they  contain,  and  they  are  also 
rougher  to  the  taste. 

Wine  contains  a  great  many  mineral  constituents;  tartrates  of  potas- 
sa  and  lime,  chlorides  of  sodium,  potassium,  and  calcium,  and  sulphates 
of  potassa  and  lime.  The  percentage  of  ash  ranges  from  0'18  to  0'40. 

NOTE. — The  wine-consumers  of  the  United  States  have  been  so  long  habituated  to  the 
wines  of  foreign  source,  that  they  have  been  unable  to  overcome  the  prejudices  against 
the  wines  of  native  production.  The  vineyards  of  California,  of  the  interior  lakes,  and  of 
various  parts  of  the  Middle  States  now  produce  wines  so  thoroughly  good,  that  a  revision  of 
the  present  standards  of  taste  is  demanded  alike  in  the  interests  of  consumers  and  producers. 
A  sound  taste  and  patriotism  coincide  in  claiming  the  highest  excellence  for  our  native  wine. 


580  CEREBRAL   SEDATIVES. 

The  peculiar  odor  of  wine  (bouquet)  is  due  to  oenanthic  acid,  and 
cenanthic  ether,  produced  by  a  reaction  of  the  acid  on  the  alcohol. 

According  to  Fresenius,  the  quality  of  a  wine  is  so  much  the  better 
the  less  it  contains  of  free  acid,  the  more  it  contains  of  sugar,  and 
the  greater  its  quantity  of  extract ;  and,  further,  its  quality  is  not  de- 
cidedly influenced  by  the  quantity  of  alcohol,  and  can  not  be  deter- 
mined by  its  specific  gravity. 

A  certain  quantity  of  free  acid  is  necessary,  but  it  should  not  be 
greater  than  can  be  masked  by  the  alcohol,  sugar,  and  extractive  mat- 
ter. The  flavor  and  odor  of  wine  are  produced  by  ethers  formed  by 
the  action  of  the  free  acid  on  the  alcohol ;  hence  the  importance  of 
this  acid  constituent. 

Dr.  Druitt,  in  his  "  Report  on  Cheap  Wines,"  has  very  well  summed 
up  the  qualities  of  good  wine  in  the  following  conclusions  : 

"  1.  The  wine  should  have  an  absolute  unity,  or  taste  as  one  whole. 

"  2.  Wine  should  contain  a  certain  amount  of  alcohol. 

"  3.  Wine  should  be  slightly  sour. 

"  4.  Sweetness  is  characteristic  of  a  certain  class  of  wines,  while 
certain  other  wines  are  dry,  or  free  from  sugar. 

"  5.  Wines  should  have  a  taste  free  from  mawkishness,  and  indica- 
tive of  instability. 

"  6.  Roughness  or  astringency  is  a  most  important  property,  and 
belongs  to  most  red  wines.  In  moderation  it  is  relished,  as  sourness 
is,  by  a  healthy,  manly  palate,  just  as  the  cold  souse  is  welcome  to  the 
ekin.  In  excess  it  leaves  a  permanent  harshness  on  the  tongue. 

"  7.  The  wine  must  have  body.  This  is  the  impression  produced 
by  the  totality  of  the  soluble  constituents  of  wine — the  extractive,  that 
which  gives  taste  to  the  tongue,  and  which,  as  wine  grows  older,  is 
deposited  along  with  the  cream  of  tartar  forming  the  crust. 

"  8.  ^Bouquet  is  that  quality  of  wine  which  salutes  the  nose.  Fla- 
vor is  that  part  of  the  aromatic  constituent  which  gratifies  the  throat. 

"  9.  The  wine  must  satisfy.  A  man  must  feel  that  he  has  taken 
something  which  consoles  and  sustains.  Some  liquids,  as  cider  and 
thin  wines,  leave  rather  a  craving,  empty,  hungry  feeling  after  them." 

PHYSIOLOGICAL  ACTIONS. — As  respects  the  alcohol  which  they  con- 
tain, the  physiological  actions  of  wines  could  be  discussed  with  the 
previous  article.  But  wines  differ  from  alcohol,  and  from  brandy  and 
whisky,  not  only  in  spirituous  strength,  but  in  the  possession  of  the 
varied  and  important  constituents  mentioned  above. 

The  sparkling  wines  are  more  sedative  to  the  stomach,  and  are 
more  intoxicating,  relatively  to  their  alcoholic  strength,  than  the  other 
wines.  As  they  contain  a  considerable  quantity  of  unappropriated 
sugar,  acid  fermentation  is  apt  to  occur,  and  acidity,  with  headache, 
follows  their  use.  As  respects  the  influence  on  the  pulse,  they  are  less 
stimulating  than  the  stronger  wines,  and  the  experiments  of  Dr.  Ed- 


WINE.  581 

ward  Smith  have  demonstrated  that  they  increase  the  excretion  of  car- 
bonic acid. 

The  dry  acid  wines  are  more  purely  stimulant,  partly  in  conse- 
quence of  their  alcohol,  and  partly  in  consequence  of  the  important 
ethers-  which  they  contain.  As  they  are  free  from  sugar,  acid  fermen- 
tation does  not  follow  their  use,  but  with  some  subjects  the  free  acid 
present  in  them  disagrees. 

The  sweet  wines  have,  generally,  considerable  body  and  alcoholic 
strength.  They  rather  pall  on  the  appetite  ;  are  apt  to  disorder  the 
stomach,  and  produce  headache.  Some  of  them  have  fine  bouquet 
and  flavor,  and  are  satisfying  to  the  palate  ;  but  as  a  rule  they  are  not 
borne  as  well  as  the  dry  wines. 

The  red  wines,  light  and  dark,  are  astringent  and  have  considerable 
body  and  alcoholic  strength.  The  tannin  which  they  contain,  and 
coloring-matters,  are  apt  to  cause  stomach-disorders,  constipation,  and 
a  febrile  state.  By  reason  of  the  large  amount  of  alcohol  in  them, 
especially  in  port,  they  approach  whisky  and  brandy  in  power  as 
stimulants  and  narcotics. 

THERAPY. — 

"  Good  wine  is  a  good  familiar  creature,  if  it  be  well  used."     (Othello.) 

The  effervescing  or  sparkling  wines  often  render  important  service 
in  irritable  states  of  the  stomach  without  inflammatory  action.  The 
vomiting  of  pregnancy,  of  sea-sickness,  of  yellow  fever,  of  cholera- 
morbus,  with  depression,  and  of  true  cholera,  are  not  infrequently  ar- 
rested by  tablespoonf  ul-doses  of  iced  champagne  every  fifteen  minutes. 

A  generous  glass  of  a  dry  wine  (sherry)  taken  with  the  principal 
meal  greatly  assists  the  digestion  of  the  sedentary  who  suffer  from 
atonic  dyspepsia.  The  wine  should  be  taken  during  the  course  of  the 
meal,  and  at  no  other  time.  Persons  who  suffer  from  acidity,  due  to 
an  excess  of  formation  of  acid  gastric  juice,  are  relieved  by  a  dry  acid 
wine,  taken  during  the  meal  or  just  previously.  For  this  purpose  a 
genuine  Rhine  wine — for  example,  Forster  Riesling — is  best. 

In  diarrhoea  and  dysentery,  after  the  acuter  symptoms  have  sub- 
sided, and  when  there  is  considerable  depression,  those  wines  are  in- 
dicated which  contain  tannin — the  red  wines,  claret,  Ives's  seedling, 
port,  etc. 

In  cases  of  anaemia  and  chlorosis,  wines  render  an  important  ser- 
vice by  increasing  digestion  and  assimilation.  To  aid  in  this  process, 
red  wines  with  a  good  deal  of  sugar  and  extractives  are  most  neces- 
sary. When  wines  produce  headache,  and  the  digestion  is  disordered 
by  them,  and  the  appetite  impaired,  they  are  not  serviceable  in  these 
maladies.  Moreover,  for  the  nervous  and  hypochondriacal,  wines  must 
be  prescribed  with  caution,  for  the  habit  of  indulgence  is  quickly  ac- 
quired by  such  subjects.  In  convalescence  from  acute  diseases,  there 


582  CEREBRAL   SEDATIVES. 

can  be  no  difference  of  opinion  as  to  the  great  value  of  wine  as  a 
restorative.  Wines  of  considerable  body  and  alcoholic  strength  are 
indicated  under  these  circumstances.  "When  there  is  much  nervous 
restlessness,  wakefulness,  and  cardiac  depression,  a  wine  rich  in  ethers 
is  specially  useful,  according  to  Anstie.  In  chronic  wasting  diseases, 
as  phthisis,  scrofula,  etc.,  the  stronger  wines,  as  sherry,  burgundy, 
port,  may  take  the  place,  in  some  cases,  of  the  spirits,  whisky  and 
brandy.  In  these  wasting  diseases,  wines  serve  a  double  purpose : 
they  stimulate  the  activity  of  the  primary  assimilation,  and  within 
certain  limits  they  are  utilized  as  foods.  They  are  only  harmful  when 
digestion  is  impaired  by  them  ;  and  under  no  circumstances  can  they 
take  the  place  of  other  aliment. 

In  passive  haemorrhages,  in  the  hcemorrhagic  diathesis  and  in  pur- 
pura,  wines  are  indicated,  because  they  elevate  the  arterial  tension, 
and  thus  act  indirectly  as  haemostatics. 

In  various  acute  diseases,  when  the  action  of  the  heart  becomes 
feeble  and  irregular,  the  pulse  dicrotic,  and  there  occur  wakefulness 
and  delirium,  a  wine  of  considerable  alcoholic  strength  and  rich  in 
ethers  is  peculiarly  serviceable.  Wines  are  much  more  largely  used 
in  fevers  (typhoid,  typhus,  etc.)  than  in  any  other  forms  of  disease, 
and  the  circumstances  requiring  their  employment  are  indicated  in  the 
preceding  sentence.  The  routine  practice  of  alcoholic  stimulation  in 
fevers  can  not  be  justified.  Exact  indications  for  the  use  of  wine 
exist  in  the  state  of  the  heart  and  arterial  system,  and  of  the  brain, 
and  these  should  be  sought  for  in  every  case,  instead  of  prescribing 
for  the  name.  In  fevers,  wines  precede  the  spirituous  liquors.  The 
first  weakening  of  the  heart's  action,  the  beginning  of  dicrotism,  and 
the  transitory  delirium  and  subsultus,  require  champagne  and  the  light 
and  acid  wines  ;  more  profound  adynamia,  with  diarrhoea,  the  stronger 
red  wines. 

In  acute  inflammations  (pneumonia,  pleuritis,  peritonitis,  etc.), 
wines  serve  to  maintain  the  strength  when  the  powers  of  life  are 
weakening,  or  to  maintain  the  functions  of  brain  and  heart  when 
crises  occur,  as  in  pneumonia.  The  rules  for  the  administration  of 
wine  in  acute  inflammations  are  the  same  as  in  fevers. 

Next  to  their  use  in  fevers,  wines  are  most  frequently  prescribed, 
and  with  the  greatest  advantage,  in  surgical  practice,  for  the  conse- 
quences of  wounds  and  injuries,  to  support  the  powers  of  life  under 
protracted  and  profuse  suppuration,  and  to  favor  digestion  and  as- 
similation in  the  course  of  convalescence  from  surgical  diseases. 

The  immediate  stimulant  effect  of  wine  is  of  great  value  in  sudden 
and  profuse  loss  of  blood,  whether  from  injuries  and  surgical  opera- 
tions, or  post  partum.  A  highly-etherized  wine  of  good  body  is  most 
useful  here,  because  it  produces  a  prompt  effect  and  easily  yields  up 
the  force  needed  to  keep  the  heart  and  brain  in  action,  and,  in  the 


BEER,   ALE,   PORTER.  583 

case  of  the  relaxed  uterus,  to  furnish  the  power  needed  to  procure  its 
energetic  contraction. 

Beer,  Ale,  Porter. — Beer  and  ale  are  fermented  liquors  made  from 
malted  grain,  hops  and  other  bitter  substances  being  added.  Ale  is 
produced  by  rapid  fermentation,  in  which  the  yeast  rises  to  the  sur- 
face, and  beer  is  the  product  of  slow  fermentation  in  cool  cellars,  the 
yeast  falling  to  the  bottom.  Hence  the  name  lager-beer.  Porter  em- 
braces the  qualities  of  beer  and  ale,  and  is  so  named  on  account  of  its 
strong  quality,  which  endeared  it  to  porters. 

COMPOSITION. — The  proportion  of  alcohol  varies  somewhat.  In 
Edinburgh  ale  it  amounts  to  about  six  per  cent ;  in  brown  stout,  to 
six  per  cent ;  in  porter,  to  four  per  cent  ;  in  beer,  two  to  three  per 
cent.  Besides  alcohol  and  water,  these  malt  liquors  contain  extract 
of  malt,  five  to  fourteen  per  cent ;  carbonic  acid,  0'16  to  0*60  per  cent. 
In  the  extract  are  found  also  various  aromatic  substances,  lactic  acid, 
potash  and  soda  salts,  etc. 

PHYSIOLOGICAL  ACTIONS. — So  far  as  the  alcohol  is  concerned,  beer, 
ale,  and  porter  correspond  in  physiological  actions  to  the  spirituous 
liquors  and  to  wines.  As  they  contain  malt  extract,  their  nutritive 
value  is  greater  than  spirits  and  wine.  An  important  constituent,  the 
hop,  being  an  aromatic  bitter,  the  tonic  and  stomachic  qualities  of 
these  malt  liquors  are  also  greater  than  their  congeners.  The  process 
of  fermentation,  however,  lessens  in  a  remarkable  degree  the  nutritive 
and  stomachic  qualities  of  the  constituents  which  enter  into  the  com- 
position of  malt  liquors.  Their  value  as  foods  is  much  exaggerated 
by  the  habitual  consumers.  They  increase  the  appetite  and  favor  the 
deposition  of  fat.  Although  the  malt  beverages  do  not  cause  to  any- 
thing like  the  same  extent  the  alterations  in  the  nervous  centers  pro- 
duced by  the  spirituous,  they  induce  other  and  almost  as  important 
structural  changes.  They  set  up  in  the  organism  fatty  degeneration 
of  various  tissues,  notably  of  the  liver  and  heart.  The  habitual  beer- 
consumer  is  known  by  his  obesity,  his  flushed  face,  embarrassed  breath- 
ing, puffy  hands,  yellow  conjunctiva,  etc. ;  he  is  usually  short-lived,  and 
the  end  is  reached  by  hepatic  and  cardiac  disorders.  It  is  certainly 
true  that  a  moderate  amount  of  beer  may  be  taken  daily,  for  a  life- 
time, without  any  obvious  impairment  of  the  functions  ;  but  excessive 
use  produces  with  great  certainty  the  unfavorable  effects  above  de- 
scribed. 

THERAPY. — Beer,  ale,  and  porter  are  not  usually  prescribed  in  acute 
maladies.  They  are,  however,  much  and  justly  esteemed  as  stomachic 
tonics  and  restoratives  in  chronic  wasting  diseases — for  example,  in 
convalescence  from  acute  diseases  and  surgical  injuries,  in  cases  of 
profuse  and  protracted  suppuration,  prolonged  lactation,  diseases  of 
the  joints,  scrofula,  phthisis,  etc.  Strumpf  finds,  however,  that  alco- 


584  CEREBRAL   SEDATIVES. 

holic  beverages  only  increase  the  amount  of  fat  in  milk,  and  not  the 
quantity  of  milk  as  a  whole. 

The  malt  liquors  are  harmful  in  all  stomach-disorders  with  acidity, 
and  in  chronic  affections  of  the  liver,  especially  fatty  liver.  When 
these  beverages  do  not  improve  the  appetite,  when  they  cause  a  sense 
of  epigastric  oppression,  and  when  they  coat  the  tongue,  they  are  not 
beneficial. 

When  wakefulness  is  due  to  cerebral  anaemia,  a  glass  of  beer  or 
ale  at  bedtime  will  frequently  produce  satisfactory  sleep.  Puerperal 
mania,  delirium  tremens,  and  acute  maniacal  delirium,  when  these 
symptoms  coexist  with  a  condition  of  adynamia,  are  greatly  benefited 
by  the  liberal  use  of  ale  (pale  or  Edinburgh  ale).  The  effect  of  this 
remedy  is  to  arouse  the  appetite,  to  quiet  delirium,  and  to  produce 
sleep.  In  melancholia,  excellent  results  are  often  obtained  by  the  use 
of  porter  with  a  little  tincture  of  opium. 

EXTRACT  OF  MALT. — Under  this  name  is  known  a  thick,  sirupy 
liquid  having  a  golden  or  yellowish-brown  color,  a  sweetish  taste,  and 
the  odor  of  malt.  If  properly  prepared,  it  contains,  besides  the  con- 
stituents of  barley,  the  ferment  diastase.  It  is  much  prescribed  for 
its  restorative  qualities,  and  as  a  vehicle  for  cod-liver  oil.  It  is  best 
administered  immediately  after  meals. 

Paraldehyde. — Under  this  name  is  described  a  polymeric  modifica- 
tion of  aldehyde.  Above  the  temperature  of  51°  Fahr.  it  is  a  color- 
less liquid,  having  a  peculiar  ethereal  odor,  and  a  specific  gravity  of 
•998.  It  boils  at  about  225°  Fahr.  It  is  soluble  in  eight  parts  of 
water  at  52°  Fahr.  The  dose  ranges  from  3  ss  to  3  ijss.  Water  is 
a  suitable  menstruum. 

In  appropriate  cases  it  has  proved  to  be  an  admirable  hypnotic, 
with  many  of  the  qualities  but  none  of  the  dangers  of  chloral.  In  its 
action,  first  the  cells  of  the  cerebrum  are  affected,  and  sopor  is  induced. 
Unlike  the  other  agents  of  this  class,  its  soporific  action  is  not  pre- 
ceded by  excitement  (Cervello).  Next  to  the  cerebral  hemispheres 
the  effects  of  paraldehyde  are  expended  on  the  medulla  oblongata, 
and  then  on  the  spinal  cord.  A  lethal  dose  stops  the  functioning  of 
the  medulla  and  the  respiratory  center,  but  the  cardiac  functions  cease 
after  the  respiratory.  It  differs  from  chloral  in  the  important  respect 
that  it  has  no  paralyzing  action  on  the  heart.  The  effect  of  paralde- 
hyde is,  however,  not  so  persistent  as  that  of  chloral,  but  frequent 
administration  of  the  one  can  safely  compensate  for  the  greater  power 
of  the  other  (Albertoni). 

Paraldehyde  may  be  prescribed  as  a  hypnotic  in  the  conditions 
usually  requiring  such  a  remedy — in  fevers,  rheumatism,  gout,prurigo, 
etc.  (Morselli).  It  is,  however,  in  mental  and  nervous  disorders  that 
it  is  likely  to  be  most  employed.  By  the  Italian  physicians,  to  whom 


METHYLAL.  585 

we  owe  its  introduction,  it  has  been  very  successfully  used  in  acute 
mania,  in  the  wakefulness  of  dementia  paralytica,  in  hysterical  seiz- 
ures, and  in  ordinary,  insomnia.  To  succeed,  it  must  be  given  in 
sufficient  quantity.  The  maximum  dose  mentioned  above  (  3  ijss)  has 
often  been  given  without  any  ill  effect  or  any  after-trouble  of  any 
kind,  and  has  often  proved  to  be  necessary. 

Paraldehyde  has  gained  in  favor  since  its  introduction,  and  the 
range  of  its  application  has  constantly  widened.  It  has  been  used 
with  success  in  the  treatment  of  delirium  tremens,  in  strychnine-poi- 
soning, in  the  milder  cases  of  neuralgia,  and  as  an  expectorant  /  but 
in  the  more  dangerous  affections  the  dose  must  be  large  enough  to 
make  an  impression — from  3  ss  to  3  ij.  These  large  doses  are  the  safer, 
in  that  paraldehyde  has  no  depressing  action  on  the  heart  and  lungs 
(Coudray).  An  increasing  use  as  an  expectorant,  and  as  an  ingredient 
of  cough-mixtures,  confirms  what  has  been  stated  of  its  beneficial 
effects  in  the  treatment  of  cough,  and  bronchial  affections  in  general. 

Although  paraldehyde  has  an  agreeable,  fruity  odor,  the  taste  is 
rather  pungent,  and  hence  it  were  better  given  in  the  form  of  the  pre- 
scriptions below : 

5  Paraldehyde,  3  j  ;  spirit,  chloroform.,  ij[  xv  ;  pulv.  tragacanth. 
com.,  3j  ;  syrp.  aurant.  cort.,  f  ss  ;  aquae  ad  ^  iij.  M.  Sig.:  One  or 
two  doses  (Hodgson). 

r>  Paraldehyd.,  3  ij  ;  ol.  amygd.  ex.,  3  ij  ;  chloroformi,  TTJ,  x  ;  ol. 
cinnamomi,  til  ij. 

Authorities  referred  to  : 

COUDRAY,  DR.     These  de  Paris,  1885,  quoted  by  Annuaire  de  Therapeutique,  1885. 
DESNOS,  DR.     Bui.  Gen.  de  Therap.  for  1886. 

DUJARDIN-BEAUMETZ,  DR.       Ibid. 

KERAVAL  ET  NERKAM.     Annuaire  de  Therap.  for  1886. 
PREVOST,  DR.  J.  L.     Bui.  Gen.  de  Therap.     Ibid. 

Methylal. — This  new  agent  has  been  long  known  to  chemists,  but 
its  utilization  as  a  remedy  is  very  recent.  Methylal  is  highly  volatile, 
is  soluble  in  water  and  alcohol,  and  can  be  made  into  a  homogeneous 
unguent  with  oils  and  fats.  It  is  a  very  diffusible  substance,  acts  very 
quickly,  and  is  eliminated  rapidly.  When  it  enters  the  stomach  a  sen- 
sation of  warmth  is  produced  which  diffuses  throughout  the  system, 
the  vascular  tension  falls,  the  heart  beats  rapidly,  respiration  is  in- 
creased, and  the  temperature  is  said  to  be  lowered  ;  but  we  are  inclined 
to  think  that  an  error  of  observation  has  been  committed  here.  Sleep  is 
soon  induced,  but  the  extent  and  duration  of  this  stage  of  the  action  are 
much  influenced  by  the  quantity  given  and  by  the  rate  of  elimination, 
which  is  rapid  or  slow,  according  to  the  state  of  the  eliminating  organs. 

Methylal  lessens  the  reflexes,  and  is  antagonistic  to  strychnine  and 
the  tetanizers  in  general. 


586  CEREBRAL   SEDATIVES. 

The  dose  of  methylal  ranges  from  five  to  fifteen  grains.  As  it  is 
soluble  in  water  it  may  be  given  subcutaneously  as  by  the  stomach. 
The  maladies  in  which  it  has  been  used  with  encouraging  results  are 
wakefulness,  convulsive  diseases,  as  epilepsy,  in  neuroses  of  the  re- 
spiratory organs,  and  in  cases  of  neuralgia  of  superficial  nerves.  It 
is  applied  externally,  mixed  with  almond-oil  or  alcohol,  in  the  propor- 
tion of  ten  to  twenty  per  cent  of  the  medicament.  The  rate  of 
dosage  must  be  comparatively  rapid,  as  the  diffusion  and  elimination 
of  the  remedy  go  on  so  quickly.  In  making  external  applications,  the 
state  of  the  skin  and  its  idiosyncrasies  must  be  heeded.  Violent  in- 
flammation may  be  caused  by  too  free  and  too  frequent  application  of 
the  remedy. 

Chloride  of  Methyl. — In  1884  Debove  published  a  paper  on  the 
anaesthetic  and  analgesic  properties  of  methyl  chloride.  But  little 
attention  was  given  to  the  subject.  Very  recently  he  has  reported  a 
fresh  series  of  cases,  and  the  actions  of  the  new  anaesthetic  have  been 
examined  into  with  more  zeal.  He  reports  the  treatment  of  one  hun- 
dred and  fifty  cases  of  sciatica,  of  which  only  one  in  twenty  failed  of 
relief.  He  again  asserts  that  lumbago  and  nerve-pain  are  cured  imme- 
diately, and  if  relapses  occur,  they  are  quickly  ended  by  renewed  use 
of  the  remedy.  Of  the  cases  of  facial  neuralgia,  eighteen  in  number, 
sixteen  were  cured. 

Debove  gives  precise  instructions  about  the  mode  of  applying  the 
remedy.  As  a  volatile,  ether-like  material,  rapid  evaporation  takes 
place  when  it  is  applied  by  the  spray-douche  over  the  affected  area. 
An  ordinary  atomizer  suffices.  The  spray  should  be  applied  over  as 
many  nerve-filaments  as  possible,  but  it  is  necessary  to  avoid  produc- 
ing an  inflammation  of  the  skin  or  an  erythema.  Persons  having  an 
irritable  skin  or  a  tendency  to  disease  of  the  skin  must  be  treated  with 
caution  and  with  the  minimum  of  effect  at  the  outset.  Debove  ad- 
vises discretion  in  the  case  of  those  affected  with  albuminuria  and  dia- 
betes. 

The  special  advantage  possessed  by  methyl  chloride  is  the  external 
application,  which  never  involves  more  serious  results  than  some  tem- 
porary irritation  of  the  skin  ;  and,  if  the  reports  of  its  success  be  de- 
pendable, we  have  in  this  method  the  power  to  cure  in  a  more  ready, 
easy,  and  effective  manner  than  ever  before. 

Authorities  referred  to  : 

DKBOTE,  DR.     Societe  medicate  des  ffdpitaux,  in  Revue  de  Therap.,  1887. 
ELAY,  DR.     On  Methylal,  London  Medical  Record,  May  16,  1887. 

Urethan. — A  combination  of  carbonic  acid  and  ethylic  ether. 
From  a  priori  considerations,  the  distinguished  pharmacologist  of 
Strasburg,  Professor  Schmiedeberg,  was  led  to  the  conclusion  that 


URETHAN.  587 

these  compounds  of  ethyl  must  have  the  hypnotic  powers,  to  some 
extent,  of  the  group.  A  careful  investigation  confirmed  this  view. 
Of  these  ethyl  compounds,  called  urethans,  he  found  that  the  carba- 
mate  of  ethyl  was  the  most  satisfactory,  and  to  this  he  gave  the  ge- 
neric name  of  the  group,  urethan.  He  submitted  this  to  a  charac- 
teristically thorough  examination,  and  was  thus  able  to  confirm  his 
original  conception  of  the  physiological  actions. 

PROPERTIES. — Urethan  occurs  in  whitish  crystals,  is  without  odor, 
is  tasteless,  and  insoluble  in  water.  The  dose  is  very  unequal,  for  so 
much  depends  on  the  purpose  in  view,  the  age,  character,  and  suscepti- 
bility of  the  patient.  The  dose  may  be  stated  as  from  five  grains  to 
a  drachm  or  more.  The  best  form  in  which  to  administer  it  is  the 
compressed  pellet,  but  the  capsule,  the  wafer,  or  simple  powder  may 
be  employed.  It  has  been  ascertained  of  late,  that  the  best  hypnotic 
action  can  be  developed  only  by  massive  doses.  Saundby,  however, 
narrates  two  cases  of  insomnia  in  which  two  grains  at  a  dose  seems  to 
have  been  sufficient  for  the  purpose  ;  but  the  general  opinion  is  that 
from  forty  to  eighty  grains  must  be  given  to  bring  about  a  decided 
hypnotic  action. 

Urethan  has  no  irritating  effect  on  the  stomach,  and  does  not  im- 
pair digestion.  Although  insoluble  in  water,  the  stomach  juice  dis- 
solves it  readily,  and  hence  it  promptly  diffuses  into  the  blood.  Two 
results,  apparently  opposite  in  character,  are  produced  in  due  order : 
the  first  impression  is  of  a  stimulant  character,  but  very  brief  in  dura- 
tion ;  the  next  consists  in  diminution  of  action,  slowing  of  circulation 
and  respiration,  decline  of  temperature,  and  weakening  of  the  reflexes, 
which  gradually  lessen  in  promptness  and  finally  disappear.  With  the 
onset  of  the  depression  stage,  drowsiness  comes  on,  tranquil  sleep  suc- 
ceeds, and  this  physiological  condition  passes  into  coma  and  insensibil- 
ity if  the  quantity  administered  be  toxic.  Urethan  is  not  actively 
toxic,  however,  for  Prof.  Anrep  maintains  that  so  large  a  quantity  as 
eight  to  twelve  grammes  (  3  i j  —  3  iij)  can  be  taken  by  an  adult,  with- 
out causing  danger-symptoms.  By  Jaksch,  one  gramme  (15£  grs.)  is 
held  to  be  sufficient  to  cause  sleep.  Mairet  and  Combemale  adminis- 
tered it  in  various  forms  of  mental  diseases,  and  thus  ascertained  how 
far  its  hypnotic  power  is  influenced  by  the  character  of  the  case,  the 
presence  of  pain,  and  other  disturbing  influences.  Urethan  is  not  an 
analgesic,  and  hence  pain  will  prevent  its  hypnotic  action.  The  ex- 
citement of  mania,  noises,  and  odd  situations,  may  also  prevent  the 
hypnotic  action.  The  most  frequent  cause  of  dissatisfaction  is  insuf- 
ficient quantity,  for  then  the  desired  action  fails,  and  consequently  the 
remedy  is  discredited. 

Unpleasant  after-effects  do  not  occur  unless  stomachal  troubles 
interfere,  and  headache,  nausea,  and  vertigo  are  quite  exceptional. 
When  the  conditions  are  favorable,  sleep  comes  on  in  fifteen  minutes 


588  CEREBRAL   SEDATIVES. 

to  an  hour,  is  quiet,  and  lasts  from  six  to  eight  hours.  When  it  is 
administered  for  many  days  in  succession  its  power  lessens,  although 
the  dose  may  be  increased  ;  but  if  stopped  for  a  time,  the  susceptibil- 
ity of  the  brain  is  restored,  and  then  urethan  can  be  resumed  again. 

THERAPY. — The  therapeutical  applications  of  urethau  are  based 
on  its  physiological  properties.  Schmiedeberg  began  the  consideration 
of  its  actions  for  a  priori  reasons,  and,  these  being  confirmed,  he  ex- 
tended his  investigations  to  the  physiological  and  therapeutical  aspects 
of  the  subject.  Its  hypnotic  powers,  its  influence  over  the  reflexes, 
and  its  antipyretic  action,  were  accurately  mapped  out  by  the  great 
pharmacologist,  so  that  now  the  value  of  the  new  agent  is  known,  its 
limitations  are  defined,  and  the  morbid  states  to  which  it  is  applicable 
clearly  shown. 

In  general  terms,  urethan  is  a  hypnotic  which  may  be  successfully 
used  to  procure  quiet  and  sleep,  when  the  conditions  are  favorable  to 
its  action.  As  a  hypnotic,  its  position  is  similar,  but  not  quite  equal, 
to  that  of  paraldehyde. 

Urethan  is  antagonistic  to  strychnine,  but  only  the  largest  doses, 
under  the  most  favorable  circumstances,  will  make  it  powerful  enough. 
Being  a  moderator  of  reflex  action,  it  may  prove  useful  in  epilepsy, 
chorea,  spasm,  and  cramp.  It  is  probable,  also,  that  it  may  be  bene- 
ficial in  the  spasmodic  respiratory  neuroses.  By  way  of  illustration, 
the  experiences  of  Dr.  Ferreira  may  be  referred  to  here.  Cases  of 
epilepsy,  of  urcemic  convulsions,  of  tetanus,  and  of  delirium  tremens, 
were  all  influenced  favorably,  but  a  distinctly  curative  effect  was 
manifest  in  some  of  the  epileptic  subjects,  and  in  the  cases  of  de- 
lirium tremens.  Urethan  should  have  further  trial  in  the  treatment 
of  epilepsy,  especially  in  those  nocturnal  in  occurrence. 

Phenyl-urethan. — Euphorin. 

Chloral-methan. —  Ural,  or  Uralium. 

Ethyl-chloral-urethaii. — Sonmal. 

Acetyl-hydroxy-phenyl-uretlian.— Neurodin. 

From  a  combination  of  aniline  and  carbonic  acid  compound  ethers 
are  derived  in  great  numbers  by  substitution.  Of  the  ethyl  carbamic 
ethers  we  have  ethyl-carbamic  ether,  or  urethan ;  phenyl-urethan, 
named  euphorin  ;  chloral-urethan,  or  uralium ;  ethyl-chloral-urethan, 
or  somnal ;  and  acetyl-hydroxy-phenyl-urethan,  or  neurodin. 

Although  these  derivative  combinations  agree  in  having  antiseptic, 
antirheumatic,  antithermic,  and  analgesic  properties,  they  differ  in 
many  respects,  these  distinctive  qualities  being  modified  by  the  intro- 
duction of  substitutes  having  certain  special  features. 

In  euphorin  the  analgesic  and  hypnotic  qualities  of  urethan  are 
attempted  to  be  supplemented  by  the  antiseptic  powers  of  phenol. 
Accordingly,  it  has  been  found  to  possess  the  qualities  and  powers  of 


ACETYL-HYDROXY-PHENYL-URETHAN.  589 

the  compound  ethers,  and  is  hypnotic,  analgesic,  antipyretic,  and  anti- 
septic. 

Eaphorin  is  a  whitish  powder,  a  little  pungent  in  taste,  somewhat 
aromatic  in  odor,  soluble  in  alcohol  but  very  slightly  soluble  in  water. 
The  dose  ranges  from  0'5  g.  (=  7£  grains)  to  I'O  g.  (=  15  grains).  It 
is  usually  administered  in  pill  form,  or  preferably  in  wafer  or  capsule. 
It  is  also  applied  locally  as  a  powder,  or  mixed  with  talc  and  other 
diluents,  or  made  in  ointment  with  lanolin  or  vaseline. 

In  full  doses  it  depresses  febrile  temperature,  sweating  marking 
the  end  of  the  action,  and  some  chilliness  occurs  with  the  initial  rise 
of  temperature.  In  rheumatic  fever  and  in  typhoid  two  or  three  doses 
in  twenty-four  hours  are  usually  required.  As  it  does  not  cause  de- 
pression of  the  heart,  and  but  little  cyanosis  attends  its  action,  it  is  a 
safe  and  useful  antipyretic  in  typhoid.  It  is  one  of  the  best  of  its 
class  in  the  treatment  of  acute  rheumatism.  Having  analgesic  power, 
it  is  employed  in  the  treatment  of  neuralgic  affections,  myalgia,  lum- 
bago, and  kindred  maladies. 

As  a  topical  remedy  it  is  used  in  skin  and  venereal  affections,  and 
as  an  antiseptic  in  wounds,  injuries,  and  local  catarrhal  affections. 

Chloral-urethan,  or  uralium,  is  an  efficient  hypnotic,  not  so  pow- 
erful as  chloral  but  more  active  than  urethan.  It  is  employed  as  a 
sleep-producing  remedy  under  the  same  conditions  as  chloral.  To 
procure  sleep,  a  dose  of  15  to  40  grains  is  necessary.  As  its  action  is 
slower  than  chloral  and  more  rapid  than  urethan,  it  should  be  given 
an  hour  or  two  before  the  time  when  sleep  is  desired.  As  it  is  pos- 
sessed of  antispasmodic  properties,  uralium  may  be  administered  in 
tetanus,  chorea,  epilepsy,  and  similar  affections. 

Ethyl-chloral-urethan  has  been  named  somnal,  a  proprietary  com- 
pound having  a  hypnotic  action.  Somnal  is  a  colorless  liquid  with  a  hot, 
pungent  taste.  The  dose  as  a  hypnotic  ranges  from  fifteen  minims  to 
half  a  drachm.  Differing  from  uralium  in  having  an  additional  ethyl  to 
the  hydroxyl  in  chloral,  it  is  supposed  to  possess  greater  sedative  and 
hypnotic  action.  Opinions  differ  as  to  its  utility  in  insanity,  in  which  it 
has  been  chiefly  employed.  Some  regard  it  as  uncertain,  but  Memmo 
has  had  excellent  results  from  its  administration  in  epileptic  mania, 
paranoia,  and  other  mental  disorders.  It  is  said  to  leave  no  after- 
troubles. 

Acetyl-hydroxy-phenyl-urethan. — Neurodin  differs  from  the  pre- 
ceding in  the  introduction  of  acetyl.  According  to  Von  Mering,  it 
has  valuable  pain-relieving  power,  and  is  an  efficient  remedy  for  neu- 
ralgia, headache,  sciatica,  lumbago,  and  other  painful  affections.  The 
dose  which  has  been  found  sufficient  in  these  affections  is  from  15  to 
23  grains.  It  has  been  used  as  an  antipyretic  in  febrile  diseases — in 
pneumonia,  typhoid,  scarlet  fever,  and  erysipelas.  No  dangerous  symp- 
toms have  attended  its  action,  although  considerable  sweating  and 


590  CEKEBRAL   SEDATIVES. 

some  cyanosis  have  occurred.  The  sleep-producing  effects  occur  within 
two  hours,  and  the  decline  in  temperature  comes  on  within  a  half  hour, 
reaching  its  maximum  in  about  two  hours. 

Hypnone. — Under  this  title  phenyl-methyl-acetone  has  been  brought 
forward  by  Popof  and  Nencki  as  a  representative  analgesic  and  hyp- 
notic. Dujardin-Beaumetz  and  pupils  have  followed  with  clinical 
investigations,  in  wrhich  the  claims  made  have  been  largely  confirmed. 

It  is  a  limpid,  colorless  liquid,  odorless,  but  has  a  pungent  taste. 
The  dose  is  2  to  5  minims.  It  should  be  administered  in  capsules,  or 
made  into  an  emulsion. 

Hypnone  has  been  successfully  employed  in  the  treatment  of  pain- 
ful affections  of  the  fifth  nerve,  tic-douloureux,  rheumatic  disturbances 
of  the  dental  branches  of  the  same  nerve,  in  hemicrania,  and  similar 
disorders.  It  is  applicable  to  the  treatment  of  other  neuralgic  affec- 
tions and  so-called  rheumatic  muscular  troubles,  as  lumbago,  sciat- 
ica, etc. 

Hypnone  also  is  a  moderator  of  reflex  actions,  and  has  been  util- 
ized in  the  treatment  of  epilepsy,  chorea,  and  allied  diseases.  As  re- 
spects epilepsy,  it  is  more  especially  the  nocturnal  affection  to  which 
it  is  applicable.  Asthma — the  spasmodic  variety — whooping-cough, 
singultus,  are  also  disorders  amenable  to  its  action.  Such  spasmodic 
and  painful  affections  as  hepatic  and  renal  colic,  flatulent  colic,  etc., 
are  conditions  to  the  treatment  of  which  it  may  be  successfully 
applied. 

Hypnal. — Under  this  title  a  combination  of  antipyrin  and  chloral — 
trichloral-dehydphenyl-dimethylpyrazolon — has  been  introduced.  It 
has  so  many  chemical,  physiological,  and  therapeutical  affinities  with 
the  remedies  now  under  consideration  that  it  may  well  be  described 
in  this  place. 

Hypnal  is  without  odor  or  taste  ;  it  occurs  in  rhombic  prisms,  and 
is  soluble  in  water  in  the  proportion  of  one  to  five  or  six  parts.  It 
may  therefore  be  given  in  solution  in  water,  or  combined  in  suitable 
mixtures.  The  dose  ranges  from  10  to  40  grains. 

As  its  composition  indicates,  hypnal  is  possessed  of  hypnotic,  anal- 
gesic, and  antipyretic  actions.  It  has  been  employed  successfully  for 
the  relief  of  insomnia,  hemicrania,  and  other  kinds  of  neuralgia,  and 
to  reduce  abnormal  temperature.  Unusual  exemption  from  after  ill 
consequences  is  claimed  for  this  agent.  It  is  said  to  cause  little  or 
none  of  the  cardiac  depression,  the  profuse  sweating,  the  chills,  etc., 
which  attend  on  the  action  of  its  congeners,  antipyrin  and  chloral. 
When  massive  doses  are  given,  however,  the  usual  precautions  against 
accident  should  be  taken. 

Sutyl-hypnal  differs  from  ordinary  hypnal  in  being  a  combination 
of  antipyrin  and  butyl-chloral.  It  has  not  been  much  used  hitherto. 


ETHER.  591 

Hypnone  is  a  hypnotic,  and  has  less  pain-relieving  power.  It  is 
adapted  to  the  same  conditions  as  those  in  which  paraldehyde  is  now 
prescribed.  Dubois  advises  the  use  of  hypnone  to  promote  anaesthe- 
sia when  chloroform  is  administered.  But  its  chief  employment  will 
be  confined  to  the  more  simple  cases  of  insomnia,  we  conclude  after 
some  investigation  of  its  powers. 

Either. — Ether.     JZther,  Fr. ;  Aether,  Ger. 

A  liquid  composed  of  about  seventy-four  per  cent  of  ethyl  oxide, 
and  about  twenty-six  per  cent  of  alcohol  containing  a  little  water. 
Specific  gravity  about  0'750  at  60°  Fahr. 

jEther  Fortior. — Stronger  ether.  A  liquid  composed  of  about 
ninety-four  per  cent  of  ethyl  oxide,  and  about  six  per  cent  of  alcohol 
containing  a  little  water.  Specific  gravity  not  higher  than  0'725  at 
60°  Fahr. 

A  thin,  very  diffusive,  clear,  and  colorless  liquid,  of  a  refreshing, 
characteristic  odor,  a  burning  and  sweetish  taste,  with  a  slightly  bit- 
ter after-taste,  and  a  neutral  reaction.  It  is  soluble  in  all  proportions 
in  alcohol,  chloroform,  benzol,  benzin,  fixed  and  volatile  oils,  and  dis- 
solves in  eight  times  its  volume  of  water  at  60°  Fahr.  It  boils  at  98*6° 
Fahr.  Ether  is  highly  inflammable,  and  its  vapor,  when  mixed  with 
air  and  ignited,  explodes  violently. 

Spiritus  ^theris. — Spirit  of  ether.  Consists  of  ether,  thirty  parts  ; 
alcohol,  seventy  parts.  Dose,  m,  x —  3  j. 

Spiritus  ^Etheris  Compositus. — Compound  spirit  of  ether.  Hoff- 
man's anodyne.  (Ether,  alcohol,  and  ethereal  oil.)  A  colorless,  vola- 
tile, inflammable  liquid,  having  an  aromatic,  ethereal  odor,  and  a 
burning,  slightly  sweetish  taste.  Its  specific  gravity  is  0*815.  It  is 
neutral,  or  but  slightly  acid  to  litmus.  It  gives  only  a  slight  cloudi- 
ness with  chloride  of  barium ;  but  when  a  fluid  ounce  of  it  is  evapo- 
rated to  dryness  with  an  excess  of  this  test,  it  yields  a  precipitate  of 
sulphate  of  barium,  which,  when  washed  and  dried,  weighs  six  and  a 
quarter  grains.  When  a  few  drops  are  burned  on  glass  or  porcelain, 
there  is  no  visible  residue,  but  the  surface  will  have  an  acid  taste  and 
reaction.  A  pint  of  water,  by  the  admixture  of  forty  drops,  is  ren- 
dered slightly  opalescent.  Dose,  ifi  x —  3  j.  (Pharm.  70.) 

Spiritus  ^Etheris  Nitrosi. — Spirit  of  nitrous  ether.  Sweet  spirit 
of  nitre.  An  alcoholic  solution  of  ethyl  nitrite,  containing  five  per 
cent  of  the  crude  ether.  (U.  S.  P.)  Is  a  volatile,  inflammable  liquid 
of  a  pale-yellow  color,  inclining  slightly  to  green,  having  a  fragrant, 
ethereal  odor,  free  from  pungency,  and  a  sharp,  burning  taste.  It 
slightly  reddens  litmus,  but  does  not  cause  effervescence  when  a  crys- 
tal of  bicarbonate  of  potassium  is  dropped  into  it.  When  mixed  with 
half  its  volume  of  official  solution  of  potassa  previously  diluted  with 
an  equal  measure  of  distilled  water,  it  assumes  a  yellow  color,  which 


592  CEREBRAL   SEDATIVES. 

slightly  deepens,  without  becoming  brown,  in  twelve  hours.  A  portion 
of  the  spirit  in  a  test-tube  half  filled  with  it,  plunged  into  water  heated 
to  145°,  and  held  there  until  it  has  acquired  that  temperature,  will  boil 
distinctly  on  the  addition  of  a  few  small  pieces  of  glass. 

Spirit  of  nitrous  ether  has  a  specific  gravity  of  0'837,  and  contains 
five  per  cent  of  its  peculiar  ether.  It  should  not  be  long  kept,  as  it 
becomes  strongly  acid  by  age.  Dose,  3  ss —  f  ss. 

^Ether  Aceticus. — Acetic  ether.  Acetate  of  ethyl.  A  transparent 
and  colorless  liquid,  of  a  strong,  fragrant,  ethereal,  and  somewhat  ace- 
tous odor,  a  refreshing  taste,  and  neutral  reaction.  Soluble  in  all  pro- 
portions in  alcohol,  ether,  and  chloroform,  and  in  about  seventeen  parts 
of  water.  Specific  gravity,  0'889  to  0*897.  It  is  inflammable.  Dose, 

m  x— 3  j. 

Ethyl  Jlromide. — Hydrobromic  ether.  Is  a  colorless  liquid,  vol- 
atile, having  a  fragrant  odor,  and  a  hot,  somewhat  sweetish  taste, 
afterward  rather  bitter.  It  is  not  inflammable.  Its  specific  gravity  is 
1'420,  and  it  boils  at  104°  Fahr.  ;  readily  decomposes  on  exposure  to 
light  and  air,  bromine  being  separated.  It  is  freely  soluble  in  alcohol 
and  ether,  but  very  sparingly  in  water.  Dose,  for  internal  and  sub- 
cutaneous administration,  rq,  x —  3  j. 

ANTAGONISTS  AND  INCOMPATIBLES. — Ether  dissolves  iodine,  bro- 
mine, corrosive  sublimate,  the  volatile  and  fixed  oils,  many  resins  and 
balsams,  tannin,  caoutchouc,  most  of  the  alkaloids,  sulphur,  and  phos- ' 
phorus — the  last-named  two  sparingly.  As  respects  its  stimulant  and 
anodyne  properties,  it  is  antagonized  by  arterial  sedatives,  quinine, 
oxygen,  protoxide  of  nitrogen,  the  tetanizing  alkaloids,  strychnine, 
picrotoxin,  etc. 

SYNEEGISTS. — Alcohol  and  its  congeners,  chloroform,  arterial  stimu- 
lants, cerebral  stimulants,  etc.,  assist  the  action  of  ether. 

PHYSIOLOGICAL  ACTIONS. — The  physiological  effects  of  ether  when 
inhaled  require  separate  treatment ;  hence  the  subject  of  anaesthesia 
by  vapors  will  be  discussed  in  a  special  article.  It  is  now  proposed 
to  treat  of  the  effects  of  ether  administered  by  the  usual  route — the 
stomach. 

Ether  has  a  taste  at  first  sweetish,  but  afterward  hot  and  pungent. 
It  leaves  a  cooling  sensation  in  the  stomach  after  the  subsidence  of 
the  burning,  and  this  quickly  diffuses  over  the  body.  Increased  action 
of  the  heart,  flushing  of  the  face,  warmth  of  the  surface,  with  increased 
diaphoresis,  follow  in  a  few  minutes.  The  senses  are  quickly  excited, 
the  mind  becomes  more  active,  ideas  flow  rapidly,  and  the  cerebral 
phenomena  of  alcoholic  intoxication  ensue.  These  effects  are  of  short 
duration,  and  a  feeling  of  content,  mental  calm,  and  sopor,  succeeds 
to  the  transient  excitement.  Ether  is  eliminated  rapidly,  chiefly  by 
the  lungs,  and  the  whole  duration  of  the  effects  of  even  a  large  quan- 
tity ( 3  ij)  does  not  exceed  an  hour. 


ETHER.  593 

THEKAPT. — Before  it  is  administered,  ether  should  be  diluted  with 
alcohol,  which  renders  it  readily  miscible  with  water. 

A  few  drops  of  Hoffman's  anodyne  (TTJ,  x — TTJ,  xx)  in  some  camphor- 
water  is  an  excellent  remedy  to  expel  flatus  from  the  stomach.  Gas- 
tralgia  may  often  be  quickly  relieved  by  the  same  means.  A  few 
drops  of  ether,  added  to  cod-liver  oil,  enable  the  stomach  to  bear  it 
more  easily,  and,  it  is  said,  favors  its  digestion  ;  that  it  accomplishes 
this  object  by  increasing  the  pancreatic  juice,  is  the  observation  of 
Claude  Bernard.  Paroxysms  of  hepatic  colic  are  sometimes  treated  by 
the  internal  administration  of  ether,  but  this  treatment  is  by  no  means 
equal  in  effectiveness  to  the  inhalation  of  the  vapor.  Ether  mixed 
with  turpentine  has  the  power  to  dissolve  hepatic  calculi,  hence  the 
remedy  of  Durande.  As  Trousseau  well  remarks,  chemical  results 
which  take  place  in  the  laboratory  are  not  reproduced  in  the  body 
with  equal  facility.  The  rapidity  with  which  ether  diffuses  into  the 
blood  at  the  temperature  of  the  stomach  would  appear  to  preclude  the 
possibility  of  its  exerting  any  solvent  action  on  a  calculus  fixed  in  an 
hepatic  duct.  Whatever  good  result  is  secured  by  the  administration 
of  the  remedy  of  Durande  must  be  ascribed  to  the  anodyne  and  anti- 
spasmodic  action  of  its  constituents. 

Sudden  failure  of  the  heart's  action  (syncope),  from  mental  emo- 
tion or  hysteria,  is  most  promptly  remedied  by  the  administration  of 
Hoffman's  anodyne.  Mild  attacks  of  angina  pectoris,  and  of  spas- 
modic asthma,  may  sometimes  be  aborted  by  a  full  dose  of  the  ethe- 
real preparations.  The  subcutaneous  injection  of  ether  is  very  effec- 
tive in  sudden  cardiac  depression. 

Nervous  or  hysterical  sick-headache  is  quickly  cured  by  3  ss  doses 
of  spirit  of  ether.  The  most  important  application  of  these  ethereal 
remedies  is  in  the  treatment  of  the  hysterical  paroxysms.  As  the  ac- 
tion is  prompt  and  quickly  expended,  it  is  obvious  that  ether  or  Hoff- 
man's drops  are  only  adapted  to  sudden  hysterical  seizures,  and  not  to 
more  lasting  nervous  symptoms  arising  in  an  hysterical  constitution. 
Nothing  can  be  more  satisfactory  than  the  prompt  relief  by  these 
agents  of  hysterical  flatulence,  globus  hystericus,  and  hystero-epilepsy. 
Ijl  Spts.  etheris  composit.,  tinct.  valerian,  ammon.,  aa  §  j.  M.  Sig.  : 
A.  teaspoonful  in  water  every  fifteen  minutes  until  relieved. 

As  a  cardiac  stimulant  in  fevers,  the  ethereal  preparations  are  oc- 
casionally prescribed.  For  a  quick  effect,  in  an  emergency  of  practice, 
they  are  useful,  but  are  not  equal  to  spirits  and  wine  when  a  sustained 
effect  is  required. 

Nitrous  ether  is  employed  in  domestic  practice  as  a  mild  diapho- 
retic, a  diuretic,  and  carminative.  It  no  longer  occupies  the  place  it 
formerly  held  in  medical  practice,  but  it  is  occasionally  prescribed  in 
feverishness,  as  a  constituent  in  expectorant  mixtures,  in  combination 
with  diuretic  medicines,  etc. 
40 


594  CEREBRAL  SEDATIVES. 

ETHER  BY  THE  HYPODERMATIC  METHOD. — Within  the  past  few 
years,  the  subcutaneous  injection  of  ether  has  taken  an  important  posi- 
tion in  therapeutics.  It  is  necessary,  therefore,  to  enter  into  this  sub- 
ject fully. 

When  ether  is  injected  beneath  the  skin,  more  or  less  burnitg  pain 
is  felt  at  the  point  of  insertion,  and  a  puffy  swelling  is  produced.  In 
most  subjects  this  swelling  subsides  in  an  hour  or  two,  and  no  trace  is 
left  of  the  operation.  In  some  instances,  an  induration,  the  size  of  a 
filbert,  forms,  and  slowly  disappears.  Very  rarely  inflammation  is  set 
up  about  the  site  of  the  injection,  and  followed  by  suppuration,  with 
more  or  less  sloughing.  If  not  too  large  an  amount,  suddenly  and  vio- 
lently injected,  is  used,  there  will  be  no  untoward  results. 

The  effects  of  ether  subcutaneously  are  the  same  in  kind  as,  but 
more  powerful  in  degree  than,  those  produced  by  the  stomachal  admin- 
istration. A  local  anaesthetic  impression  is  made  ;  in  a  few  seconds, 
the  action  of  the  heart  is  powerfully  increased,  and  soon  the  usual  cere- 
bral effects  are  manifest. 

Ether  was  first  employed  subcutaneously  by  Dr.  Comegys,  of  Cin. 
cinnati,  in  the  treatment  of  sciatica.  He  injected  from  fifteen  minims 
to  a  half-drachm,  in  the  neighborhood  of  the  affected  nerve.  This 
practice  has  been  followed  by  others  with  success,  and  is  now  more  or 
less  widely  used  as  a  substitute  for  "  the  deep  injection  of  chloroform.'* 
It  is  very  desirable  to  have  some  exact  observations  which  will  deter- 
mine the  comparative  value  of  these  expedients. 

The  most  important  applications  of  ether,  hypodermatically,  are  as 
a  cardiac  stimulant  in  the  case  of  sudden  and  extreme  depression  of 
the  heart,  and  as  a  general  stimulant  in  adynamic  states.  In  the  de- 
pression caused  by  haemorrhage,  whether  pulmonary  or  post  partum, 
the  injection  of  ether  may  obviate  the  necessity  for  transfusion.  This 
practice  is  strongly  urged  by  Peter,  Fe"reol,  and  Mile.  Ocoumkoff,  who 
report  cases  in  confirmation.  Remarkable  results  have  been  effected 
by  the  subcutaneous  injection  of  ether  in  adynamic  pneumonia  (ty- 
phoid pneumonia),  as  practiced  by  M.  Barth.  Thus,  of  fourteen  cases 
of  severe  type  treated  by  these  injections,  eleven  were  cured.  The 
quantity  injected  was  about  fifteen  to  twenty  minims  two,  three,  or 
four  times  a  day,  according  to  the  degree  of  adynamia.  The  effects 
which  follow  almost  immediately  are  these  :  the  respiration  becomes 
more  easy,  the  pulse  takes  on  more  strength  and  volume,  the  tongue 
moistens,  and  the  countenance  assumes  a  better  appearance.  In  from 
two  to  three  minutes  after  the  injection  has  been  practiced,  the  odor 
of  ether  is  recognizable  in  the  breath  (Barth). 

In  the  eruptive  fevers,  especially  in  variola,  the  injections  of  ether 
have  been  used  with  admirable  results  (Castel).  It  is  in  a  high  degree 
probable  that  the  same  treatment  will  prove  very  useful  in  low  forms 
of  septic  and  inflammatory  diseases  in  general.  There  can  scarcely 


CHLOROFORM.  595 

be  any  doubt  that  we  have  in  this  method  a  most  useful  addition  to 
our  therapeutical  resources. 

In  place  of  ether,  hydrobromic  ether  has  been  utilized  in  the  treat- 
ment by  the  subcutaneous  method  of  various  spasmodic  diseases,  as 
whooping-cough,  chorea,  asthma,  and  similar  affections. 

Chloroformum. — Chloroform.  Chloroforme,  Fr. ;  Chloroform,  Ger. 
A  liquid  containing  at  least  99  per  cent  by  weight  of  absolute  chloro- 
form and  not  more  than  1  per  cent  of  alcohol.  Its  specific  gravity 
should  not  be  lower  than  1*490.  A  heavy,  clear,  colorless,  diffusive 
liquid,  of  a  characteristic  pleasant  ethereal  odor,  a  burning,  sweet 
taste,  and  a  neutral  reaction.  Soluble  in  about  two  hundred  parts  of 
water,  and  in  all  proportions  in  alcohol  or  ether  ;  also  in  benzol,  ben- 
zin,  fixed  or  volatile  oils. 

If  five  cubic  centimetres  of  purified  chloroform  be  thoroughly  agi- 
tated with  ten  cubic  centimetres  of  distilled  water,  the  latter,  when 
separated,  should  not  affect  blue  litmus-paper  (absence  of  acids),  nor 
test-solution  of  nitrate  of  silver  (chloride),  nor  test-solution  of  iodide 
of  potassium  (free  chlorine).  If  a  portion  be  digested  warm  with  solu-. 
tion  of  potassa,  the  latter  should  not  become  dark-colored  (absence  of 
aldehyde).  If  a  few  cubic  centimetres  be  permitted  to  evaporate  from 
blotting-paper,  no  foreign  odor  should  be  perceptible  after  the  odor  of 
chloroform  ceases  to  be  recognized.  (U.  S.  P.) 

When  shaken  with  an  equal  volume  of  sulphuric  acid,  in  a  bottle 
closed  by  a  glass  stopper,  and  allowed  to  remain  in  contact  twenty- 
four  hours,  no  color  is  imparted  to  either.  When  one  fluid  drachm  is 
evaporated  spontaneously  with  one  drop  of  a  neutral,  aqueous  solution 
of  litmus,  the  color  of  the  latter  is  not  reddened.  The  result  of  the 
test  is  the  same  if  the  chloroform  contained  in  a  white  glass  bottle  has 
been  previously  exposed  to  direct  sunlight  for  ten  hours. 

Emulsum  Chloroformi. — Chloroform  mixture.  Purified  chloroform, 
40  c.  c. ;  expressed  oil  of  almond,  60  c.  c. ;  tragacanth,  15  grm. ;  water, 
to  make  1,000  c.  c.  M.  Dose,  a  tea-  to  a  tablespoonful. 

Spirits  Chloroformi. — Spirit  of  chloroform.  Purified  chloroform, 
60  c.  c. ;  alcohol,  940  c.  c.  Dose,  3  ss —  3  j. 

Aqua  Chloroformi. — A  saturated  solution  of  chloroform  in  water. 
Dose,  3  ss —  |  ss. 

ANTAGONISTS  AND  IxcoMPATiBLES. — Chloroform  separates  from  the 
mixture  when  prescribed  with  weak  spirits  or  glycerin.  It  is  soluble 
in  alcohol  (ten  to  six),  in  ether  (one  to  seven),  in  water  (one  to  two 
hundred).  It  dissolves  very  freely  in  olive-oil  and  turpentine,  but  does 
not  dissolve  in  or  mix  with  glycerin.  It  has  very  extensive  solvent 
power,  dissolving  caoutchouc,  gutta-percha,  mastic,  tolu,  benzoin,  co- 
pal, among  the  gums  ;  iodine,  bromine,  the  organic  alkaloids  ;  fixed 
and  volatile  oils,  resins,  and  fats.  In  cases  of  poisoning  by  the  inter- 


596  CEREBRAL   SEDATIVES. 

nal  administration  of  chloroform,  the  treatment  should  be  conducted 
on  the  same  plan  as  for  irritant  poisons.  There  is  no  chemical  anti- 
dote. To  overcome  its  effects  on  the  respiratory  and  circulatory  sys- 
tems, artificial  respiration,  cold  affusion,  and  galvanism,  may  be  em- 
ployed. 

SYXERGISTS. — Anaesthetic  agents,  opium,  chloral,  alcohol,  etc.,  pro- 
mote the  action  of  chloroform. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  chloroform  is  hot,  sweetish, 
and  pungent.  Undiluted  it  excites  violent  irritation  and  inflammation 
of  the  mucous  membrane.  In  passing  through  the  fauces  the  vapor 
may  enter  the  larynx  in  such  quantity  as  to  cause  great  heat  and  in- 
flammation, followed  by  oedema.  In  the  stomach,  chloroform  produces 
a  feeling  of  warmth,  followed  by  coldness,  like  ether  ;  but,  when  taken 
in  large  quantity  undiluted,  violent  gastritis.  Besides  the  local  action, 
chloroform  diffuses  into  the  blood,  and  affects  distant  parts.  Like 
alcohol  and  ether,  it  increases  the  action  of  the  arterial  system,  and 
occasions  excitement  of  the  brain,  followed  by  sopor.  In  lethal  doses 
profound  stupor  and  insensibility  are  produced  by  it. 

THERAPY. — A  little  chloroform  (TH,  ij — TTJ,  v),  dropped  on  sugar  and 
swallowed,  will  remove  some  kinds  of  nausea  and  vomiting.  It  can 
be  useful  in  non-inflammatory  states  only,  as,  for  example,  sea-sickness, 
the  vomiting  of  pregnancy,  sick-headache,  etc.  Gastralgia  may  some- 
times be  relieved  in  the  same  way.  The  following  formula  is  an  effec-" 
tive  remedy  for  flatulent  colic :  $  Spirit,  chlorof ormi,  tine,  carda- 
momi  comp.,  aa  |  ij.  M.  Sig.  :  A  teaspoonful  every  half-hour  in 
water.  Hepatic  and  saturnine  colic  are  also  benefited  by  chloroform, 
but  the  addition  of  opium  increases  its  efficacy,  and  is  usually  neces- 
sary in  these  cases.  Chloroform  is  a  solvent  of  biliary  calculi,  and 
has  been  prescribed  with  the  view  to  effect  a  solution  of  calculi  con- 
tained in  the  gall-bladder,  or  lodged  in  the  hepatic  duct.  It  undoubt- 
edly affords  some  relief,  but  not  probably  because  of  its  solvent 
action.  As  has  been  remarked  of  ether,  it  is  in  the  highest  degree 
improbable  that  sufficient  chloroform,  even  when  it  is  administered  in 
large  doses,  can  reach,  the  calculus  to  effect  its  solution,  when  experi- 
ments out  of  the  body  have  shown  that  some  hours  are  required  to 
dissolve  a  calculus  immersed  in  chloroform.  In  irritable  ulcer  of  the 
rectum,  and  itching  about  the  anal  region,  an  ointment  of  chloroform 
gives  great  relief  :  IJ  Ung.  zinci  oxidi,  3  j  ;  chlorof  ormi,  3  j.  M.  Ft. 
ung.  The  vapor  of  chloroform  may  be  applied  directly  to  these  parts. 

In  hay-asthma,  whooping-cough,  spasmodic  asthma,  irritable  reflex 
cough,  the  vapor  of  chloroform  may  be  used  as  follows  :  To  a  cup  of 
warm  water,  80°  to  100°  Fahr.,  add  a  teaspoonful  of  spiritus  chloro- 
formi,  and  repeat  every  five  minutes.  This  inhalation  should  not  be 
used  except  in  the  presence  of  a  medical  man,  and  not  more  than  five 
teaspoonfuls  should  be  inhaled  at  a  time.  The  patient  should  inhale 


CHLOROFORM.  597 

the  vapors  as  they  arise,  directing  them  into  the  air-passages  from  the 
cup  by  a  paper  shield.  A  little  chloroform  (a  minim  or  two)  is  a  use- 
ful constituent  of  expectorant  mixtures,  when  a  neurotic  element  is 
present. 

Chloroform  is  a  very  valuable  hypnotic  in  delirium,  tremens.  It  is 
unsafe  when  used  by  inhalation  in  the  treatment  of  this  affection,  but, 
by  the  stomach,  not  unfrequently  excellent  results  are  obtained  from 
it.  It  is  contraindicated  when  there  are  a  vigorous  action  of  the  heart 
and  an  elevated  state  of  the  arterial  tension,  and  useful  when  symp- 
toms of  depression  and  adynamia  are  present.  It  should  be  given  in 
the  form  of  the  spirit.  $  Spirit,  chlorof ormi,  tinct.  capsici,  aa  f  j.  M. 
Sig.  :  A  teaspoonful  in  water  every  half-hour,  hour,  or  two  hours. 

Neuralgia. — Chloroform  is  extremely  valuable  in  the  treatment  of 
this  disease,  and  it  is  the  most  effective  when  used  by  the  method  of 
"  deep  injection,"  first  proposed  by  the  author.  This  plan  of  treat- 
ment consists  in  the  injection  deeply,  in  the  neighborhood  of  the 
affected  nerve,  of  five  to  fifteen  minims  of  pure  chloroform.  The  offi- 
cial spirit  of  chloroform,  ether,  or  even  alcohol,  may  be  used  for  this 
purpose.  The  first  named,  in  the  quantity  of  fifteen  minims,  is  prob- 
ably the  best.  Rarely  does  any  local  mischief  result  from  these  in- 
jections, except  a  temporary  induration.  The  author  has  procured  by 
this  means  apparently  permanent  relief  to  long-standing  cases  of  neu- 
ralgic pain  (tic-douloureux)  affecting  the  superficial  divisions  of  the 
fifth.  Other  practitioners  have  been  equally  successful,  and  the  cases 
thus  treated  now  include  neuralgic  affections  of  the  most  important 
nerves. 

Pain  in  superficial  nerves  may  sometimes  be  relieved  by  the  local 
application  of  chloroform.  I£  Chloroformi,  tinct.  aconiti  rad.,  aa  f  ss  ; 
liniment,  saponis,  f  j.  M.  Sig.  :  Liniment.  A  piece  of  flannel,  moist- 
ened with  this,  is  applied  to  the  painful  part,  evaporation  being  pre- 
vented by  a  covering  of  oiled  silk. 

An  impending  paroxysm  of  intermittent  may  be  prevented  by 
a  full  dose  of  chloroform  (  3  j  —  3  ij)  administered  before  the  onset 
of  the  chill.  The  inhalation  of  chloroform  is  used  for  the  same 
purpose. 

A  few  drops  of  chloroform,  frequently  repeated,  is  an  excellent 
means  of  relief  in  cholera.  It  allays  nausea  and  vomiting,  arrests 
diarrhoea,  relieves  the  cramps,  and  restores  the  temperature.  It  may 
be  given  in  the  form  of  spiritus  chloroformi,  or  of  chlorodyne,  a  very 
celebrated  empirical  remedy.  No  single  remedy  has  been  more  effica- 
cious than  chlorodyne  in  the  treatment  of  true  cholera. 

It  has  been  stated  lately  that  chloroform  has  a  curative  effect  in 
tape-worm.  The  following  formula  has  been  successful :  $  Chloro- 
formi, 3  j  ;  crotoni  olei,  mj  ;  glycerini,  §  j.  M.  Take  as  a  draught 
(Persh.) 


598  CEREBRAL  SEDATIVES. 

Chloroform  as  a  Counter-irritant. — When  chloroform  is  applied  to 
the  skin  and  evaporation  prevented,  it  causes  heat,  redness,  and  even 
vesication.  Frequently,  chloroform  is  used  locally  to  produce  this 
effect,  but  usually  in  combination  with  other  counter-irritants.  $ 
Chloroformi,  ol.  terebinthinae,  aa  f  j  ;  lin.  saponis,  §  ij.  M.  Sig.  : 
Liniment.  IjE,  Chloroformi,  lin.  camphorae,  aa  f  j.  M.  Sig.  :  Lini- 
ment. These  are  elegant  counter-irritant  applications,  in  cases  requir- 
ing the  milder  remedies  of  this  class,  and  are  used  in  various  internal 
inflammations  and  local  affections  characterized  by  pain.  Commercial 
chloroform  can  be  used  in  preparing  them. 

Chloroclyne. — This  empirical  preparation  is  largely  used  in  cholera, 
find  in  painful  diseases  requiring  an  anodyne.  Numerous  formulae  have 
been  published,  but  none  of  them  appear  to  possess  the  exact  qualities 
of  the  original  preparation  by  Dr.  J.  C.  Browne.  The  dose  of  the 
genuine  chlorodyne  ranges  from  ten  to  thirty  drops.  The  following 
formula  makes  a  product  more  nearly  resembling  the  original  than  any 
other  known  to  the  author  : 

Chloroform 4  ounces. 

Ether 1  ounce. 

Alcohol 4  ounces. 

Treacle 4  ounces. 

Extract  of  licorice 2^  ounces. 

Muriate  of  morphine 8  grains. 

Oil  of  peppermint 16  minims. 

Sirup ITi  ounces. 

Acid,  hydrocyan.  dil 2  ounces. 

Dissolve  the  muriate  of  morphine  and  the  oil  of  peppermint  in  the 
alcohol,  mix  the  chloroform  and  ether  with  this  solution,  dissolve  the 
extract  of  licorice  in  the  sirup,  and  add  the  treacle  ;  shake  these  two 
solutions  together,  and  add  the  hydrocyanic  acid.  Dose,  five  to  fifteen 
minims. 

Some  of  the  published  formula  contain  resin  of  cannabis  Indica, 
atropine,  perchloric  acid,  in  addition  to  the  ingredients  above  given. 

Another  chlorodyne,  known  as  "  Oilman's,"  has  many  advantages, 
and  is  now  widely  used.  Its  composition  is  as  follows  :  $  Chloro- 
formi purificati,  3  ij ;  glycerini,  f  ij ;  spts.  vini  rect.,  §  ij ;  acid,  hydro- 
canic.  dil.,  3  ij ;  tinct.  capsici,  3  ij  ;  morphinae  muriatis,  gr.  viij  ;  syrupi 
(treacle),  f  iij.  M.  The  dose  of  this  chlorodyne  for  an  adult  is  a  teaspoon- 
ful.  In  prescribing  the  various  mixtures  known  by  the  common  name — 
chlorodyne — the  strength  should  be  ascertained  before  administering. 

The  following  formulae  (Fox)  are  very  efficacious  in  the  local  affec- 
tions for  which  they  are  recommended  : 

IJ,  Chloroformi,  ff[  vj  ;  cucumber  cerate,  f  j.  M.  Sig.  :  Ointment 
for  pruritus.  $  Plumbi  carbonat.,  3  ss  ;  chloroformi,  TTI  iv  ;  ung. 
aquae  rosae,  §  j.  M.  Sig.  :  Ointment  for  pruritus.  R  Chloroformi, 


ANAESTHETICS.  599 

m,  viij  ;  glycerin.,  3  j  J  ung.  simplicis,  3  vj  ;  potassii  cyanidi,  grs.  iv. 
M.  Sig. :  Ointment  for  pruritus.  Tfr  Morphinae  acetat.,  1  part ;  chlo- 
roform, 8  parts  ;  lard,  60  parts  ;  oil  of  sweet  almonds,  40  parts.  M. 
An  ointment  to  be  applied  several  times  a  day  in  pruritus  pudendi. 

Authorities  referred  to  : 

BARTHOLOW,  DR.  ROBERTS.  On  the  Deep  Injection  of  Chloroform  for  the  Relief  of  Tie- 
Douloureux.  The  Practitioner,  July,  1874,  p.  9. 

FOURNIKR,  DR.  H.     Annuaire  de  Therapeutique,  1879,  pp.  68-70. 

FEREOL,  DR.  Injection*  Sous-cutanees  de  Chloroforme.  Annuaire  de  Therapeutique, 
1879,  p.  68. 

GUBLER,  DR.  ADOLPH.    Commentaires  Therapeutique  du  Codex  Medicamentarius,  p.  670. 

HUSEMANN,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
1869. 

TROUSSEAU  ET  PIDOUX.     Traite  de  Therapeutique  et  Matiere  Medicale,  eighth  edition. 

ANAESTHETICS  AND  ANAESTHESIA. 

-ffither  Fortior. — The  stronger  ether. 

Chloroformum  Purificatum. — Purified  chloroform. 

Neither  of  these  anaesthetics  should  be  used  until  its  conformity  to 
the  standard  of  the  United  States  Pharmacopoeia  has  been  ascertained. 
The  tests  of  purity  are  given  under  their  respective  heads  in  the  pre- 
ceding article. 

The  term  anaesthetic,  proposed  by  Dr.  Oliver  Wendell  Holmes, 
means  an  agent  capable  of  producing  anaesthesia,  or  insensibility  to 
pain.  It  is  true,  anaesthesia  is  a  term  which,  according  to  its  etymo- 
logical signification,  should  be  applied  to  loss  of  sensation  of  touch, 
chiefly,  and  analgesia  should  be  used  to  signify  loss  of  the  sense  of 
pain  ;  but  the  word  anaesthesia,  as  expressive  of  the  state  of  profound 
unconsciousness  induced  by  anaesthetics,  is  now  so  firmly  established 
by  usage  that  it  were  better  to  retain  it.  Insensibility  to  pain  (anal- 
gesia) may  be  produced,  without  simultaneous  loss  of  common  sensation, 
touch  (anaesthesia).  By  the  inhalation  of  ether,  chloroform,  bichloride 
of  methylene,  nitrous  oxide,  and  some  other  agents,  the  functions  of 
animal  life  can  be  so  far  suspended  that  surgical  operations  involving 
intense  pain,  and  certain  natural  processes,  accompanied  by  great  suf- 
fering, can  be  performed  entirely  without  the  consciousness  of  the 
subject  concerned. 

PHYSIOLOGICAL  ACTIONS. — When  the  vapor  of  ether  or  chloroform 
is  inhaled,  a  sense  of  faucial  irritation  and  of  the  need  of  air  is  expe- 
rienced, and  more  or  less  cough  is  produced.  The  irritation  of  the 
fauces  excites  the  flow  of  mucus,  and  the  reflex  act  of  swallowing. 
The  feeling  of  need  of  air  causes  the  patient  to  push  aside  the  inhaler 
or  sponge,  and  in  children  may  lead  to  violent  struggling.  The  sensi- 
bility of  the  glottis  is  soon  diminished,  the  coughing  ceases,  and  the 
inhalation  then  proceeds  quietly. 


600  CEREBRAL   SEDATIVES. 

The  first  effect  is  a  general  exhilaration,  the  pulse  increases  in  fre- 
quency, the  respirations  become  more  rapid,  and  sometimes  assume  a 
sobbing  or  convulsive  character  ;  the  face  flushes  ;  talking,  laughing^ 
crying,  singing,  and  sometimes  praying,  indicate  the  cerebral  intoxica- 
tion. This  stage  of  excitement  varies  in  duration  in  different  indi- 
viduals, and  is  more  pronounced  in  character  and  more  persistent  in 
those  of  mercurial  disposition,  and  in  the  hysterical.  At  this  period, 
although  the  patient  can  be  easily  aroused,  sensibility  to  pain  is  de- 
cidedly diminished  ;  although  the  sense  of  touch  may  be  preserved, 
taste  and  smell  are  abolished,  and  the  sight  is  either  abnormally  acute 
or  is  perverted  by  illusions.  If  the  inhalation  be  continued,  the  patient 
passes  into  the  condition  of  complete  insensibility.  In  women  and 
children,  and  males  reduced  by  illness,  the  production  of  insensibility, 
if  the  anaesthetic  be  not  inhaled  too  rapidly,  takes  place  quietly  ;  but, 
if  the  subject  be  a  robust  male,  in  full  health,  especially  if  the  inhala- 
tion has  been  proceeded  with  rapidly,  the  stage  of  insensibility  is  pre- 
ceded by  a  tetanic  convulsive  stage,  in  which  the  voluntary  muscular 
system  and  the  respiratory  muscles  become  rigid,  the  breathing  ster- 
torous, the  face  cyanosed.  This  condition  of  rigidity  is  similar  to,  if 
not  identical  with,  the  tetanic  stage  of  the  epileptic  paroxysm.  If  the 
inhalation  of  the  anaesthetic  be  pushed  still  further,  the  tetanic  rigidity 
subsides,  the  cyanosis  disappears,  the  breathing  proceeds  quietly,  and 
a  condition  of  complete  muscular  relaxation,  and  of  abolition  of  reflex 
movements,  is  established.  "When  this  is  accomplished,  the  arm  drop& 
without  resistance  when  let  fall,  the  conjunctiva  is  insensible  to  irri- 
tation, the  pupils  do  not  alter  in  size  when  exposed  to  light,  and  no 
mechanical  irritation  awakens  the  least  consciousness  of  pain.  The 
surface  is  cool,  and  bathed  with  abundant  perspiration,  the  counte- 
nance is  placid,  the  eyes  closed,  the  pupils  rather  contracted  than  di- 
lated ;  the  respiration  easy,  but  more  shallow  than  normal ;  the  pulse 
slower — it  may  be  feebler,  it  may  be  stronger  than  in  health.  The 
functions  of  the  cerebrum  are  suspended  ;  only  the  lower  centers,  pre- 
siding over  respiration  and  circulation,  continue  in  action.  Out  of  this 
condition,  and  without  interference,  the  patient  will  presently  emerge. 
If,  however,  the  inhalation  be  continued,  these  organic  functions  will 
be  suspended,  and  life  will  be  terminated  by  the  cessation  of  the  action 
of  the  heart  and  of  the  respiratory  organs. 

There  are  several  modes  of  dying  from  anaesthetic  vapors  : 
1.  By  the  first  mode,  the  death  is  sudden  and  occurs  very  soon 
after  the  inhalation  has  begun,  and  is  ascribed  to  "  irritation  of  the 
peripheral  nervous  system,  accumulation  of  carbonic  acid  in  the  blood, 
and  arrest  of  the  action  of  the  heart."  This  explanation,  the  author 
submits  with  diffidence,  seems  very  unsatisfactory,  for  phenomena  of 
this  kind,  up  to  the  point  of  cardiac  paralysis,  must  ensue  in  all  cases 
of  chloroform  narcosis.  The  sudden  death,  at  the  beginning  of  inha- 


ANAESTHETICS.  601 

lation,  seems  to  be  more  properly  explicable  on  the  theory  that  the 
first  chloroform  vapor  which  reaches  them  paralyzes  the  cardiac  gan- 
glia, already  in  an  abnormal  state  of  susceptibility  from  causes  not 
now  understood,  for  this  accident  sometimes  occurs  in  persons  who 
have  previously  taken  the  anaesthetic  without  unfavorable  symptoms 
of  any  kind. 

2.  By  the  second  mode,  called  by  Richardson  epileptiform  syncope, 
death  ensues  in  the  stage  of  rigidity  preceding  complete  muscular 
relaxation,  and  is  due  to  tetanic  fixation  of  the  respiratory  muscles, 
and   consequent   interference  with   the   pulmonary  circulation,  accu- 
mulation of  blood  on  the  venous  side,  and  arrest  of  the  heart's  action. 
In  these  cases  respiration  ceases  before  the  pulsations  of  the  heart 
cease. 

3.  By  paralysis  of  the  respiratory  muscles.     Death  ensues  during 
the  stage  of  complete  muscular  relaxation,  and  the  action  of  the  heart 
continues  for  some  seconds,  or  even  minutes,  after  respiration  has 
ceased. 

4.  By  paralysis  of  the  heart.     This  also  occurs  in  the  course  of 
complete  insensibility  ;  the  motor  ganglia  are  paralyzed,  and  the  heart 
suddenly  ceases  to  act,  the  respiration  continuing  for  a  short  time 
longer. 

5.  This  mode  of  dying  is  made  up  of  two  factors  :  depression  of 
the  functions  by  chloroform  narcosis,  and  the  shock  of  the  accident, 
or  the  surgical  operation.     Death  may  ensue  during  the  inhalation, 
or  may  occur  afterward. 

CONDITIONS  OF  THE  ORGANISM  RENDERING  THE  USE  OF  ANAES- 
THETICS DANGEROUS. — Experience  has  demonstrated  that  old  drunk- 
ards are  peculiarly  unfavorable  subjects.  When  tumor  or  abscess  of' 
the  brain  exists,  it  is  dangerous  to  administer  anaesthetics.  Instances, 
of  sudden  death  under  these  circumstances  are  relatively  numerous. 
Very  much  enlarged  tonsils,  swollen  epiglottis,  oedema  of  the  glottis, 
are  contraindications,  but  not  insuperable,  to  the  use  of  anaesthetics. 
Emphysema  of  the  lungs  is  so  frequently  accompanied  by  ischasmia, 
of  the  arterial,  and  engorgement  of  the  venous  side  of  the  systemic 
circulation,  and  with  dilatation  of  the  right  cavities,  that  it  must  be 
considered  a  dangerous  state  in  which  to  administer  chloroform,  or 
even  ether.  Fatty  change  in  the  muscular  substance  of  the  heart 
must  be  considered  peculiarly  unfavorable,  for  more  deaths  have  en- 
sued from  this  cause  than  any  other. 

Chloroform  and  ether  have  been  administered  with  safety  in  cases 
of  phthisis  and  heart-disease  (valvular  lesions),  the  muscular  substance 
and  its  contained  ganglia  being  free  from  structural  change. 

Experience  has  abundantly  demonstrated  that  those  reduced  by 
illness  and  disease,  and  the  feeble,  bear  anaesthetics  better  than  the 
healthy  and  robust ;  that  children  and  women  are  better  subjects  than 


(502  CEREBRAL  SEDATIVES. 

adults  and  men  ;  that  anaesthetics  are  safer  when  given  for  operations 
for  disease  than  for  injury. 

Incomplete  anaesthesia  is  a  condition  of  danger.  Numerous  acci- 
dents have  occurred  from  the  use  of  anaesthetics  for  trivial  operations 
— notably  for  extraction  of  teeth — in  which  but  a  partial  degree  of 
insensibility  is  induced.  In  such  cases  the  heart,  enfeebled  by  chloro- 
form narcosis,  is  suddenly  paralyzed  by  the  reflex  action  proceeding 
from  the  peripheral  injury.  The  district  of  tissue  supplied  by  the 
fifth  nerve  is  an  especially  dangerous  region,  owing  doubtless  to  the 
intimate  connection  of  the  nucleus  of  the  fifth  with  the  nucleus  of  the 
pneumogastric.  By  far  the  largest  number  of  fatal  cases  have  resulted 
from  a  neglect  of  this  rule  :  it  is  never  safe  to  proceed  in  a  surgical 
operation  with  anaesthetics,  unless  complete  insensibility  has  been  pro- 
duced. The  author  is  aware  that  Trousseau  and  Pidoux  have  attrib- 
uted the  number  of  cases  of  fatal  chloroform  narcosis,  which  have 
occurred  in  England,  to  the  fact  that  the  just-mentioned  rule  is  ad- 
hered to  by  English  surgeons.  Their  words  are  as  follows  :  "  En 
Angleterre,  les  cfiirurgiens  portent  V etherisation  jusqu'd  ?  abolition  de 
toutes  les  facultes  animates,  jusqu'au  commencement  de  la  periode 
d'etherisme  organique.  Plus  prudents  sous  ce  rapport  que  leurs  con- 
freres de  la  Grande- Bretagne,  les  chirurgiens  francais  ont  V habitude 
de  s'arreter  des  que  la  sensibilite  aux  excitations  de  la  peau  est  abolie 
et  que  la  resolution  musculaire  commence.  Cette  prudence  explique 
comment  les  chirurgiens  francais  ont  eprouve  mains  d' accidents  graves 
et  compte  moins  de  morts  subites"  (Vol.  ii,  p.  322.) 

MODES  OF  CONDUCTING  THE  INHALATION. — After  ascertaining  that 
none  of  the  contraindications  mentioned  above  exist,  the  patient  may 
be  prepared  for  the  inhalation  of  the  anesthetic  vapor.  The  inhala- 
tion should  not  be  proceeded  with  soon  after  a  full  meal.  Vomiting, 
as  the  narcosis  subsides,  is  usual,  and,  as  the  insensibility  of  the  glottis 
persists  for  some  time  afterward,  particles  of  food  may  be  lodged  in 
the  chink,  causing  fatal  suffocation.  Several  cases  of  this  kind  have 
been  reported.  On  the  other  hand,  it  is  bad  practice  to  administer 
an  anaesthetic  after  a  prolonged  period  of  fasting,  for  the  exhaustion 
thereby  induced  may  be  an  influential  factor  in  determining  a  fatal 
result.  Before  the  inhalation  is  begun,  it  is  proper  to  administer  an 
ounce  or  two  of  whisky  or  brandy.  Much  more  important  is  the  ex- 
pedient proposed  by  Bernard  and  afterward  by  Nussbaum,  to  premise 
a  subcutaneous  injection  of  morphine.  Bernard  proposed  to  administer 
the  morphine  before  beginning  the  inhalation  ;  whereas  Nussbaum 
used  it  after  unconsciousness  to  pain  had  been  produced.  The  ad- 
vantages of  the  former  method  are  obvious.  When  the  morphine 
influence  takes  place,  the  inhalation  will  proceed  quietly  without  the 
struggling  and  coughing,  and  spasmodic  breathing,  which  so  interfere 
with  the  administration  of  anaesthetics,  especially  of  ether.  The  use 


ANAESTHETICS.  603 

of  morphine  subcutaneously  also  lessens  materially,  if  not  prevents 
entirely,  the  stage  of  rigidity  and  spasm.  The  quantity  of  the  anaes- 
thetic required  is  much  less,  and  the  stage  of  insensibility  more  pro- 
longed, when  morphine  is  thus  given. 

Besides  the  foregoing  conspicuous  advantages  derived  from  the 
preliminary  subcutaneous  injection  of  morphine,  there  can  be  no  doubt 
that  this  agent  antagonizes  the  paralyzing  action  of  the  anaesthetic  on 
the  cardiac  and  respiratory  centers,  and  prevents  the  subsequent  shock 
due  to  the  administration  of  the  anaesthetic  and  the  performance  of  a 
surgical  operation. 

The  proposal  of  Bernard,  as  subsequently  advocated  by  Nussbaum, 
was  some  time  afterward  strongly  urged  by  the  late  Prof.  William 
Warren  Greene,  M.  D.,  of  Pittsfield,  Massachusetts,  and  Dr.  J.  C. 
Reeve,  of  Dayton,  Ohio.  Soon  after  the  publication  of  Bernard's 
observations,  the  author,  in  his  "Manual  of  Hypodermatic  Medica- 
tion," proposed  the  use  of  morphine  and  atropine  combined  as  more 
perfectly  realizing  the  object  contemplated.  Since  this  time,  at  Lyons, 
the  combination  of  morphine  and  atropine  has  been  largely  employed 
preliminary  to  ether  inhalation.  The  method  is  known  as  •"  anesthe- 
sies  mixtes,"  or,  anaesthesia  by  a  mixed  method  (Aubert).  The  addi- 
tion of  atropine  is  to  increase  the  forces  of  the  antagonism  against  the 
depression  of  the  cardiac  and  respiratory  functions.  The  experience 
of  the  Lyons  school  is  decidedly  in  favor  of  the  method  of  mixed  an- 
aesthesia. Adverse  reports  from  other  quarters,  however,  have  not 
been  wanting,  but  the  relevancy  of  their  facts  is  doubtful. 

When  the  anaesthetic  is  about  to  be  administered,  the  operator 
should,  by  a  cheerful  and  confident  manner,  remove  the  fears  of  the 
patient.  None  of  the  parapherna  of  the  operation  to  be  performed 
should  be  exhibited  before  the  patient,  and  no  remarks  should  be  made 
in  his  hearing  regarding  his  case,  the  anaesthetic  sleep,  or  the  surgical 
procedure.  Only  the  physician  having  the  administration  of  the  an- 
aesthetic in  charge,  and  the  necessary  assistants,  should  be  present  in 
the  apartment.  An  abundant  supply  of  fresh  air  should  be  insured 
to  the  patient,  and  all  the  appliances  required  for  resuscitation  should 
be  at  hand,  but  not  ostentatiously  paraded  before  the  patient. 

The  simplest  apparatus  only  is  required.  Complicated  inhalers 
have,  as  frequently  as  the  towel  or  the  handkerchief,  been  used  in 
fatal  cases  of  chloroform  narcosis.  A  cone  of  stiff  paper,  lined  with 
lint  or  felt,  and  large  enough  to  cover  the  nose  and  mouth  of  the 
patient,  is  the  best  form  of  inhaler  for  the  administration  of  ether. 
Lente's  ether-inhaler  consists  of  a  cone  of  hard  rubber  lined  with  felt, 
and  having  attached  to  the  apex  a  flexible  rubber  tube  communicating 
with  the  ether-bottle.  This  is  a  very  satisfactory  apparatus.  A  simi- 
lar but  much  less  complicated  and  expensive  inhaler  is  that  of  Dr.  Allis, 
of  Philadelphia.  The  utility  and  desirableness  of  this  apparatus  are 


604  CEREBRAL  SEDATIVES. 

much  commended  by  Prof.  William  Goodell.  "When  ether  is  inhaled, 
the  atmosphere  is,  as  far  as  possible,  excluded,  in  order  that  the  anaes- 
thetic effect  may  be  quickly  induced.  The  important  point  in  the 
administration  of  chloroform  is  to  secure  such  an  admixture  of  atmos- 
pheric air  as  that  the  amount  of  chloroform-vapor  shall  not  exceed 
three  and  a  half  per  cent.  If  this  rule  be  regarded,  the  form  of  in- 
haler is  of  little  importance.  The  original  method  of  Simpson  con- 
sisted in  applying  the  vapor  by  dropping  slowly  chloroform  on  a  piece 
of  thin  cloth  laid  over  the  mouth  and  nose,  or  by  a  linen  handkerchief 
moistened  with  half  a  drachm.  The  mouth  and  nose  should  be  pro- 
tected from  the  irritant  action  of  the  chloroform  by  inunction  with  oil. 

A  cone  made  of  a  towel,  having  a  large  opening  at  the  apex,  and 
containing  a  suitable,  very  porous  sponge,  is  now  probably  more  em- 
ployed than  any  other  form  of  inhaler  for  giving  chloroform.  The 
typical  method  for  administering  it  is  that  of  Snow  :  in  a  bag  of  suit- 
able size  the  vapor  of  chloroform  is  mixed  with  air  in  the  proper  pro- 
portion, and  then  given  directly  ;  but,  obviously,  such  an  arrangement 
is  not  often  available. 

In  administering  the  vapor  of  chloroform  by  any  of  the  modes  in 
use,  it  should  not  be  forgotten  that  it  has  a  density  and  weight  four 
times  those  of  air,  and  that,  consequently,  when  a  cloth  or  handker- 
chief is  held  closely  over  the  mouth,  the  air  is  displaced,  and  the  pa- 
tient may  be  breathing  little  more  than  chloroform-vapor.  During 
the  administration  of  ether,  attention  should  be  directed  to  the  state 
of  the  respiration,  for  arrest  of  the  respiratory  movements  is  the  only 
source  of  danger.  When  chloroform  is  being  inhaled,  the  state  of  the 
circulation,  as  well  as  of  the  respiratory  apparatus,  must  be  regarded. 

MEANS  OF  REMOVING  DANGEROUS  SYMPTOMS. — Suspension  of  the 
heart's  action  is  to  be  met  at  once  by  the  withdrawal  of  the  vapor, 
and  the  inversion  of  the  patient,  according  to  the  method  of  Nelaton ; 
failure  of  respiration,  by  forcibly  drawing  out  the  tongue,  by  the 
practice  of  artificial  respiration,  and  by  faradization  of  the  respiratory 
muscles.  Artificial  warmth  should  be  applied,  and  cooling  of  the  body 
by  cold-water  douche,  etc.,  should  be  prohibited.  Acupuncture  of  the 
heart,  galvano-puncture,  injection  of  ammonia  into  the  veins,  are  meas- 
ures which  have  been  used  in  extreme  cases,  but  unfortunately  rarely 
with  success.  Amyl  nitrite,  by  inhalation  or  subcutaneously,  has 
proved  very  useful  in  some  cases.  Schirmer  arouses  patients  by  irri- 
tating the  nasal  mucous  membrane  by  means  of  a  roll  of  paper  of  suit- 
able size,  and  this  may  be  made  more  exciting  by  dipping  the  end  in 
aqua  ammonia.  Alcoholic  stimulants — whisky  or  brandy — have  often 
been  used  hypodermatically  with  asserted  advantage.  At  the  present 
time  the  subcutaneous  injection  of  ether  is  the  popular  expedient.  It 
is,  however,  very  questionable  whether  the  administration  of  alcohol 
or  one  of  its  derivatives  can  be  useful  in  a  condition  of  things  brought 


ANJESTHETICS.  605 

about  by  an  anaesthetic  of  alcoholic  origin.  The  author  believes,  in- 
deed, that  serious  mischief  is  done  by  this  practice  in  cases  capable  of 
resuscitation. 

In  practicing  resuscitation  for  arrest  of  breathing  due  to  ether, 
artificial  respiration  by  the  method  of  Silvester,  faradization  of  the 
chest-muscles,  and  inversion  of  the  body  by  the  method  of  Nelaton, 
are  the  most  promising  expedients. 

THERAPY. — Anaesthetic  agents  are  used  to  quiet  pain  and  spasm 
from  disease,  to  render  the  dressing  of  injuries  and  surgical  operations 
painless,  and  to  produce  muscular  relaxation.  Ether-inhalations  give 
entire  relief  to  the  pain  of  neuralgia  (tic-douloureux),  cancer,  and  in- 
flammation ;  to  pain  dependent  on  spasms — tetanus,  chorea,  hepatic 
and  nephritic  colic,  etc.  It  is  not  necessary  in  these  cases,  as  a  rule, 
to  induce  full  anaesthesia,  for,  as  has  already  been  pointed  out,  the 
sensibility  to  pain  ceases  before  the  condition  of  insensibility  is  reached 
— before,  indeed,  the  perceptive  centers  of  conscious  impressions  are 
otherwise  impaired  than  as  to  the  appreciation  of  pain.  Paroxysms  of 
maniacal  delirium,  and  of  puerperal  mania,  when  violent  and  uncon- 
trollable, are  sometimes  quickly  quieted  and  refreshing  sleep  obtained, 
from  which  the  patient  eventually  arouses  in  a  calmer  frame  of  mind. 
Ether  is  the  proper  agent  for  this  purpose.  It  should  not  be  forgotten 
that  anaesthetics  are  dangerous  in  delirium  tremens. 

In  puerperal  convulsions  due  to  reflex  irritation,  or  to  uraemia,  the 
use  of  chloroform  is  invaluable.  It  is  equally  effective  in  the  reflex  con- 
vulsions of  early  life,  in  the  urcemic  convulsions  of  scarlet  fever,  and 
in  the  so-called  hystero-epilepsy.  When  puerperal  or  other  forms  of 
convulsive  seizures  are  due  to  cerebral  haemorrhage,  no  good  can  be 
accomplished  by  anaesthetic  inhalations.  In  any  case,  although  con- 
vulsions may  be  arrested  by  anaesthetic  inhalations,  other  appropriate 
measures  must  be  resorted  to  for  the  permanent  removal  of  the  causes. 
A  paroxysm  of  epilepsy  impending  may  be  aborted  by  the  inhalation 
of  ether,  but  the  nitrite  of  amyl  is  a  more  effective  remedy  for  this 
purpose. 

In  certain  neuroses  of  the  respiratory  organs,  great  relief  is  ob- 
tained by  anaesthetic  inhalations.  Laryngismus  stridulus  may  be 
quickly  cured  by  the  vapor  of  chloroform.  A  few  drops  of  chloroform 
on  a  handkerchief  will  suffice,  and  special  care  should  be  taken  to  dilute 
the  vapor  largely  with  air.  A  similar  procedure  will  relieve  severe 
paroxysms  of  whooping-cough,  but  a  more  energetic  use  of  chloroform 
is  required  when  convulsions  occur  during  a  fit  of  coughing.  No  single 
agent  gives  more  relief  in  asthma,  but,  like  all  other  remedies  for  this 
disease,  the  power  of  relief  declines,  and  increasing  doses  of  the  anaes- 
thetic become  necessary,  so  that  the  habit  of  chloroform  or  ether  nar- 
cosis is  formed. 

Anaesthetic  inhalations  should  not  be  recommended  in  cases  which 


606  CEREBRAL   SEDATIVES. 

will  probably  require  their  use  for  a  long  time,  because  the  inclination 
for  this  kind  of  intoxication  grows  rapidly,  and  is  as  difficult  to  control 
as  the  opium-habit.  The  author  has  seen  one  case  in  which  the  patient 
consumed  a  pound  of  chloroform  daily,  but,  as  might  be  expected,  this 
extraordinary  consumption  of  the  anaesthetic  did  not  long  continue,  for 
the  patient  succumbed  in  a  few  months. 

In  obstetric  practice  the  applications  of  anaesthetics  are  numerous 
and  important.  The  indications  and  contraindications  for  chloroform 
in  natural  labor  may  be  formularized  as  follows  :  When  the  labor  is  of 
short  duration,  and  not  excessively  painful,  anaesthetics  should  not  be 
used  ;  on  the  other  hand,  when  the  labor  is  protracted  and  the  suffering 
great,  they  favor  the  progress  of  the  case  and  prevent  exhaustion  and 
uterine  inertia.  In  primipara  caution  is  necessary.  The  inhalation  of 
the  anaesthetic  should  not  begin  until  near  the  close  of  the  first  stage, 
unless  those  painful  but  ineffectual  contractions  occur  which  have  been 
aptly  characterized  as  "nagging  pains,"  when  the  vapor,  very  much 
diluted,  may  be  cautiously  inhaled  for  their  relief.  The  inhalation 
should  be  practiced  only  during  the  existence  of  the  pain.  The  influ- 
ence of  the  anaesthetic  on  the  pulse,  respiration,  and  uterine  contrac- 
tions, should  be  carefully  observed,  and,  if  the  pulse  fail,  the  respirations 
become  shallow,  or  the  pains  lose  in  efficiency,  the  inhalation  should  be 
discontinued.  If  the  anaesthetic  cause  great  excitement,  and  the  patient 
become  loudly  clamorous  for  more,  while  the  uterine  contractions  are 
lessening  in  force,  it  is  doing  harm  and  should  be  withdrawn.  It  is 
never  necessary,  nor  proper,  to  administer  the  anaesthetic  to  complete 
unconsciousness.  Toward  the  close  of  the  second  stage,  when  the  head 
begins  to  distend  the  external  parts,  the  quantity  of  chloroform  may  be 
somewhat  increased,  but  the  inhalation  should  be  discontinued  when 
the  occiput  has  passed  under  the  pubic  arch.  If  these  rules  are  fol- 
lowed, the  action  of  the  anaesthetic  is  beneficent.  Properly  adminis- 
tered, the  use  of  chloroform  may  be  considered  perfectly  safe  in  the 
parturient  female.  It  is  generally  conceded  that  no  well-authenticated 
case  of  death  from  the  use  of  chloroform  in  labor  has  occurred,  when  the 
administration  was  in  the  hands  of  a  properly-qualified  medical  man. 

The  following  evil  results,  the  author  believes,  have  followed  the 
incautioiis  use  of  anaesthetics  in  labor  :  the  progress  of  the  case  arrested, 
so  that  forceps  became  necessary  ;  slow  and  imperfect  uterine  contrac- 
tions, and  consequent post-partum  haemorrhage ;  a  toxic  condition  of  the 
mother's  blood,  with  after  -  excitement,  wakefulness,  and  puerperal 
mania  ;  asphyxia  of  the  child,  tedious  convalescence,  and  subinvolution 
of  the  womb. 

When  instrumental  delivery  is  required,  the  utility  of  anaesthetics 
is  unquestionably  great.  It  facilitates  the  necessary  manipulations,  and 
prevents  shock.  The  inhalation  should  be  carried  far  enough  in  these 
cases  to  produce  sufficient  quietude  in  the  patient,  and  it  may  be  to 


ANAESTHETICS.  607 

complete  muscular  resolution.  When  turning  is  to  be  performed,  the 
state  of  chloroform  narcosis  must  be  deep  enough  to  suspend  uterine 
contractions. 

If  puerperal  convulsions  occur  at  any  stage,  the  utility  of  chloro- 
form is  unquestionable.  The  limits  of  its  utility  in  these  cases  have 
already  been  indicated. 

When  careful  examination  of  the  pelvic  viscera  is  to  be  made  to 
establish  the  diagnosis  in  difficult  and  obscure  cases,  as,  for  example, 
phantom  tumor,  ovarian  and  fibroid  growths,  pelvic  abscess,  etc.,  the 
importance  of  full  anaesthesia  can  hardly  be  over-estimated. 

The  use  of  anaesthetics  in  operative  surgery  is  now  an  indispensable 
practice.  It  may  be  compendiously  stated  that  ether,  or  chloroform, 
is  required  in  all  surgical  operations  of  magnitude,  for  the  reduction  of 
dislocations,  for  the  taxis  in  strangulated  hernia,  for  dressing  painful 
wounds  and  adjusting  fractures,  for  breaking  up  adhesions,  and  con- 
tractions of  muscles  and  tendons  in  cases  of  deformity,  for  establishing 
the  diagnosis  in  feigned  diseases,  etc. 

The  after  nausea  and  vomiting,  which  are  sometimes  most  depress- 
ing, and  occasionally  dangerous,  produced  by  anaesthetics,  may  be  pre- 
vented by  the  hypodermatic  injection  of  morphine  and  atropine  before 
beginning  the  administration  of  the  anaesthetic.  After  the  patient 
emerges  from  the  anaesthetic  sleep,  the  above-mentioned  unpleasant 
after-effects  may  be  relieved  by  a  minute  quantity  of  morphine  (^  of 
a  grain)  and  atropine  (y^  of  a  grain)  injected  subcutaneously. 

COMPARATIVE  UTILITY  OF  ETHER  AND  CHLOROFORM. — Chloroform 
is  more  pleasant  to  inhale,  and  is  less  irritant  to  the  air-passages  than 
ether.  The  vapor  of  chloroform  is  not,  and  the  vapor  of  ether  is,  in- 
flammable, whence  it  follows  that  the  former  may  be  alone  admissible 
at  night  under  some  circumstances.  The  stage  of  excitement  is  longer 
from  ether  than  from  chloroform,  but,  as  ether  may  be  given  much 
more  rapidly,  this  difference  in  action  may  be  made  to  disappear  in 
practice.  Chloroform  is  more  prompt  in  its  effects,  and  the  narcosis 
induced  by  it  more  sustained,  than  is  the  case  with  ether  ;  but  these 
advantages  possessed  by  chloroform  are  quite  balanced  by  the  greater 
freedom  with  which  ether  may  be  administered.  The  danger  from 
the  inhalation  of  chloroform  is  vastly  greater  than  from  ether. 

It  follows  from  the  above  considerations  that  ether  should  be  used 
in  preference  to  chloroform  in  all  cases,  except  during  labor.  Chloro- 
form is  to  be  preferred  in  labor,  because  more  pleasant  to  inhale,  more 
prompt  in  action,  and  without  inflammability.  The  consideration  of 
safety  must  necessarily  take  precedence,  but  experience  has  shown 
that  chloroform  is  perfectly  safe  in  labor  when  properly  administered. 

The  frequency  with  which  fatal  cases  of  chloroform  narcosis  have 
been  reported — amounting  in  the  aggregate  now  to  about  five  hun- 
dred— imposes  an  immense  responsibility  on  the  administrator.  In  the 


COS  CEREBRAL   SEDATIVES. 

present  state  of  opinion  on  the  subject,  the  use  of  chloroform,  when 
ether  is  available,  for  the  production  of  anaesthesia,  can  hardly  be  jus- 
tified, especially  if  a  fatal  result  follow  its  administration. 

Ethyl  Bromide. — The  physical  properties  of  this  ether  are  men- 
tioned on  another  page  in  connection  with  ether.  As  an  anaesthetic, 
it  was  first  known  to  Mr.  Nunnely,  of  Leeds,  and  he  first  employed  it 
in  surgical  practice  in  1865.  Dr.  Turnbull  gave  an  account  of  its  prop- 
erties, based  on  experimental  and  clinical  evidence,  in  1877,  but  the 
most  extended  trials  of  its  anaesthetic  powers  were  made  by  Dr.  Levis, 
of  Philadelphia,  in  1879-'80.  In  the  latter  year  two  unsuccessful 
cases  occurred,  one  in  the  hands  of  Dr.  Levis,  its  chief  promoter,  and 
the  other  in  the  practice  of  Dr.  Marion  Sims,  of  New  York.  These 
fatal  cases,  and  some  crude  physiological  experiments,  undertaken  to 
prove  that  ethyl  bromide  is  a  heart-paralyzer,  started  a  reaction  against 
this  anaesthetic,  then  beginning  a  promising  career,  and  in  a  short  time 
it  fell  into  almost  complete  disuse.  It  has,  however,  valuable  properties 
which  should  preserve  it  from  neglect.  To  induce  complete  insensi- 
bility, from  four  to  six  grammes  (  3  j —  3  jss)  must  be  administered  rap- 
idly. The  odor  is  not  unpleasant,  and  but  little  irritation  of  the  air- 
passages  is  produced.  If  administered  in  full  quantity,  there  is  a  very 
brief  (scarcely  noticeable)  stage  of  excitement,  and  the  period  of  rigid- 
ity is  very  short  and  not  pronounced.  The  face  is  flushed,  the  ears 
red,  the  eyes  injected,  and  the  pupils  are  more  or  less  dilated.  The 
action  of  the  heart  is  accelerated,  and  the  pulse  increases  in  force. 
The  respiration  is  also  somewhat  quickened,  and  in  some  subjects  be- 
comes snorting  or  stertorous,  but  irregularity  or  arrest  of  the  respira- 
tory movements  has  not  occurred.  More  or  less  embarrassment  of 
breathing  has  been  occasionally  caused  by  an  accumulation  of  bron- 
chial mucus.  It  does  not  often  induce  nausea  and  vomiting  ;  but 
women  are  more  apt  to  be  disturbed  in  this  way  than  men.  The  du- 
ration of  the  stage  of  insensibility  is  brief  and  the  awakening  prompt, 
with  little  of  the  confusion  of  mind  and  excitement  characteristic  of 
ether  and  chloroform.  As  a  rule,  the  patient  wakes  out  of  the  anaes- 
thetic condition  with  little  distress  of  any  kind. 

In  the  fatal  cases  recorded,  there  are  strong  doubts  in  regard  to 
the  share  of  ethyl  bromide  in  the  result.  In  Dr.  Levis's  case  the  pa- 
tient was  far  advanced  in  pulmonary  disease,  and  was  unfit  for  the 
administration  of  any  anaesthetic.  In  Dr.  Sims's  case  the  death  of  the 
patient  occurred  a  number  of  hours  after  the  operation,  which  was  a 
tedious  one,  requiring  very  protracted  use  of  the  anaesthetic.  It  is  said 
that  a  strong  odor  of  bromine  pervaded  the  entire  body  of  this  sub- 
ject. It  is,  however,  in  a  high  degree  improbable  that  decomposition 
of  the  ethyl  bromide  takes  place  when  it  is  inhaled. 

In  administering  this  anaesthetic  the  method  pursued  with  ether  is 


ANAESTHETICS.  609 

best.  If  given  promptly,  in  sufficient  quantity,  and  but  slightly  di- 
luted with  air,  the  stage  of  insensibility  can  be  induced  in  about  five 
minutes  (Levis).  It  is  not  suited  to  operations  requiring  much  time. 
It  is,  however,  peculiarly  well  adapted  for  slight  or  brief  operations 
of  a  very  painful  character,  and  for  ophthalmic  practice  it  is  unequaled, 
according  to  Chisolm. 

M.  Perier  states  that  he  has  used  ethyl  bromide  very  often  as  a 
local  anaesthetic,  instead  of  ether,  and,  he  affirms,  with  great  success. 
The  method  to  which  he  refers  is  local  anaesthesia  as  inaugurated  by 
Richardson  with  the  spray-douche.  Among  other  distinct  advantages 
over  ether,  ethyl  bromide  is  not  inflammable,  and  can  consequently  be 
used  under  circumstances  prohibiting  the  former. 

The  inhalation  of  ethyl  bromide  has  been  utilized  in  the  treatment 
of  diseases  for  the  relief  of  which  the  bromides  have  been  given  by 
the  stomach.  MM.  Bourneville  and  Oilier  have  carefully  investigated 
this  action  of  ethyl  bromide  in  hysteria  and  epilepsy.  They  find  that 
hysterical  seizures  are  promptly  arrested,  and  that  in  epilepsy  the 
daily  administration  of  this  remedy  during  a  period  of  two  or  three 
months  notably  diminishes  the  frequency  of  the  attacks.  This  prac- 
tice might  be  advantageously  extended  to  the  treatment  of  severe  chorea, 
whooping-cough,  spasmodic  asthma,  hepatic  and  renal  colic,  etc.  For 
these  purposes,  only  sufficient  ethyl  bromide  is  inhaled  to  relieve  the 
pain  or  spasm,  or  to  induce  sopor. 

Bichloride  of  Methylene. — This  agent,  similar  to  chloroform,  was 
first  proposed  as  an  anaesthetic  by  Dr.  B.  W.  Richardson.  It  is  more 
agreeable  to  inhale,  and  less  apt  to  produce  after-sickness,  than  chloro- 
form, but  it  is  not  less,  and  probably  more,  dangerous  to  life.  Five  or 
six  deaths  have  occurred  in  the  cases  in  which  methylene  bichloride 
was  administered.  Spencer  Wells  has  constantly  used  it  since  it  was 
introduced,  without  a  single  untoward  result.  But  he  employs  a  spe- 
cial administrator,  and  gives  the  vapor  with  a  regulated  supply  of  air. 
His  apparatus  consists  of  a  mask  closely  fitting  over  the  mouth  and 
nose,  connected  by  a  flexible  tube  with  a  bottle  containing  the  anaes- 
thetic, and  with  a  rubber  hand-ball,  which  sends  into  the  mask,  with 
every  contraction  of  the  bulb  by  the  hand,  this  quantity  of  air  with 
the  anaesthetic  vapor.  As  no  accidents  have  happened,  and  yet  pa- 
tients are  kept  narcotized  for  hours  at  a  time,  there  can  be  no  doubt 
of  the  security  afforded  by  this  method  of  conducting  the  inhalation. 
It  were  well  if  this  plan  were  applied  to  the  inhalation  of  chloroform 
as  well  as  bichloride  of  methylene. 

Authorities  referred  to  : 

ANSTIE,  DR.  FRANCIS  EDMUND.     StimvJ.ants  and  Narcotics,  American  edition. 
AUBERT,  DR.  M.  P.    Anesthesies  mixtespar  f 'ether,  la  morphine  el  Vatropine.    Lyon  Medi 
tale,  January  14,  1883. 
41 


610  CEREBRAL   SEDATIVES. 

BOETTCHER,  PROF.  DR.  A.  Ueber  die  Wirkung  des  Chloroforms  auf  das  Slut.  Vir- 
thaw's  Archiv,  xxxii,  1865,  p.  126. 

BRINGS,  DE,  DR.  H.  Anesthesie  mixte  par  le  chloroforme  et  la  morphine.  Ann.  de 
Therap.,  1879. 

GCBLER,  DR.  A.     Commentaires  7herapeutiques  du  Codex  Medicamentarius,  etc.,  p.  670. 

HUSEMANN,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  1034. 

KdHLER,  DR.  HERMANN.  Chloroform,  Aether  und  die  als  Ersatzmittel  des  Chloroform 
empfohlenen  Alkoholderivate  zusammengestelle  und  besprochen.  Schmidt's  Jahrbiicher,  vol. 
cxlii,  p.  209,  and  vol.  cxlv,  p.  305. 

LENTE,  DR.  FREDERIC  D.     New  York  Medical  Journal,  vol.  viii,  p.  615. 

MEDICO-CHIRURGICAL  TRANSACTIONS.  Report  of  the  Committee,  etc.,  to  inquire  into  the 
Uses  and  the  Physiological,  Therapeutical,  and  Toxical  Effects  of  Chloroform,  etc.,  vol. 
xxix,  second  series,  p.  323. 

MORGAN,  DR.  J.  The  Danger  of  Chloroform  and  the  Safety  and  Efficiency  of  Ether, 
London,  1872. 

XOTHNAGEL,  DR.  HERMANN.  Die  fettige  Degeneration  der  Organe  bei  Chloroformvergif- 
tung.  Berliner  klinische  Wochen.,  iii,  4,  1866. 

IBID.     Handbuch  der  Arzneimittellehre,  p.  125. 

PETREQUIN,  DR.  J.  E.  Nouvettes  Recherches  sur  la  Choix  dfaire  entre  la  Chloroforme 
et  F  Ether  reef.,  etc.  Gaz.  Heb.,  4-6,  1867. 

REEVE,  DR.  J.  C.     American  Journal  of  Medical  Sciences,  October,  1867. 

RICHARDSON,  DR.  B.  W.     The  Medical  Times  and  Gazette,  1866-1871,  various  articles. 

SANSOM,  DR.  ARTHUR  ERNEST.  Chloroform :  Its  Action  and  Administration,  Phila- 
delphia, 1866. 

SIMPSON,  SIR  J.  Y.     Anaesthesia,  Hospitalism,  etc.,  Works,  American  edition. 

SNOW,  DR.     On  Chloroform  and  other  Ancesthetics,  London,  1858. 

SQUIBB,  DR.  E.  R.     New  York  Medical  Journal,  April,  1871. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  de  Matiere  Medicale,  eighth  edition, 
vol.  ii,  p.  301. 

VERRIET-LITARDIERE,  DR.  These  de  Paris,  1879.  Anesthesie  mixte  par  le  chloroforme 
et  la  morphine. 

Authorities  for  ethyl  bromide  : 

CHISOLM,  PROF.  J.  J.,  M.  D.     Maryland  Medical  Journal,  vol.  ix,  No.  32. 

DUVAL,  DR.  M.  A.      These  de  Paris,  1881.     Bromure  d'ethyle  comme  anesthesique. 

LEVIS,  DR.  R.  Ethyl  Bromide  as  an  Ancestfietic.  The  Medical  Record,  New  York, 
March  27,  1880. 

NUNNELT,  MR.  THOMAS.     Transactions  of  the  British  Medical  Association  for  1865. 

PERIER,  DR.     Annuaire  de  1  her apeutique  pour  1881,  p.  62. 

TERRILLON,  DR.  Bromure  d'ethyle  comme  anesthesique.  Annuaire  de  Therapeutique 
pour  1881. 

TURNBULL,  DR.  L.     Artificial  Ancesthesia,  Philadelphia,  1882. 

LOCAL  ANAESTHESIA. — The  diminution  of  the  cutaneous  sensibility, 
by  the  application  of  ice  and  freezing  mixtures,  has  long  been  practiced. 
It  was  not,  however,  until  Richardson's  method  by  the  hand-ball  spray 
apparatus  had  been  proposed,  that  there  had  been  much  use  made  of 
local  anaesthesia. 

This  method  consists  in  directing  a  current  of  atomized  ether 
against  the  part  to  be  anaesthetized.  The  ether  employed  for  this 


LOCAL   ANAESTHESIA.  611 

purpose  should  have  a  specific  gravity  not  to  exceed  0*723.  Rhigolene, 
the  lightest  liquid  known,  a  product  of  the  fractional  distillation  of 
petroleum,  is  more  effective  than  ether,  but  great  difficulty  attends  its 
use,  owing  to  its  extreme  volatility.  When  a  current  of  atomized 
ether  or  rhigolene  is  directed  against  the  skin,  the  rapid  evaporation 
produces  an  intense  degree  of  cold,  in  consequence  of  which  the  nerves 
lose  their  power  of  transmitting  impressions  to  the  sensorium. 

A  serious  drawback  to  the  process  of  producing  local  anaesthesia 
is  the  unpleasant  burning  which  follows  in  the  part  when  it  recovers 
from  the  freezing,  and  also  the  great  pain  which  attends  the  applica- 
tion of  ether-spray  to  certain  parts. 

THERAPY. — For  small  operations,  such  as  extraction  of  teeth  and 
opening  abscesses,  the  method  of  local  anaesthesia  is  extremely  useful. 
It  has  been  and  can  be  used  with  entire  success  in  much  larger  opera- 
tions, but  it  is  generally  employed  for  merely  minor  ones. 

The  application  of  ether-spray  to  the  spine  is  an  extremely  service- 
able remedy  in  spinal  irritation  and  in  chorea.  In  the  latter  disease 
it  alone  suffices  to  effect  a  cure.  In  neuralgia  of  superficial  nerves, 
lumbago,  muscular  rheumatism,  etc.,  the  ether-spray  affords  relief  very 
quickly,  which  may  be  permanent. 

INFILTRATION  ANAESTHESIA. — Schleich's  method  consists  in  the 
injection  into  the  substance  of  the  skin  of  a  solution  of  the  alkaloids 
having  anaesthetic  property.  The  pressure  exerted  by  the  fluid  is 
augmented  by  the  oedema  which  ensues  ;  hence  it  is  known  as  "  infil- 
tration anaesthesia."  Besides  the  local  action  of  the  anodyne,  and  the 
pressure  on  the  nerve  endings,  absorption  takes  place,  and  a  systemic 
impression  adds  to  the  local  effect.  The  infiltration  area  is  quite  in- 
sensitive, and  is  marked  by  an  urticaria-like  eruption.  The  local  anaes- 
thesia lasts  about  twenty  minutes,  but  the  systemic  effects  continue 
during  the  usual  time  of  a  hypodermatic  injection.  The  anaesthetic 
area  can  be  extended  in  any  direction,  by  successive  injections.  The 
strength  of  the  solution  may  vary  with  the  indications  and  the  char- 
acter of  the  tissue  injected.  Schleich  employed  three  solutions  con- 
taining cocaine,  morphine,  and  common  salt,  as  follows  : 

No.  1. 
3  Cocaine  hydrochlor -2  =  (gr.  3)  appro*. ; 

Morphine  hydrochlor -025  =  (gr.  £)  approx. ; 

Sodii  chlorid -2  =  (gr.  3)  approx. ; 

Aquae  destillat.  et  steril ad  100  =  f  §  iv. 

Add  2  drops  of  a  5-per-cent  solution  of  carbolic  acid. 

No.  2. 
3   Cocaine  hydrochlor •!  =  (gr.  l£)  approx. ; 

Morphine  hydrochlor -025  =  (gr.  £)  approx. ; 

Sodii  chlorid 42  =  (gr.  3)  approx. ; 

Aquae  destil.  et  steril ad  100  (f  §  iv). 

Add  2  drops  of  a  5-per-cent  solution  of  carbolic  acid. 


g!2  CEREBRAL   SEDATIVES. 

The  Schleich  solution  No.  3  has  been  found  too  dilute  to  have  any 
decided  effect,  and  is  not  any  longer  used  on  this  side  of  the  Atlantic. 
In  fact,  while  the  method  is  still  used,  surgeons  do  not  restrict  them- 
selves to  any  specified  formula.  The  main  point  is  mixed  anaesthesia, 
or  infiltration  anaesthesia,  and  the  adaptation  of  this  principle  to  com- 
paratively weak  solutions  of  the  anodyne. 

Solution  No.  1  is  intended  to  be  used  where  the  skin  is  inflamed  or 
is  highly  sensitive.  No.  2  is  intended  for  ordinary  conditions,  and  a 
very  weak  solution  is  used  when  extensive  tracts  of  the  skin  are  to  be 
rendered  insensitive  by  successive  injections,  whereby  the  danger  of 
toxic  effects  is  enhanced. 

Eucaine  has  been  proposed  as  a  substitute  for  cocaine  in  this  infil- 
tration method.  It  is  less  depressing  on  the  circulation  and  is  less 
toxic,  and  the  anaesthetic  area  is  greater  and  the  effect  more  persistent. 
Braun,  however,  in  a  recent  elaborate  investigation  has  shown  that 
eucaine  is  distinctly  inferior  to  cocaine  for  the  purpose  of  local  or 
infiltration  anaesthesia.  In  comparing  the  various  agents  employed  in 
this  mode  of  anaesthesia,  Braun  found  that  the  order  of  efficiency 
was  first,  cocaine,  second,  eucaine  "  B,"  third,  eucaine  "  A."  His  final 
statement  was  that  cocaine  and  eucaine  "  B  "  are  the  only  substances 
to  be  employed  in  this  way  ;  that  they  alone  cause  local  sensory 
paralysis  without  injury  to  the  tissues.  As  respects  the  power  of 
cocaine  to  lessen  the  sensibility  of  parts,  the  weakest  solution  having 
anaesthetic  effect  was  recently  ascertained  to  be  1  in  20,000,  or,  ap- 
proximately, one  grain  of  the  hydrochlorate  to  two  pints  of  distilled 
water. 

The  salt  of  eucaine  usually  employed  is  the  hydrochlorate.  This 
for  internal  administration  may  be  given  in  solution,  pill,  or  capsule, 
in  doses  corresponding  with  those  of  cocaine,  over  which  it  has  the 
advantage  that  it  has  no  toxic  effects,  causes  no  cardiac  depression,  and 
no  nausea  or  vomiting.  For  ordinary  purposes  it  may  be  applied  top- 
ically in  a  3-per-cent  solution,  in  ophthalmic,  nasal,  or  faucial  affec- 
tions, and  in  various  minor  surgical  operations.  Indeed,  according  to 
Schleich,  eucaine  may  be  substituted  for  cocaine  in  all  of  the  applica- 
tions made  by  the  infiltration  method,  as  in  other  respects. 

Eucaine,  "A"  and  "B." — Eucainae  hydrochlorat.  Eucaine  is  a 
modified  cocaine,  possessed  of  similar  anodyne  property,  but  with- 
out some  ill  effects  that  render  cocaine  undesirable.  Eucaine  "  A " 
(alpha)  is  a  benzoylamethylester  in  which  for  the  ecgonin  of  cocaine 
is  substituted  another  piperidine  derivative.  Among  its  advantages 
over  cocaine  are  that  it  is  less  poisonous  and  is  less  injured  by  hot 
water,  and  has  fewer  after  effects.  Of  the  two  eucaines,  it  is  asserted 
that  eucaine  "  B  "  is  more  soluble,  less  irritating,  and  possessed  of 
equal  anaesthetic  property.  It  is  preferred,  therefore,  for  the  produc- 
tion of  local  anaesthesia  by  Schleich's  method.  By  Heinze  it  is  ad- 


NITROUS  OXIDE.  613* 

vised  that  it  should  be  administered  in  salt  solution  without  morphine, 
according  to  the  following  formula  : 

Eucaine  "  B  " '1  (1'5  grs.  approx.) 

Sodium  chloride -8  (12  approx.) 

Distilled  water ad  100-    (f  §  iv  approx.) 

Nitrous  Oxide. — Protoxide  of  nitrogen.     Laughing-gas. 

COMPOSITION  AND  PROPERTIES. — A  colorless,  inodorous  gas,  having 
a  slightly  sweetish  taste,  and  a  specific  gravity  of  1'527.  It  consists 
of  one  equivalent  each  of  nitrogen  and  oxygen.  It  increases  the  rate 
of  combustion  of  inflammable  substances.  Water  at  ordinary  temper- 
ature absorbs  about  three  fourths  of  its  bulk  of  the  gas.  By  pressure 
and  cold  the  gas  may  be  condensed  into  a  liquid,  and  can  then  be  stored 
up  in  suitable  vessels  for  transportation  and  use.  The  quantity  of  the 
gas  taken  up  by  cold  water  may  be  much  increased  by  pressure,  and 
the  water  will  then  yield  it  up  on  heating.  Hence  this  constitutes  a 
convenient  mode  of  storing  the  gas  for  preservation.  The  ordinary 
mode  of  storing  the  gas  is  in  gas-bags  holding  about  eight  gallons,  in 
gasometers,  or  in  the  liquid  form  in  strong  metallic  casks. 

PHYSIOLOGICAL  ACTIONS. — The  first  surgical  operation  performed 
with  a  modern  anaesthetic  was  the  extraction  of  a  tooth,  the  subject 
being  unconscious  from  the  inhalation  of  nitrous  oxide.  It  had  long 
been  known  that  this  gas  produced  decided  exhilaration  when  inhaled 
to  a  certain  point.  It  has  a  very  short  anaesthetic  stage,  unless  the  in- 
halation of  the  gas  be  continued. 

The  first  effect  of  the  inhalation  of  nitrous  oxide  is  a  subjective 
dizziness,  whirring  noises  in  the  ears,  and  tingling  and  loss  of  sensa- 
tion throughout  the  body.  Extraordinary  illusions  beguile  the  senses, 
and  the  intoxicated  subject  suddenly  breaks  forth  into  singing,  decla- 
mation, sobbing,  melancholy,  or  manifests  a  pugnacious  tendency  and 
assaults  those  about  him.  As  the  effects  quickly  cease,  and  as  the  re- 
turn to  consciousness  is  very  abrupt,  the  subject  is  surprised  and 
ashamed  to  find  himself  in  some  ridiculous  or  grandiose  position  quite 
foreign  to  his  usual  demeanor. 

When  used  to  produce  anaesthesia  for  surgical  operations,  the  inha- 
lation of  the  gas  is  forced,  and  the  stage  of  excitement  is  very  brief. 
The  countenance  assumes  a  frightful  aspect,  most  alarming  to  those 
who  have  not  witnessed  the  inhalation  of  the  gas.  The  face  becomes 
deadly  pale,  the  respirations,  at  first  shallow,  soon  assume  a  stertorous 
character,  the  jaw  becomes  fixed,  the  eyes  protrude,  and  the  pallor  of 
the  face  is  presently  replaced  by  a  bluish  and  purplish  tint. 

So  far  as  the  exterior  phenomena  can  afford  any  indication  of  the 
nature  of  the  action,  the  condition  produced  by  nitrous  oxide  is  an 
asphyxiated  state.  The  blood  ceases  to  be  oxygenated,  carbonic  acid 
accumulates,  and  the  centers  of  conscious  impressions  are  rendered  in- 


614*  CEREBRAL   SEDATIVES. 

active  in  consequence  of  the  deficient  supply  of  oxygen  and  the  excess 
of  carbonic  acid.  The  rational  indications  of  the  nature  of  the  narcosis 
produced  by  nitrous  oxide  are  confirmed  by  physiological  experiment. 
It  has  been  found  that  the  exhalation  of  carbonic  acid  is  decidedly 
diminished  by  the  inhalation  of  nitrous  oxide,  and  that  animals  live  no 
longer  in  an  atmosphere  of  this  gas  than  in  an  atmosphere  of  nitrogen. 

The  inhalation  of  nitrous  oxide  appears  to  be  almost  free  from 
danger,  and  it  is  rare  that  unpleasant  after-effects  follow  its  adminis- 
tration. Four  fatal  cases  have  certainly  occurred,  which  can  with  pro- 
priety be  attributed  to  the  lethal  action  of  this  gas,  and  various  cases 
have  fallen  under  the  observation  of  the  author  in  which  nervousness, 
vague  mental  symptoms,  and  headache,  have  been  experienced  after 
the  inhalations. 

THERAPY. — The  very  prompt  action  of  nitrous  oxide  and  the  quick 
subsidence  of  the  narcosis  render  it  a  very  useful  anaesthetic  agent 
when  small  operations,  quickly  executed,  are  to  be  performed.  It  is 
especially  adapted  for  the  extraction  of  teeth,  opening  of  abscesses,  and 
similar  minor  operations.  But  it  has  also  been  used  successfully  for 
maintaining  prolonged  anaesthesia  for  the  performance  of  capital  oper- 
ations. There  is  no  difficulty  in  keeping  up  insensibility  from  fifteen 
minutes  to  a  half  hour,  since  the  introduction  of  liquefied  gas  and  of 
apparatus  for  its  suitable  application. 

It  has  been  asserted  that  diabetes  mellitus  may  be  caused  by  its 
administration,  but  the  evidence  is  far  from  satisfactory.  That  albu- 
minuria  may  be  induced  thereby  has  also  been  alleged,  but  the  evi- 
dence for  this  is  still  less  conclusive.  What  danger  soever  arises  in 
the  course  of  its  administration  is  due  to  the  nature  of  its  physio- 
logical actions,  and  can  occur  only  in  such  subjects  as  have  rigid 
arteries,  or  atheromatous  degeneration,  which  may  result  from  pre- 
mature or  actual  old  age.  The  blood  pressure  rises  during  the  inhala- 
tion of  the  gas,  and  the  venous  stasis  occurring,  any  vessel  far  adj 
vanced  in  the  calcareous  and  fatty  change  may  yield  to  the  increased 
pressure  and  cerebral  haemorrhage  result.  Some  cases  of  apoplexy 
apparently  thus  induced  have  been  reported.  Ordinarily,  should 
any  threatening  symptom  arise  during  the  administration  of  the  gas, 
it  is  only  necessary  to  withdraw  the  gas  and  apply  artificial  respira- 
tion. 

Authorities  referred  to : 

AMORT,  DR.  ROBERT.  The  Physiological  Action  of  Nitrous  Oxide.  New  York  Medical 
Journal,  August,  1870. 

JOHNSON,  DR.  GEORGE.  A  Lecture  on  the  Physiology  of  Coma  and  Ancesthesia.  Medi- 
cal Times  and  Gazette,  April  3,  1869. 

JOLYET  ET  T.  BLANCHE,  MM.  Recherches  experimentalcs  sur  F  Action  du  Oaz protoxyde 
d1  Azote.  Bulletin  General  de  Therap.,  vol.  Ixxxv,  p.  91. 

RICHARDSON,  DR.  B.  W.     Medical  Times  and  Gazette,  vol.  i,  1868. 


CHLORAL.  613 

Chlorai.— Chloral.  Hydrate  of  chloral.  Chloral,  Fr.  ;  CMoralhy- 
drat,  Ger. 

Separate,  rhomboidal,  colorless  and  transparent  crystals,  slowly 
evaporating  when  exposed  to  the  air,  having  an  aromatic,  penetrating, 
and  slightly  acrid  odor,  a  bitterish,  caustic  taste,  and  a  neutral  reaction. 
Freely  soluble  in  water,  alcohol,  or  ether ;  also  soluble  in  four  parts  of 
chloroform,  in  glycerin,  benzol,  benzin,  disulphide  of  carbon,  fixed  or 
volatile  oils.  It  liquefies  when  mixed  with  carbolic  acid  and  camphor. 

Dose,  grs.  v — 3j,  or  more,  but  it  should  not  be  forgotten  that  3  ss 
has  produced  toxic  symptoms. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  depression  of  the  heart 
and  respiration  caused  by  chloral  is  antagonized  by  alcoholic  stimu- 
lants, ammonia,  atropine,  by  galvanism,  and  by  artificial  heat.  These 
are,  therefore,  appropriate  remedies  to  be  employed  in  cases  of  poison- 
ing. Strychnine  is  held  by  Liebreich  to  be  antagonistic,  and  hence  it 
may  be  administered  hypodermatically  when  the  measures  above  men- 
tioned are  being  used. 

Alkalies  decompose  chloral  with  the  production  of  formic  acid  and 
chloroform,  hence  all  agents  having  an  alkaline  reaction  are  incompat- 
ible. 

SYNEKGISTS. — The  hypnotic  medicines,  notably  opium,  and  the  an- 
aesthetics,  deepen  the  effects  of  chloral  when  they  are  simultaneously 
administered. 

PHYSIOLOGICAL  ACTIONS. — Chloral  has  considerable  antiseptic  prop- 
erty, and  is  preservative  of  animal  textures.  It  produces  redness  and 
inflammation  of  the  skin,  when  kept  in  contact  with  it  for  a  lengthened 
period.  The  taste  of  chloral  is  hot  and  pungent,  and  it  excites  an 
abundant  flow  of  saliva.  In  the  stomach  it  causes  first  a  cooling  sen- 
sation, followed  by  warmth,  and  when  taken  in  large  quantity  may  set 
up  a  high  degree  of  gastric  irritation,  nausea,  and  vomiting.  In  mod- 
erate quantity  chloral  rather  stimulates  than  impairs  the  appetite,  and 
indigestion  and  nausea  do  not,  as  a  rule,  follow  as  an  after-effect. 

Chloral  diffuses  into  the  blood  rapidly.  The  changes  which  occur 
after  its  entrance  into  the  vessels  are  much  disputed.  Liebreich,  as  is 
well  known,  was  led — by  observing  the  reaction  when  chloral  is  brought 
into  the  presence  of  an  alkali — to  the  deduction  that  the  soda  of  the 
blood  would  split  up  chloral  into  chloroform  and  formic  acid,  and  that, 
therefore,  the  effects  belonging  to  chloroform  might  be  produced  by  the 
administration  of  chloral.  It  is  probably  true  that  this  reaction  does 
take  place  to  some  extent,  but  there  are  several  insuperable  objections 
to  the  theory  of  Liebreich  : 

1.  The  effects  of  chloral  differ  from  those  produced  by  a  corre- 
sponding quantity  of  chloroform. 

2.  After  the  administration  of  chloral,  there  is  no  elimination  of 
chloroform  by  the  breath  or  urine. 


614  CEREBRAL  SEDATIVES. 

3.  Chloral  is  more  decidedly  hypnotic,  and  much,  less  anaesthetic, 
than  chloroform. 

4.  Crystals  of  chloral  have  been  recognized  in  the  blood,  and  the 
products  of  the  decomposition  of  chloral  have  recently  been  recovered 
from  the  urine. 

The  effects  which  follow  an  ordinary  medicinal  dose  (fifteen  to 
thirty  grains)  are  not  the  same  in  all  subjects,  although  it  must  be 
admitted  that  a  great  degree  of  uniformity  exists.  "When  there  is 
present  an  insusceptibility  to  its  hypnotic  action  it  produces  headache, 
and  in  some  subjects  a  delirious  excitement.  Immediately  preceding 
its  hypnotic  action  there  is  developed  in  all  subjects  a  stage  of  excite- 
ment, usually  very  short  in  duration,  and  followed  by  sudden  and 
complete  sopor.  The  sleep  produced  by  chloral  is  extraordinarily 
like  natural  sleep,  and  is  calm,  dreamless,  and  refreshing.  It  is  not  a 
condition  of  narcotism,  and  the  patient  may  be  easily  aroused  to  take 
food  and  nourishment,  and  will  quickly  and  without  difficulty  fall 
asleep  again.  As  a  rule  no  unpleasant  after-effects  are  experienced 
from  a  dose  of  chloral — no  headache,  faintness,  giddiness,  nausea,  and 
constipation,  so  common  after  morphine.  The  quantity  of  chloral  ne- 
cessary to  produce  sleep,  without  dangerous  narcotism,  ranges  from 
fifteen  to  forty  grains,  and  the  duration  of  the  effect  varies  in  differ- 
ent subjects  from  two  to  eight  hours.  Chloral  does  not  destroy  the 
sensibility  to  pain,  unless  administered  in  a  quantity  sufficient  to  sus- 
pend the  functions  of  the  cerebrum.  It  is  not  a  pain-relieving  agent 
in  the  sense  that  morphine  is. 

When  sleep  is  produced  by  proper  medicinal  doses  of  chloral  the 
pupil  contracts  a  little,  the  pulse  may  remain  unaltered  or  become 
slower,  and  the  respirations  are  unaffected.  When  a  dangerous  or 
lethal  dose  is  taken,  profound  narcotism  will  follow  ;  the  respirations 
will  be  slower  and  shallower,  the  pulse  will  become  weak,  rapid,  and 
irregular  ;  sensibility  and  the  reflex  movements  will  be  abolished,  and 
complete  muscular  relaxation  will  ensue.  The  mode  of  dying  is  by 
suspension  of  the  functions  of  the  cerebrum,  and,  finally,  by  paralysis 
of  the  respiratory  center,  and  of  the  cardiac  motor  ganglia.  Death 
may  be  suddenly  produced  by  paralysis  of  the  heart,  in  cases  of  fatty 
degeneration  of  the  muscular  tissue  of  this  organ,  without  proceed- 
ing so  far  as  to  involve  the  lower  centers  of  the  brain. 

A  marked  reduction  in  temperature,  notably  in  rabbits — so  much 
as  8°  Fahr. — is  produced  by  chloral,  but  this  effect  may  be  considera- 
bly lessened  by  enveloping  the  body  in  non-conductors  (Brunton), 
which  act  by  preventing  the  cooling  of  the  blood  by  the  atmosphere. 
The  first  effect  of  chloral  is  to  raise  the  arterial  tension  (stage  of 
excitement),  but  this  action  quickly  ceases,  and  a  decided  lowering  of 
the  tension  results.  The  diminished  arterial  tension  and  the  weak- 
ened action  of  the  heart  are  the  principal  factors  in  the  reduction  of 


CHLORAL.  615 

the  body  temperature,  for  the  combined  action  of  these  agencies  is  to 
lessen  the  combustion  process.  After  death  from  chloral,  congestion 
of  the  meninges  of  the  brain  and  cord,  of  the  lungs,  and  distention 
of  the  right  cavities  of  the  heart,  have  been  observed.  The  arrest 
of  the  heart's  action  takes  place  in  the  diastole. 

Chloral  does  not  affect  the  motor  nerves  nor  impair  the  contrac- 
tility of  muscle  ;  hence  the  paralytic  phenomena  both  of  animal  and 
of  organic  life  produced  by  it  are  due  to  its  direct  action  on  the 
nervous  centers. 

Very  large  quantities  of  chloral  have  been  taken  without  pro- 
ducing fatal  symptoms.  I  have  seen  a  patient  who  took  daily  from 
two  drachms  to  three  drachms  of  chloral  for  many  months,  without 
any  symptoms  of  acute  poisoning.  While  it  is  true  that  enormous 
doses  (several  hundred  grains)  have  been  taken  without  producing 
lethal  effects,  it  is  equally  true  that  serious  symptoms  and  death  have 
resulted  from  very  moderate  doses  (twenty  to  thirty  grains).  Great 
care  should  therefore  be  taken  in  prescribing  an  agent  of  such  uncer- 
tain power.  A  fatty  heart,  atheromatous  degeneration  of  the  vessels, 
advanced  disease  of  the  lungs,  and  instability  of  the  nervous  system, 
are  contraindications  of  the  use  of  chloral. 

CHLORAL-HABIT. — The  habitual  use  of  chloral  constitutes  a  dis- 
order, which,  if  not  as  persistent  as  the  opium -habit,  has  its  own 
difficulties  and  dangers  of  no  little  importance.  Those  who  take 
choral  habitually  have  irritable,  injected,  and  rather  brilliant  eyes,  and 
are  voluble  in  speech,  and  have  a  rather  excited  and  hurried  manner. 
They  complain  usually  of  singing  in  the  ears,  of  an  empty  or  vacuous 
feeling  in  the  brain,  and  are  subject  to  sudden  attacks  of  vertigo. 
They  are  wakeful,  and  very  nervous  and  excitable,  without  chloral, 
when  the  time  for  sleep  arrives,  and  they  are  usually  entirely  unable 
to  sleep  without  the  usual  dose  of  the  hypnotic.  During  the  day  they 
are  melancholy,  easily  fatigued,  and  their  voluntary  movements  are  apt 
to  be  uncertain  and  disordered.  The  appetite  is  always  capricious, 
frequently  wanting  ;  digestion  is  labored  ;  the  secretion  of  bile  is  de- 
ficient, the  stools  being  rather  white  and  pasty  ;  the  urine  stained  with 
the  bile-elements,  and  sometimes  albuminous. 

An  increasing  weakness  and  irregularity  in  the  action  of  the  heart ; 
dyspnoea,  chiefly  when  the  stomach  is  distended  ;  redness,  injection, 
and  ecchymoses  of  the  skin,  have  been  occasionally  observed  to  occur 
in  cases  of  the  chloral-habit. 

The  best  method  of  managing  these  unfortunate  cases  consists  in 
the  very  gradual  diminution  of  the  daily  quantity  of  chloral ;  in  regu- 
lation of  the  diet  and  administration  of  a  suitable  supply  of  food  ;  air, 
exercise,  and  change  of  scene  ;  chalybeate  tonics  ;  hyoscyamus  and 
lupuline  as  calmatives,  strychnine  and  picrotoxin  as  nerve  stimulants  ; 
occasional  purgatives. 


616  CEREBRAL   SEDATIVES. 

THERAPY.  —  Chloral  is  a  remedy  of  great  value  in  sea-sickness. 
From  fifteen  to  thirty  grains  every  four  hours,  the  recumbent  posture 
for  a  short  time,  and  suitable  nourishment,  are  the  most  effective  means 
we  now  possess  for  this  troublesome  disorder.  In  some  cases  of  sick- 
ness of  pregnancy  chloral  is  equally  effective,  but,  like  other  remedies 
for  this  condition,  it  often  fails.  According  to  the  author's  observation, 
it  is  most  effective  when  there  is  much  dizziness,  faintness,  and  repug- 
nance to  food,  and  but  little  vomiting.  When  the  odor  of  chloral 
invites  nausea,  as  is  not  unfrequently  the  case,  it  may  be  given  advan- 
tageously by  enema.  And,  furthermore,  rectal  injection  of  fifteen  to 
thirty  grains,  properly  diluted,  is  an  effective  remedy  for  nausea  and 
vomiting  of  reflex  origin,  as  occur  in  cases  of  uterine  fibroids,  gastro- 
enteritis of  children  (Kjelberg),  etc. 

In  severe  cases  of  cholera-morbus,  with  cramps,  coldness  of  the  sur- 
face, cold  breath  and  cold  tongue,  remarkable  relief  is  procured,  and 
the  patient  not  unfrequently  wrested  from  a  condition  of  extreme  dan  - 
ger,  by  the  hypodermatic  injection  of  chloral.  There  is  no  means  of 
treatment  of  cholera  now  known  so  effective  as  this,  as  the  author  has 
personally  witnessed.  The  effectiveness  of  chloral  is  increased  by  com- 
bination with  morphine.  Tfr  Chloral,  hydratis,  3  iij  ;  morphinae  sulph., 
gr.  iv  ;  aquse  laur.-cerasi,  §  j.  M.  Sig.  :  From  fifteen  to  thirty  minima 
— -for  cholera,  cholera-morbus,  etc.  This  injection  produces  consider- 
able burning  pain  and  an  indurated  lump,  but  in  the  author's  expe- 
rience suppuration  has  not  followed. 

As  chloral  produces  a  lowering  of  the  temperature,  and,  according 
to  Richardson,  diminishes  the  coagulability  of  the  fibrin,  good  results 
may  be  expected  from  its  use  in  inflammations  and  fevers.  It  is  es- 
pecially indicated  when  the  temperature  is  high  and  there  are  much 
delirium  and  restlessness  present.  The  author  has  observed  excellent 
results  from  its  use  under  these  circumstances  in  the  eruptive  fevers, 
pneumonia,  etc.  It  should  not  be  forgotten,  however,  that  chloral 
must  be  prescribed  with  caution  when  there  is  ischaemia  of  the  arterial 
system — a  condition  which  must  necessarily  exist  when  a  considerable 
portion  of  the  lung-space  is  blocked  up  by  fibrinous  or  caseous  de- 
posits. In  pleuritis,  endo-  and  pericarditis,  and  in  peritonitis,  much 
good  will  result  from  the  use  of  moderate  doses  of  choral — five  grains 
every  three  hours.  It  is  useful  because  it  allays  restlessness,  causes 
sleep,  lowers  the  fever,  and  limits  or  prevents  fibrinous  deposits  and 
exudations. 

The  most  important  uses  of  chloral  are  in  diseases  of  the  nervous 
system.  As  an  hypnotic,  pure  and  simple,  it  is  quite  unrivaled.  Cases 
of  sleeplessness,  due  to  mental  overwork,  anxiety,  or  physical  fatigue, 
are  entirely  relieved  by  fifteen  to  twenty  grains  of  chloral.  The  re- 
freshing sleep  thus  obtained  not  unfrequently  leads  to  repeated  and 
long-continued  use  of  chloral,  and  thus  the  chloral-habit  is  formed.  It 


CHLORAL.  617 

follows  that  sleep  should  be  procured  by  proper  hygienic  methods  in 
such  cases,  if  possible,  and  chloral  should  be  resorted  to  only  after  the 
failure  of  such  means.  No  hypnotic  is  so  uniformly  successful  in  pro- 
curing sleep  in  delirium  tremens  ;  but  this  remedy,  as  other  remedies  of 
the  same  class,  not  unfrequently  fails.  It  is  more  particularly  adapted 
to  those  cases  in  which  the  delirium  has  succeeded  to  a  debauch,  and 
is  less  useful,  and  may,  indeed,  produce  serious  symptoms,  in  old,  worn- 
out  drunkards.  Violent  excitement  not  unfrequently  is  produced  by 
it  when  it  fails  to  cause  sleep.  The  author  must  caution  his  younger 
readers  against  the  too  large  administration  of  chloral  in  this  disease. 
Sleep  may  be  procured  which  will  end  in  fatal  exhaustion.  Especially 
should  caution  be  used  in  the  old  drunkard,  whose  heart  and  vascular 
system  may  have  undergone  serious  fatty  and  calcareous  degeneration. 
In  suitable  cases  there  is  no  doubt  chloral  is  a  remedy  of  the  highest 
value,  but  it  should  not  be  used  to  the  exclusion  of  suitable  hygienic 
and  dietetic  treatment. 

Various  forms  of  mania,  in  which  delirium  and  wakefulness  are 
prominent  symptoms,  are  largely  benefited  by  hypnotic  doses  of 
chloral.  This  remark  is  true  of  acute  mania,  acute  melancholia, 
puerperal  mania,  acute  maniacal  delirium,  and  the  excitement  which 
occurs  in  general  paralysis  of  the  insane.  When  it  agrees,  and  pro- 
duces refreshing  sleep,  marked  improvement  in  the  mental  state  not 
unfrequently  follows  its  use.  In  incurable  and  intractable  cases, 
chloral  often  renders  the  greatest  service  as  a  calmative  and  an 
hypnotic. 

Puerperal  convulsions,  when  the  patient  is  in  a  condition  to  swal- 
low, may  be  arrested  by  full  doses  of  chloral — twenty  grains  every 
two  hours  ;  also,  subcutaneously  in  five-grain  doses,  it  is  highly  effec- 
tive, according  to  Purefoy,  and  by  the  rectum  its  acts  admirably  in 
many  cases.  Infantile  convulsions,  when  due  to  reflex  irritation,  may 
be  suspended  by  the  same  means.  When  the  jactitations  of  chorea 
are  so  incessant  as  to  prevent  sleep,  or  when  they  occur  during  sleep, 
chloral  may  be  administered  with  advantage.  It  is  not  a  curative 
agent  in  chorea,  but  when  it  produces  quiet  and  refreshing  sleep  it 
indirectly  contributes  to  the  cure. 

Some  of  the  respiratory  neuroses  are  greatly  benefited  by  chloral. 
The  paroxysms  of  spasmodic  asthma  may  be  arrested  by  it,  and  the 
spasmodic  attacks  of  difficult  breathing  which  accompany  emphysema 
may  be  decidedly  ameliorated  by  timely  doses  of  chloral.  It  must  not 
be  forgotten,  however,  that  the  use  of  chloral  is  not  unattended  with 
danger  in  pulmonary  diseases  with  ischsemia  of  the  arterial  system. 
In  the  spasmodic  stage  of  whooping-cough,  great  relief  to  the  parox- 
ysms may  be  obtained  by  the  use  of  this  agent.  From  five  to  ten 
grains  will  generally  be  a  suitable  quantity  for  administration  in  these 
cases.  Impending  attacks  of  laryngismus  stridulus  may  be  prevented, 


618  CEREBRAL   SEDATIVES. 

and  seizures  already  in  action  can  be  quickly  arrested,  by  a  full  dose 
of  chloral — five  to  fifteen  grains. 

We  have  no  remedy  more  effective  in  tetanus  than  chloral,  but  it 
must  be  given  in  large  doses.  Nocturnal  attacks  of  epilepsy  may  not 
unfrequently  be  prevented  by  a  full  dose  of  chloral  at  bedtime.  In 
paralysis  agitans,  good  effects  have  been  attained  by  hypnotic  doses 
at  bedtime.  Chloral  is  a  physiological  antagonist  to  strychnine,  and 
may,  therefore,  be  used  with  advantage  in  poisoning  by  this  substance. 

Chloral  is  not  unfrequently  prescribed  to  relieve  pain,  but  under  a 
mistaken  notion  of  its  physiological  powers.  It  can  only  relieve  pain 
by  suspending  the  functions  of  the  cerebrum,  and  in  doses,  therefore, 
which  are  dangerous.  It  has  no  direct  pain-relieving  power,  like  mor- 
phine. When  pain  is  to  be  relieved  and  sleep  procured,  the  combina- 
tion of  chloral  and  morphine  is  extremely  effective.  Although  chloral 
does  not  directly  suspend  the  functions  of  the  sensory  nerves,  it  relieves 
certain  kinds  of  pain  due  to  irregular  or  overaction  of  unstriped  mus- 
cular fibers.  Very  great  relief  is  afforded  by  chloral  to  the  irregular 
pains  of  the  first  stage  of  labor,  which  cause  suffering  but  do  not  ad- 
vance the  case — the  so-called  "nagging  pains,"  in  popular  obstetric 
language.  Rigidity  of  the  os  uteri  and  soft  parts  may  be  corrected 
by  the  timely  administration  of  chloral,  and  exhaustion  may  be  pre- 
vented by  giving  it  in  such  a  way  as  to  suspend  irregular  uterine 
action  and  to  procure  sleep.  After-pains  are  stopped  by  chloral.  In 
all  these  cases  of  obstetric  diseases,  large  doses  are  generally  required. 

A  solution  of  chloral  is  an  excellent  antiseptic  application  to  foul 
wounds:  it  destroys  the  odor  of  putrefaction,  arrests  fermentative 
changes,  and  promotes  the  formation  of  healthy  granulations.  It  may 
be  used  to  preserve  anatomical  preparations  and  morbid  specimens. 
A  weak  solution  of  chloral  (gr.  j  to  grs.  iv —  §  j)  is  an  excellent  in- 
jection in  gonorrhoea. 

Equal  parts  of  chloral  and  camphor,  triturated  together,  form  a 
clear  fluid,  which  is  often  of  great  service  in  neuralgia,  applied  to  the 
affected  part.  It  is  painted  lightly  over  the  surface  with  a  camel's- 
hair  brush,  and  is  allowed  to  dry  on.  It  is  said  to  allay  spasmodic 
cough  when  painted  over  the  larynx.  The  solution  of  camphor  and 
chloral  thus  prepared  has  decided  solvent  properties.  Morphine  sul- 
phate will  dissolve  in  it  in  the  proportion  of  a  scruple  to  two  drachms, 
and  chloroform  can  then  be  added  without  a  separation  of  the  ingre- 
dients. A  mixture  thus  prepared  is  a  very  effective  local  application 
in  superficial  neuralgice,  and  as  an  internal  remedy  in  colic,  cholera- 
morbus,  cholera,  etc. 

Authorities  referred  to : 

AMORT,  DR.  ROBERT.     The  New  York  Medical  Journal,  TO!,  xv,  p.  606. 
ANDREWS,  DR.  J.  B.     The  Physiological  Action  and  Therapeutic  Use  of  Chloral,  Utica. 
N.  V.,  1871. 


CROTON-CHLORAL  HYDRATE.  619 

BROWNE,  LENNOX.     The  British  Medical  Journal,  March  7,  1874,  p.  304. 

DA  COSTA,  DR.  J.  M.  Clinical  Notes  on  Chloral.  American  Journal  of  Medical  Sci- 
ences, April,  1870,  p.  359. 

DEMARQUAY,  M.     Notes  sur  le  Chloral.     Bulletin  de  Therapeutigve,  vol.  Ixxvii,  p.  307. 

HUSEMANN,  DR.  THEOD.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  1088. 

KEEN,  DR.  W.  W.  The  Anatomical,  Pathological,  and  Surgical  Uses  of  Chloral. 
American  Journal  of  Medical  Sciences,  July,  1875. 

LIEBREICH,  DR.  OSCAR.  Das  Chloralhydrat,  ein  neues  Hypnoticum  und  AncBstheticum, 
und  dessen  Anwendung  in  der  Medicin,  zweite  Auflage,  Berlin,  1869. 

LANGE,  DR.  Ueber  die  Wirkung  des  Chloralhydrat.  Berliner  klinische  Wochenschrift, 
No.  10,  1870. 

PERSONNE  AND  BOUCHUT,  MM.     The  Medical  Times  and  Gazette,  vol.  xi,  1869,  p.  605. 

RICHARDSON,  DR.  B.  W.  On  the  Physiological  Actions  of  Chloral.  The  Medical 
Times  and  Gazette,  vol.  xi,  1869. 

REYNOLDS,  DR.  J.  RUSSELL.     The  Practitioner,  vol.  iv,  p.  188,  March,  1870. 

TOMASZEWICZ,  A.  Die  Wirkungen  des  Chloral  und  der  Trichloressigsaure.  Archiv 
fur  Physiologie,  ix,  p.  35,  Mai,  1874.  Schmidt's  Jahrbiicher,  No.  8,  1874. 

WELLS,  MR.  SPENCER.  On  Hydrate  of  CMoral  and  its  Use  in  Practice.  The  Medical 
Times  and  Gazette,  vol.  xi,  1869. 


Croton-Chloral  Hydrate. — This  substance  occurs  in  rather  small  and 
brilliant  tabular  crystals.  It  is  soluble  in  water,  but  not  freely  so  ; 
and,  as  respects  antagonists  and  incompatibles,  may  be  classed  with 
chloral  hydrate.  Dose,  grs.  ij — grs.  xv,  largely  diluted  in  water.  It 
may  also  be  conveniently  made  into  pills  with  glycerite  of  traga- 
canth. 

PHYSIOLOGICAL  ACTIONS  AND  THERAPY. — Croton-chloral  resembles 
chloral  in  its  hypnotic  action,  but  it  is  feebler  and  also  less  certain. 
As  in  lethal  doses  it  causes  death  by  paralysis  of  respiration,  it  is 
admissible  in  cases  of  weak  heart.  It  differs  from  chloral,  especially 
in  the  singular  property  which  it  possesses  of  causing  anaesthesia  of  the 
head.  Croton-chloral  is  much  less  certain  in  its  effects  than  chloral  : 
sometimes  one  or  two  grains  will  relieve  severe  trigeminal  neuralgia  ; 
and  often  from  five  to  fifteen  grains  are  necessary.  When  pain  is  to 
be  relieved  and  sleep  procured,  the  best  results  are  obtained  by  a  com- 
bination of  the  two  agents. 

Croton-chloral  has  proved  very  effective  in  various  neuralgias.  It 
has  been  especially  useful  in  tic-douloureux,  in  which  it  should  be  given 
in  doses  of  two  to  five  grains  every  hour  or  two,  until  fifteen  grains 
have  been  taken.  It  is  probably  not  safe  to  exceed  this  amount  at 
one  time.  The  pains  of  dysmenorrhoea  and  sciatica  have  also  been 
relieved  by  the  use  of  this  remedy. 

Authorities  referred  to  : 

THE  BRITISH  MBDICAL  JOURNAL,  October  30,  1873,  March  7,  1874. 
SCHMIDT'S  JAHRBUCHER.     Papers  by  Profs.  Liebreich,  Benson,  Baker,  and  Wichham 
Legg,  Band  161,  p.  16 


620  CEREBRAL   SEDATIVES. 

Chloralamide. — Chloral  and  formamide.  Occurs  as  a  whitish,  crys- 
talline substance,  having  a  somewhat  bitter  taste.  It  is  soluble  in 
water,  but  not  freely  so  (about  14  to  100)  at  ordinary  temperature. 
It  may  be  administered  hypodermatically,  but  preferably  in  the  form 
of  powder,  or  wafer,  or  capsule.  The  dose  ranges  between  gr.  v  and 
3  j,  but  the  hypnotic  dose  has  been  fixed  at  forty-five  grains  as  effi- 
cient in  most  cases  in  adults. 

ACTIONS  AND  USES. — Chloralamide  is  not  very  quick  in  action — an 
hour  or  two  elapsing  before  its  characteristic  effects  are  manifest.  It 
is  said  to  be  somewhat  more  prompt  when  administered  by  the  rectum. 
It  is  a  hypnotic,  lessens  the  reflexes,  acts  on  the  vaso-rnotor  center 
in  the  medulla,  reducing  the  blood  pressure  ;  lowers  the  respiratory 
movements  and  the  action  of  the  heart.  When  sleep  is  caused  by 
small  doses  the  repose  is  quiet,  undisturbed  by  dreams,  and  no  after 
headache  or  nausea  occur.  That  Chloralamide,  as  claimed  by  its  pro- 
prietors, is  absolutely  free  from  untoward  effects,  can  not  be  admitted  ; 
for  when  massive  doses  are  given  the  same  results  follow  as  are  ob- 
served from  most  of  the  members  of  the  aromatic  and  fatty  series 
of  medicaments — that  is,  more  or  less  profuse  sweating  comes  on,  a 
rigor  announces  the  onset  of  an  active  reaction,  and  irregular  action 
of  the  heart  and  sighing  and  shallow  respiration  occur.  In  sufficient 
quantity  it  acts  on  the  blood,  also  disorganizing  the  red  blood-glob- 
ules, separating  the  haemoglobin,  and  giving  to  the  blood  the  charac- 
teristic chocolate  color,  or  brownish-black  hue,  such  as  the  other  reme- 
dies of  the  group  bring  about  when  freely  administered. 

A  measles-like  eruption  is  apt  to  appear  on  the  skin  ;  and  in  one 
instance  Pye-Smith  noticed  an  exfoliation  of  the  skin,  as  in  scarlatina. 
In  this  respect,  again,  chloralamide  resembles  its  congeners. 

In  its  therapeutical  applications  chloralamide  partakes  of  the  effects 
of  its  constituents — chloral  and  formamide.  It  is  an  efficient  hypnotic 
when  wakefulness  is  not  due  to  pain.  It  occupies  a  position  between 
chloral  and  paraldehyde  as  a  sleep-producer,  and,  like  them,  is  efficient 
the  less  the  wakefulness  is  due  to  serious  disturbances.  It  has  been 
used  with  success  in  the  insomnia  of  fevers  and  acute  affections,  but 
has  not  succeeded  well  in  delirium  tremens.  In  asylum  practice  chlo- 
ralamide has  been  employed  in  the  wakefulness  of  the  insane,  but  not 
with  a  higher  measure  of  success  than  has  attended  other  approved 
hypnotics.  Dr.  Strahan  used  it  in  two  hundred  cases  of  mental  dis- 
order in  which  insomnia  was  the  chief  feature,  but  he  found  it  no 
more  efficient  than  chloral  or  paraldehyde,  although  it  may  be  safer. 
Dr.  Umpfenbach,  an  alienist,  tried  it  in  many  cases  of  insomnia  in 
asylum  practice,  but  it  proved  to  have  no  advantages  over  chloral. 

In  the  wakefulness  of  paralysis  agitans,  of  sclerosis,  and  other 
cerebral  affections  it  acts  favorably.  Good  results  may  be  expected 
from  its  use  in  nocturnal  epilepsy.  Alt  reports  favorably  on  its  util- 


SULPHONAL.  621 

ity  in  chorea,  having  effected  cures  with  it  when  other  approved  reme- 
dies had  failed. 

Sulphonal. — This  name  is  applied  to  a  chemical  product  of  the 
same  series  as  chloralamide,  and  they  closely  correspond  in  physio- 
logical action.  Sulphonal  occurs  in  colorless,  tasteless,  and  odorless 
crystals,  not  freely  soluble  in  cold  water  (1  to  100  or  150),  but  more 
freely  in  boiling  water.  It  is  best  administered  in  powder,  in  wafer, 
or  in  capsule.  The  dose  ranges  from  gr.  v  to  gr.  xxx. 

Kast,  who  first  investigated  the  properties  of  sulphonal,  found  it 
to  be  without  toxic  qualities  ;  but  the  large  clinical  use  made  of  the 
new  hypnotic  speedily  revealed  the  fact  that  it  may  cause  untoward 
symptoms,  and  already  numerous  deaths  from  it  have  been  reported. 
It  is  not  actively  toxic.  Very  early  attention  was  called  to  its  dan- 
gers, when  given  in  too  large  doses,  by  Morandon,  Voisin,  Falret,  and 
others,  and  Dr.  Petitt,  of  Dayton,  reported  a  death  from  its  adminis- 
tration to  a  melancholic  after  two  doses  of  one  gramme  (15 '4  grains) 
each.  Toxic  doses  in  animals  cause  death  by  coma  and  convulsions, 
preceded  by  disorder  of  muscular  movements  (Mairet,  Knoblauch). 

Sulphonal  is  a  certain  and  comparatively  safe  hypnotic.  To  pro- 
cure the  best  results  from  it,  certain  peculiarities  of  its  action  must 
be  regarded.  Its  hypnotic  effect  develops  somewhat  slowly,  and  from 
two  to  four  hours  elapse  after  it  is  taken  before  sleep  comes  on. 
Hence  it  should  be  administered  early  in  the  evening  if  it  is  desired  to 
affect  the  patient  the  first  part  of  the  night.  As  the  effects  of  sulpho- 
nal come  on  slowly,  so  in  a  corresponding  degree  they  are  apt  to  be 
prolonged.  More  or  less  drowsiness  is  experienced  the  next  day  after 
a  single  dose,  and  it  often  happens  that  sleep  is  better  on  the  second 
night.  Where  the  administration  of  sulphonal  is  rendered  necessary 
for  a  continuous  period,  it  often  suffices  to  administer  a  sufficient  dose 
on  alternate  nights.  Combination  with  trional  improves  the  action, 
and  is  often  effective.  If  a  dose  of  trional  be  administered  at  bed- 
hour,  with  sulphonal,  the  hypnotic  action  begins  promptly,  and  is 
carried  on  through  the  after  part  of  the  night.  Thus,  sulphonal,  gr.  x  ; 
trional,  gr.  v.  M.  Ft.  pulv.  no.  i.  The  existence  of  pain,  or  the 
febrile  state,  interferes  with  its  action  as  a  sleep-producer.  It  is  not 
followed  by  unpleasant  after-effects — by  nausea,  headache,  hebetude 
of  mind.  As  a  hypnotic  it  has  been  largely  used  in  asylum  practice 
in  all  forms  of  chronic  mental  disorders  characterized  by  insomnia,  in 
paranoia,  mania,  and  hallucinatory  delusions  caused  by  alcoholism, 
and  in  fevers,  inflammatory  diseases,  and  other  acute  and  chronic  mala- 
dies. Valvular  disease  of  the  heart  does  not  contraindicate  its  use. 

As  compared  with  chloral,  sulphonal  is  rather  more  certain  and 
far  safer.  It  is  more  efficient  and  safer  than  chloralamide  as  a  hyp- 
notic merely,  although  its  range  of  action  is  smaller. 


622  CEREBRAL   SEDATIVES. 

Trional. — Sufficient  experience  has  now  been  gained  with  trional  to 
establish  it  permanently  in  the  group  of  hypnotics.  It  is  closely  allied 
to  sulphonal,  but  it  is  much  more  prompt  in  action.  Its  effects  begin 
in  fifteen  minutes  to  a  half  hour,  and  continue  four  to  eight  hours, 
according  to  the  size  of  the  dose.  It  is  almost  entirely  free  from  un- 
pleasant after  disturbances,  and  does  not  cause  nausea  or  other  stom- 
ach distress,  nor  are  confusion  of  mind  and  headache  results  of  its 
impression  on  the  brain.  Like  other  hypnotics  of  this  kind,  trional 
has  little  power  to  relieve  pain,  which  in  turn  affects  the  hypnotic 
action.  Combination  with  other  remedies  of  the  same  group  promotes 
the  action  of  each  component  of  the  prescription.  This  seems  to  be 
true  especially  of  sulphonal  and  trional,  as  already  explained.  Dose, 
five  to  ten  grains,  in  powder,  wafer,  or  compressed  pellet. 

Chloralose  is  a  new  chemical  product  with  this  proprietary  desig- 
nation. It  is  obtained  by  the  action  of  chloral  on  glucose,  and  is  a 
crystalline  substance.  The  dose  ranges  from  two  to  five  grains.  It 
is  said  to  be  an  excellent  and  certain  hypnotic,  producing  its  effect 
without  causing  any  untoward  accidents.  Further  experience  is  neces- 
sary to  demonstrate  its  real  place  as  a  remedy. 

Amylen  Hydrate  is,  in  chemical  language,  dimethyl-ethylcarbinol,  a 
name  too  unwieldy  for  common  use,  and  hence  the  present  designation. 
It  is  a  transparent,  colorless  liquid,  having  an  odor  of  a  disagreeable 
kind  resembling  paraldehyde,  and  a  camphoraceous  taste.  The  dose 
ranges  from  five  minims  to  3  j.  The  best  vehicle  for  covering  the  taste 
is  extract  of  licorice.  For  hypodermic  administration  it  may  be  dis- 
solved in  distilled  water,  in  oil  of  vaseline,  or  in  chloroform  water. 

Amylen  hydrate  appears  to  have  no  local  irritant  action,  and  is 
feebly  toxic.  Very  large  doses  have,  it  is  true,  caused  stomachal 
disturbance,  but  ordinary  medicinal  doses  are  free  from  such  effects. 
The  action  of  the  heart  and  respiratory  movements  are  lowered  by  it, 
and  febrile  temperature  is  depressed  from  toxic  doses  ;  the  reflexes 
are  lessened  in  activity  and  ultimately  abolished  ;  the  normal  body- 
heat  is  reduced,  and  profound  coma  and  insensibility  ensue.  From 
such  a  condition  of  coma  and  vital  depression  due  to  a  mistake  in  the 
quantity  of  amylen  hydrate  given,  some  patients  in  the  Leipsic  Hospital 
recovered  on  the  third  day  without  any  recognizable  after  ill-conse- 
quences. The  hypnotic  effect  follows  the  ingestion  of  the  remedy  in 
a  few  minutes — from  five  to  fifteen  or  twenty  minutes — and  is  rarely 
postponed  to  an  hour ;  and  if  produced  by  ordinary  medicinal  doses, 
no  change  takes  place  in  the  rhythm  and  force  of  the  cardiac  move- 
ments, nor  in  the  respiratory  movements. 

Von  Mering,  whose  experience  was  gained  in  Jolly's  clinic,  was  the 
first  to  ascertain  the  powers  of  amylen  hydrate  as  a  hypnotic.  Schar- 


CHLOKETONE.  623 

schmidt  found  it  to  be  successful  in  eighty  per  cent  of  his  cases  as  a 
hypnotic,  the  subject  of  these  experimental  trials  being  in  the  clinic 
of  psychiatry.  The  duration  of  the  sleep  is  usually  six  to  eight  hours. 
Two  to  four  grammes  (30  to  60  grs.)  were  prescribed  on  the  first 
trials,  but  subsequent  experience  shows  that  a  less  amount — from  five 
to  twenty  grains — will  usually  succeed  in  procuring  sound  sleep  of 
several  hours'  duration.  The  existence  of  pain  and  other  systemic 
disturbances  will  interfere  with  its  action. 

Amylen  hydrate  apparently  deserves  attentive  consideration  as 
a  hypnotic.  Where  insomnia  is  the  main  condition  and  no  other 
sources  of  disturbance  exist,  it  is  one  of  the  most  promising  remedies. 
In  the  insomnia  of  mental  disorders,  Krafft-Ebing  has  prescribed  it 
with  success.  By  Von  Mering  it  has  been  used  in  delirium  tremens 
with  distinct  advantage.  Dr.  Wildermuth  has  employed  it  in  epilepsy, 
and  finds  it  exceptionally  useful  in  cases  of  the  grand  mal,  especially 
when  nocturnal.  He  found  it  also  to  have  great  utility  in  the  removal 
of  bromism,  while  at  the  same  time  it  prevented  the  recurrence  of  the 
epileptic  paroxysms. 

In  various  spasmodic  and  vase-motor  neuroses,  such  as  asthma,  sin- 
gultus,  whooping-cough,  tetanus,  strychnine  poisoning,  it  has  afforded 
great  relief.  The  condition  of  muscular  cramp  is  an  indication  for  its 
use.  Although  not  an  analgesic,  it  relieves  pain  indirectly  by  allaying 
the  cramp  which  is  the  cause  of  pain.  In  this  way  it  brings  about  relief 
to  hepatic  colic,  and  also,  it  is  said,  removes  the  catarrhal  state  of  the 
mucous  membrane  which  is  the  cause  of  the  accompanying  jaundice. 

Ghloretone  is  a  white  crystalline  substance  having  a  camphoraceous 
appearance  and  odor.  Its  composition,  according  to  Willgerodt,  is 

CH3 

CC13— C— OH, 
CH3 

and  is  therefore  a  trichlor  tertiary  butyl  alcohol. 

Chloretone  is  sparingly  soluble  in  cold  water,  but  is  freely  soluble 
in  ether,  chloroform,  acetone,  and  strong  alcohol. 

It  may  be  administered  in  pill,  capsule,  or  powder,  and  may  be  inhaled 
in  the  form  of  vapor.  When  introduced  into  the  stomach  or  injected 
subcutaneously  or  intravenously,  or  its  vapor  inhaled,  it  passes  into 
the  blood  quickly  and  diffuses  through  all  parts  of  the  organism.  In 
actual  contact  with  the  tissues,  it  lowers  sensibility,  ultimately  sus- 
pending the  pain-sense  and  causing  complete  anaesthesia  if  the  amount 
applied  is  sufficient.  As  a  local  ansesthetic  its  effects  are  closely  allied 
to  those  of  cocaine.  It  has  a  selective  action  on  the  brain  and  nervous 
system,  from  which  it  is  obtained  in  larger  quantity  than  from  any 
other  part  of  the  body.  It  does  not  affect  the  composition  of  the 


624*  CEREBRAL   SEDATIVES. 

blood  nor  act  on  the  blood-globules,  nor  on  the  haemoglobin.  As 
regards  the  circulation,  the  effects  are  not  those  of  a  depressing  agent ; 
the  blood-pressure  usually  remains  unaffected  and  the  amplitude  of 
the  pulse-wave  continues  undiminished. 

Chloretone  administered  in  any  way  causes  hypnotism  and  anaes- 
thesia. The  functions  of  the  brain,  cord,  and  neurons  are  ultimately 
suspended  if  the  amount  ingested  has  been  sufficient.  It  is  not 
eliminated  in  the  form  in  which  it  is  taken,  and  does  not  appear 
as  chloretone  in  the  expired  air  and  in  the  urine.  As  the  relative 
proportion  of  chlorides  in  the  urine  is  increased  by  its  administration, 
it  is  probable  that  it  undergoes  oxidation  in  its  passage  through  the 
system. 

Chloretone  is  distinctly  antiseptic,  preventing  the  decay  of  organic 
matters,  both  solid  and  fluid,  by  destroying  the  organisms  concerned 
in  putrefactive  decomposition.  A  solution  of  five  per  cent  is  sufficient 
to  prevent  change  in  organic  fluids  and  to  render  sterile  instruments 
and  vessels. 

The  therapeutical  applications  of  chloretone  are  based  on  its  physio- 
logical actions.  As  it  is  not  actively  toxic,  the  dose  ranges  from  5  to 
20  grains,  in  pill,  or  tablet,  or  wafer.  As  a  local  application  the  finely 
divided  powder  may  be  used,  or  a  half-per-cent  solution,  or,  vaporized 
by  heat,  it  may  be  inhaled  cautiously. 

It  is  a  useful  local  antiseptic  and  anaesthetic  in  cases  of  wounds  and ' 
injuries  requiring  such  an  agent.  Internally,  in  cases  of  nausea  and 
vomiting,  seasickness,  ulcer  of  stomach,  vomiting  of  pregnancy,  and 
similar  conditions,  it  is  an  efficient  remedy. 

Chloretone  is  indicated  in  insomnia  due  to  painful  affection,  for  it 
is  anaesthetic  as  well  as  hypnotic.  To  procure  the  best  results  from 
its  administration  in  cases  of  insomnia,  it  should  be  given  several  hours 
before  the  expected  period  of  wakefulness. 

Dormiol. — Amylene  chloral. 

COMPOSITION  AND  PROPERTIES. — By  the  combination  of  amylene 
hydrate  with  chloral  hydrate,  dormiol  is  produced.  It  is  an  oily, 
limpid  liquid,  volatile,  and  having  an  aromatic  and  somewhat  pun- 
gent taste.  It  is  not  decomposed  at  the  boiling  temperature.  It  is 
soluble  in  alcohol,  ether,  benzene,  chloroform,  and  the  fatty  and  ethe- 
real oils.  When  mixed  in  equal  proportions  with  water  it  forms  a 
milky  fluid,  which  gradually  clears.  This  fifty-per-cent  solution  is 
utilized  for  making  a  preparation  for  dispensing,  by  mixing  one  part 
with  four  parts  of  water,  but  it  must  be  kept  in  a  cool  place  and  in 
the  dark,  as  it  is  liable  to  undergo  decomposition  if  exposed. 

The  dose  of  this  ten-per-cent  solution  is  from  3  j  to  3  iv.  When 
administered  as  a  hypnotic,  it  has  been  found  to  act  more  efficiently  in 
a  single  large  dose  than  in  a  succession  of  smaller  doses. 


DORMIOL.  625* 

PHYSIOLOGICAL  ACTIONS. — Applied  to  the  external  integument, 
dormiol  causes  a  burning  sensation  followed  by  vesication,  and  this  is 
surrounded  by  a  reddish  erythematous  zone.  It  is  an  antiseptic,  arrest- 
ing decomposition  and  destroying  foul  odors.  In  the  ordinary  medic- 
inal administration  it  does  not  disagree  with  the  stomach,  nor  does  it 
impair  the  appetite.  It  is  not  constipating.  Dormiol  is  absorbed 
promptly,  and  its  actions  are  manifest  within  fifteen  minutes  to  a  half 
hour  after  taking. 

As  its  composition  indicates,  its  effects  are  expended  on  the  gray 
matter  of  the  cerebrum,  producing  quiet  and  deep  sleep,  according 
to  the  amount  taken.  Its  hypnotic  action  is  not  absolutely  certain, 
for  it  does  occasionally  fail ;  but  usually  it  causes  quiet  sleep,  even 
in  conditions  of  high  mental  excitement.  The  duration  of  the  sleep 
varies  from  one  to  ten  hours,  the  average  being  about  five  hours,  and 
the  subject  awakes  refreshed,  without  headache  or  other  disturbances. 
The  circulation  and  respiration  are  not  affected  by  ordinary  medicinal 
doses,  and  it  passes  through  the  blood  unchanged. 

THERAPY. — Dormiol's  particular  sphere  of  action  is  as  a  hypnotic. 
As  it  is  quite  prompt  in  action,  it  suffices  to  give  an  efficient  dose  a 
half  hour  before  the  expected  time.  In  mental  disorders  it  has  been 
used  with  much  success.  It  not  only  procures  sleep,  but  by  allaying 
mental  excitement  brings  about  a  more  healthy  mental  state.  Cures 
have  been  effected  by  its  timely  and  efficient  administration.  In  alco- 
holic delirium  it  is  more  useful  and  far  safer  than  chloral.  As  it  does 
not  affect  the  circulation,  it  may  be  given  whenever  wakefulness  is  to 
be  overcome,  quite  irrespective  of  the  state  of  the  heart  and  vessels. 


624  CEREBRAL   SEDATIVES. 

Opium. — Opium.  Opium,  Fr.  ;  Opium,  Ger.  The  concrete  milky 
exudation  obtained  in  Asia  Minor  from  the  unripe  capsules  of  Papa- 
ver  somniferum,  by  incision  and  spontaneous  evaporation.  (Nat.  Ord. 
Papaveracece). 

Opium  should  yield  at  least  nine  per  cent  of  morphine  by  the  pro- 
cess of  assay. 

Opii  Pulvis. — Powdered  opium.  Opium  dried  at  a  temperature 
not  exceeding  185°  Fahr.,  and  reduced  to  a  moderately  fine  powder 
(No.  50).  It  should  contain  not  less  than  twelve  nor  more  than  six- 
teen per  cent  of  morphine.  Dose,  gr.  j — gr.  iij. 

Opium  Deodoratum. — Deodorized  opium.  Opium  freed  from  ma- 
terials soluble  in  ether — odorous  matters,  narcotine,  etc.  It  should 
contain  fourteen  per  cent  of  morphine.  Dose,  gr.  j — gr.  iij. 

Emplastrum  Opii, — Plaster  of  opium.  (Extract  of  opium,  Bur- 
gundy pitch,  and  lead-plaster.) 

Mctractum  Opii. — Extract  of  opium.     Dose,  gr.  ss — gr.  ij. 

Pilulce  Opii. — Pills  of  opium.  Dose,  one  to  four  pills.  Each  pill 
contains  one  grain  of  opium. 

Pulvis  Ipecacuanhoe  et  Opii. — Compound  powder  of  ipecacuanha. 
Dover's  powder.  Ten  grains  contain  one  grain  each  of  ipecac  and  of 
opium,  and  eight  grains  of  sugar  of  milk. 

Tinctura  Opii. — Tincture  of  opium.  Laudanum.  Thirteen  min- 
ims or  twenty-five  drops  are  equivalent  to  one  grain  of  opium.  ^ 

Acetum  Opii. — Vinegar  of  opium.  Ten  minims  or  twenty  drops 
are  about  equal  to  one  grain  of  opium. 

Tinctura  Opii  Camphorata. — Camphorated  tincture  of  opium. 
Paregoric.  Half  a  fluid  ounce  contains  nearly  one  grain  of  opium. 
Dose,  for  children,  from  gtt.  v. — gtt.  xx  ;  for  adults,  from  3  j —  §  j. 

Trochisci  Glycyrrhizce  et  Opii. — Troches  of  licorice  and  opium. 
Dose,  one  to  three  or  four. 

Tinctura   Opii  Deodorati. — Deodorized  tincture  of  opium.     Dose, 

m  v—  3  j. 

Vinum  Opii. — Wine  of  opium.  (Opium,  cinnamon,  cloves,  sherry 
wine.)  Dose,  ft\,  v —  3  j. 

COMPOSITION. — About  half  of  the  weight  of  opium  is  made  up 
of  gum,  pectin,  albumen,  fragments  of  the  poppy-capsules,  and  cal- 
careous salts.  It  contains,  also,  some  coloring-matter,  and  a  volatile 
substance  in  minute  quantity.  The  proportion  of  water  varies  from 
twelve  to  thirty  per  cent.  A  large  number  of  basic,  acid,  and  neutral 
substances  have  been  and  are  still  being  discovered  in  opium,  hence  its 
chemistry  is  very  complex. 

The  following  natural  alkaloids  have  been  found  in  opium.  Vari- 
ous derivatives  of  these  have  also  been  described.  This  list,  except 
some  unimportant  modifications,  is  taken  from  Fltickiger  and  Han- 
bury's  admirable  Pharmacographia  : 


OPIUM.  625 

Hydrocotarnine. — Crystallizable,  alkaline.     Volatile  at  100°.     (Clt 

H..N.O,.) 

Morphine  (morphina). — Crystallizable,  alkaline.     (C^H^NjO,.) 
Pseudo-morphine. — Crystallizes  with   HaO,   does   not   unite   even 
with  acetic  acid.     (C^H^NjO^) 

Codeine  (codeina). — Crystallizable,  alkaline,  soluble  in  water.     (Clg 

H4NA.) 

Thebaine  (thebaina). — Crystallizable,  alkaline.     (C^H^IN^O,.) 
Protopine. — Crystallizable,  alkaline.     (C^H^NjC^.) 
Laudamine. — An  alkaloid,  which,  as  well  as  its  salts,  forms  large 
crystals.     (C^H^N^-) 

Codamine. — Crystallizable,  alkaline  ;  can  be  sublimed.     (C^H^Nj 

0,) 

Papaverine  (papaverina). — Crystallizable,  alkaline.     (CajHaiN1O4.) 

Khceadine. — Crystallizable,  not  distinctly  alkaline  ;  can  be  sub- 
limed.  (C^H^O..) 

Meconidine. — Amorphous,  alkaline  ;  melts  at  58°  ;  not  stable  ;  the 
salts  also  easily  altered.  (CaHa8N,O4.) 

Cryptopine  (cryptopina). — Crystallizable,  alkaline  ;  salts  tend  to 
gelatinize  ;  hydrochlorate  crystallizes  in  tufts.  (C^H^NjO,..) 

Laudanosine. — Crystallizable,  alkaline.     (CaiHaTN1O4.) 

Narcotine  (narcotina). — Crystallizable,  not  alkaline  ;  salts  not  sta- 
ble. (C^H^N.Cv) 

Lanthopine. — Microscopic  crystals,  not  alkaline.     (CJ3H!16N1O4.) 

Narceine  (narceina). — Crystallizable  as  a  hydrate  ;  readily  soluble 
in  boiling  water  or  in  alkalies.  (CasHa.N^Cv) 

The  only  important  derivative  in  the  therapeutic  sense  is  apomor- 
phine,  obtained  from  morphine  by  the  action  of  hydrochloric  acid. 
This  possesses  active  emetic  property,  and  will  be  grouped  with 
emetics. 

Besides  the  foregoing  alkaloidal  and  basic  substances,  opium  con- 
tains a  peculiar  acid  (meconic  acid),  and,  according  to  T.  and  H.  Smith, 
a  peculiar  form  of  lactic  acid  (thebolactic). 

The  proportion  of  morphine  in  Turkey  opium  should  not  be  less 
than  ten  per  cent,  and  in  good  specimens  may  reach  fifteen  per  cent. 
Pseudo-morphine  occurs  in  the  minute  quantity  of  0'02  per  cent.  The 
proportion  of  codeine  varies  from  one  fifth  to  two  fifths  per  cent.  The- 
baine and  papaverine  exist  in  Turkey  opium  in  about  the  proportion 
of  one  per  cent.  Narcotine  is  found  in  considerable  quantity  in  differ- 
ent varieties  of  opium,  and  ranges  in  amount  from  one  and  five  tenths 
to  ten  per  cent.  Narceine  varies  from  O'l  to  O'Tl.  The  quantity  of 
cryptopine  and  rhceadine  is  extremely  small. 

The  morphine  of  opium  exists  in  the  drug  in  the  form  of  the  tri- 
basic  meconate.  The  proportion  of  meconic  acid  is  about  three  to  four 
per  cent  of  the  crude  opium. 


626  CEREBRAL   SEDATIVES. 

The  value  of  opium  depends  on  the  quantity  of  morphine  which  it 

contains. 

Morphina. — Morphine.  In  colorless  crystals,  which  are  inflammable 
and  wholly  dissipated  by  red  heat.  It  is  scarcely  soluble  in  cold  water. 
sligntly  so  in  boiling  water,  and  freely  soluble  in  boiling  alcohol. 
Nitric  acid  first  reddens  it,  and  then  renders  it  yellow.  With  a  solu- 
tion of  sesquichloride  of  iron,  it  assumes  a  deep-blue  color.  Its  so- 
lution restores  the  color  of  litmus,  previously  reddened  by  an  acid. 
(U.  S.  P.) 

Morphines  Acetas. — Morphine  acetate.  A  white,  yellowish- white, 
crystalline  or  amorphous  powder,  slowly  losing  acetic  acid  when  kept 
for  some  time  and  exposed  to  the  air,  having  a  faintly  acetous  odor, 
a  bitter  taste,  and  a  neutral  or  faintly  alkaline  reaction.  When  fresh- 
ly prepared,  the  salt  is  soluble  in  twelve  parts  of  water  and  in  sixty- 
eight  parts  of  alcohol ;  if  it  has  been  kept  for  some  time,  it  is  incom- 
pletely soluble  in  water,  unless  a  little  acetic  acid  is  added.  Dose,  gr. 
|— gr.  ss. 

MorphincB  Hydrochloras. — Morphine  hydrochlorate.  In  snow- 
white,  feathery  crystals,  wholly  soluble  in  water  and  in  alcohol.  Dose, 

gr-  i— gr-  ss- 

Morphince  Sulphas. — Morphine  sulphate.  In  snow-white,  feathery 
crystals,  which  are  wholly  soluble  in  water.  Dose,  gr.  \ — gr.  ss.  ^ 

Pulvis  Morphince  Compositus. — Compound  powder  of  morphine 
(Tully's  powder).  (Morphine  sulphate,  one  grra.;  camphor,  nineteen 
grm.;  glycyrrhiza,  twenty  grm.;  precipitated  calcium  carbonate,  twen- 
ty parts  ;  and  sufficient  alcohol  to  make  sixty  grm.)  Dose,  gr.  j — 
gr.  x. 

Trochisci  Morphines  et  Ipecacuanha. — Troches  of  morphine  and 
ipecacuanha.  (Morphine,  ipecac,  sugar,  oil  of  gaultheria,  mucilage.) 

Codeina. — Codeine.  White,  or  yellowish- white,  more  or  less  trans- 
lucent, rhombic  prisms,  somewhat  efflorescent  in  warm  air,  odorless, 
having  a  slightly  bitter  taste  and  an  alkaline  reaction.  Soluble  in 
eighty  parts  of  water  at  60°  Fahr.  and  in  seventeen  parts  of  boiling 
water  ;  very  soluble  in  alcohol  and  in  chloroform  ;  also,  soluble  in  six 
parts  of  ether.  Dose,  gr.  ss — gr.  ij. 

Various  salts  of  codeine  are  now  prepared,  but  the  sulphate  is  the 
most  important  and  desirable. 

The  other  alkaloids  of  opium  are  not  official. 

Narcotinoe,  Hydrochloras. — Hydrochlorate  of  narcotine  (not  offi- 
cial). Dose,  gr.  ij — gr.  x,  as  an  antiperiodic. 

ANTAGONISTS  AND  INCOMPATIBLES. — As  regards  chemical  antago- 
nism, the  alkaline  carbonates,  lime-water,  and  the  salts  of  iron,  lead, 
copper,  zinc,  mercury,  and  Fowler's  solution,  are  incompatible  with 
the  preparations  of  opium.  Notwithstanding  this  chemical  incom- 


OPIUM.  627 

patibility,  the  metallic  salts  are  frequently  given  in  conjunction  with 
opium,  and  the  systemic  effects  of  both  are  produced.  Astringent 
vegetables  (tannin)  are  also  incompatible  ;  they  limit  physiological 
activity  by  forming  tannate  of  morphine,  which  is  not  readily  soluble. 

In  cases  of  opium-poisoning,  if  any  portion  of  the  drug  remain  un- 
absorbed  in  the  stomach,  the  most  prompt  and  efficient  emetic  should 
be  used.  Apomorphine  should  be  injected  subcutaneously,  if  the  patient 
is  unable  to  swallow  ;  if  conscious,  the  sulphate  of  copper  may  be  ad- 
ministered by  the  stomach.  In  a  case  of  opium  narcosis  which  re- 
sisted ordinary  emetics,  violent  emesis  was  induced  by  a  solution  of 
bicarbonate  of  sodium,  followed  by  a  solution  of  tartaric  acid.  In  the 
absence  of  other  and  more  active  emetics,  powdered  mustard  may  be 
administered — a  tablespoonful  to  a  teacupful  of  warm  water.  When 
the  opium  swallowed  is  in  solution,  the  stomach-pump  should  be  used 
if  the  narcosis  is  profound.  Cold  affusion,  artificial  respiration,  when 
the  breathing  flags,  and  faradization  of  the  chest-muscles,  are  measures 
of  great  practical  utility.  The  author  has  personally  witnessed  in 
several  cases  the  excellent  effects  of  faradization,  first,  in  causing  such 
irritation  of  the  surface  as  to  produce  reflex  excitation  of  the  respi- 
ratory center  ;  and,  second,  inducing  contractions  of  the  respiratory 
muscles.  As  a  peripheral  irritant,  faradization  is  more  humane  and 
seemly,  and  also  more  efficient,  than  flagellation. 

The  action  of  opium  is  antagonized,  at  least  in  a  part  of  the  sphere 
of  its  influence,  by  belladonna.  These  agents  are  opposed  as  regards 
their  influence  on  the  intra-cranial  circulation,  on  the  pupil,  on  the  re- 
spiratory organs,  and  on  the  heart.  Opium  in  lethal  doses  causes  paresis 
of  the  arterioles  and  veins  ;  belladonna  contracts  them,  and,  by  energiz- 
ing the  cardiac  movements,  substitutes  an  active  for  a  passive  conges- 
tion. It  can  not  be  too  strongly  insisted  on  in  this  connection  that  bella- 
donna in  too  great  quantity,  or  too  long  in  action,  exhausts  the  irritabil- 
ity of  the  unstriped  muscular  fiber,  and  thus  induces  the  very  state  which 
its  administration  was  intended  to  relieve.  The  state  of  the  pupil,  the 
action  of  the  heart,  and  the  condition  of  the  reflex  movements,  are  the 
guides  to  the  administration  of  belladonna  in  cases  of  opium  narcosis. 
The  smallest  quantity  of  belladonna  which  will  dilate  the  pupil,  raise 
the  tension  of  the  arterial  system,  deepen  the  respiration,  and  re-estab- 
lish the  reflex  excitability,  should  be  used.  The  author  has  a  strong 
conviction,  arising  from  some  painful  personal  experience,  that  it  is  a 
fatal  error  to  attempt  to  restore  a  patient  in  opium  narcosis  to  com- 
plete consciousness  by  repeated  doses  of  belladonna.  The  action  of 
these  agents  combined  is  to  produce  profound  sopor,  and  this  is  not  a 
condition  of  danger  so  long  as  the  pulse,  respiration,  and  reflex  move- 
ments are  in  good  condition.  To  substitute  belladonna  narcosis  for 
opium  narcosis  is  only  increasing  the  hazard  under  which  the  patient  is 
already  struggling.  Impatient  to  afford  relief,  and  assuming  that  the 


028  CEREBRAL   SEDATIVES. 

tendency  to  sleep  must  be  obviated,  the  physician  too  frequently,  as  the 
history  of  many  cases  plainly  shows,  repeats  the  doses  of  belladonna 
until  its  action  greatly  preponderates,  and  the  irritability  of  the  cardiac 
ganglia  is  completely  exhausted.  The  author,  therefore,  feels  himself 
warranted  in  repeating  that  the  utility  of  belladonna  consists  in  its 
poicer  to  maintain  the  action  of  the  heart,  and  the  respiration,  until 
elimination  has  taken  place,  and  that  even  coma  is  of  little  importance 
provided  the  respiration,  circulation,  and  reflex  movements  are  prop- 
erly maintained. 

The  hypodermatic  injection  of  atropine  is  the  most  efficient  and 
satisfactory  method  of  employing  this  physiological  antagonist.  Not 
more  than  y^7  of  a  grain  of  the  sulphate  should  be  administered  at  a 
dose,  and  this  may  be  repeated  every  fifteen  minutes  (up  to  three 
doses)  until  dilatation  of  the  pupil,  increased  power  of  the  cardiac  move- 
ments, deeper  respiration,  warmth  and  dryness  of  the  skin,  and  flush- 
ing of  the  face,  are  produced.  No  more  can  be  accomplished  by  the 
largest  doses,  and  the  results  of  the  antagonism  must  be  awaited. 
Belladonna  continues  longer  in  action  than  opium.  In  a  succeeding 
chapter,  devoted  to  the  consideration  of  the  combined  administration 
of  opium  and  belladonna,  or  morphine  and  atropine,  the  nature  and 
degree  of  the  antagonism  will  be  more  fully  elaborated. 

Coffee  is  also  an  antagonist  to  opium,  especially  caffeine  subcuta- 
neously,  in  doses  of  three  to  five  grains,  repeated  as  may  be  required,' 
up  to  twenty  grains.  Good  results  have  undoubtedly  been  obtained 
by  the  free  use  of  black  coffee,  in  milder  cases  of  opium  narcosis. 
The  unpleasant  confusion  of  mind,  and  vertigo,  which  in  so  many 
subjects  are  experienced  after  the  subsidence  of  the  effects  of  a  me- 
dicinal dose,  may  sometimes  be  removed  by  a  cup  of  strong  coffee. 
These  cerebral  effects  may  be  prevented,  or  relieved  when  they  occur, 
by  a  full  dose  of  bromide  of  potassium.  This  discovery,  if  we  may 
dignify  so  small  a  matter  by  so  imposing  a  title,  was  briefly  an- 
nounced by  the  author  in  the  first  edition  of  his  work  on  "  Hypoder- 
matic Medication." 

Gubler  has  shown  that  some  of  the  cerebral  effects  of  opium  are 
antagonized  by  quinine.  Tartar  emetic  and  digitalis  also  oppose  to 
some  extent  the  action  of  this  remedy  on  the  intra-cranial  circulation. 

SYSTEKGISTS. — The  cerebral  and  hypnotic  effects  of  opium  are  pro- 
moted by  alcohol  and  its  derivatives  (notably  chloral),  and,  within 
certain  limits,  by  the  mydriatics.  The  sudorific  action  of  opium  is  in- 
creased by  ipecacuanha. 

PHYSIOLOGICAL  ACTIONS. — As  opium  is  a  very  complex  substance, 
made  up  of  numerous  principles  which  differ  remarkably  among  them- 
selves, it  will  conduce  to  a  better  understanding  of  its  actions  to  con- 
sider, first,  opium  as  a  whole,  and  then  follow  with  some  details  re- 
garding its  individual  constituents. 


OPIUM.  629 

The  physiological  effects  of  opium  are  best  studied  as  respects — 1, 
small  medicinal  doses  ;  2,  full  medicinal  doses  ;  3,  lethal  doses. 

1.  The  preparations  of  opium  have  a  disagreeable,  bitter,  and.  rather 
nauseous  taste.     Dryness  of  the  mouth  and  fauces,  huskiness  of  voice, 
and  diminution  in  the  sense  of  taste,  occur  in  a  short  time  after  admin- 
istration of  the  drug  has  begun,  and  continue  during  the  whole  period 
of  its  influence.     To  the  dryness  succeeds  a  viscid  secretion,  which 
contains  excrementitious  matter  having  a  foul  odor.     When  opium 
does  not  produce  nausea,  the  appetite  may  not  be  impaired,  may  be 
even  increased  ;  but  the  rule  is  that  the  desire  for  food  is  lessened  by 
opium.     The  secretion  of  mucus,  and  of  the  special  glandular  appara- 
tus of  the  gastro-intestinal  mucous  membrane,  is  lessened  by  opium, 
and  hence  the  digestion  and  the  peristaltic  movements  are  less  active. 
The  excretions  being  thus  locked  up,  dullness  and  hebetude  are  expe- 
rienced, the  skin  looks  muddy,  the  tongue  is  coated,  and  the  breath  is 
offensive.     When  the  influence  of  the  opium  ceases,  it  not  unfrequent- 
ly  happens  that  the  constipation  is  succeeded  by  relaxation  of  the  in^ 
testines,  and  rather  profuse  and  fetid  evacuations,  and  increased  urin- 
ary discharges,  take  place. 

The  action  of  the  heart  becomes  stronger,  and  the  arterial  tension 
rises.  When  opium  agrees,  the  sense  of  fatigue  vanishes,  and  muscu- 
lar movements  become  more  rapid  and  easy.  The  face  flushes  a  little, 
the  pupil  contracts  slightly,  the  conjunctivse  may  be  somewhat  in- 
jected, and  the  expression  of  the  eye  more  brilliant.  At  this  stage  the 
ideas  flow  more  rapidly,  but  are  less  sustained  and  orderly.  The  ap- 
preciation of  time,  the  sequence  of  events,  and  the  sense  of  moral  fit- 
ness, are  diminished.  The  cerebral  excitement  is,  after  a  period  which 
varies  in  different  individuals,  succeeded  by  calm,  by  drowsiness,  and 
sleep  when  it  occurs  is  usually  disturbed  by  visions  and  dreams,  often 
of  a  frightful  character.  In  most  subjects,  after  the  sopor  has  passed 
off,  headache,  vertigo,  confusion  of  mind,  nausea,  constipation,  and 
muscular  hebetude,  are  experienced. 

2.  When  full   medicinal   doses   are   administered,   the   symptoms 
above  described  occur  in  a  more  intense  degree.    The  stage  of  cardiac 
stimulation  and  of  cerebral  excitement  is  of  much  shorter  duration  ; 
and  the  stage  of  intoxication  and  sopor  not  only  comes  on  more  quick- 
ly, but  is  much  more  pronounced.     At  first  the  pulse  is  increased  in 
frequency  and  the  respiratory  movements  are  more  rapid  ;  but  the  car- 
diac pulsations  soon  diminish  in  number  and  force,  and  the  respira- 
tions become  sighing  in  character  and  more  shallow.     There  is  also 
present  decided  dryness  of  the  mouth,  fauces,  and  larynx,  and  swallow- 
ing becomes  somewhat  difficult  and  the  voice  grows  husky.     Nausea 
and  vomiting,  or  at  least  weight  and  oppression  of  the  epigastrium, 
ensue.      Confusion  of   ideas,  vertigo,  somnolence,  are   succeeded  by 
deep  sleep,  contracted  pupils,  slow  and  relaxed  pulse,  slow  and  snoring 


630  CEREBRAL   SEDATIVES. 

respirations,  a  perspiring  skin,  and,  in  many  persons,  an  intense  gen- 
eral pruritus,  which,  however,  is  more  harassing  at  the  nasal  orifices. 

Persons  not  habituated  to  the  use  of  opium  usually  experience,  after 
a  full  medicinal  dose  has  expended  its  force,  very  distressing  sequelae, 
referable  to  the  cerebro-spinal  system.  The  most  important  of  these 
after-effects  are  headache,  confusion  of  mind,  vertigo — which  is  espe- 
cially severe  on  assuming  the  erect  posture — nausea,  retching  and  vom- 
iting, complete  anorexia,  and  constipation.  A  mild  but  defined  hepa- 
togenic  jaundice  not  unfrequently  occurs,  and  the  urine  is  tinged  with 
the  coloring-matter  of  the  bile. 

3.  A  lethal  dose  of  opium  causes  but  a  transient  excitement ;  the 
stage  of  narcosis  quickly  supervenes,  and  the  functions  of  animal  life 
are  often  rather  abruptly  suspended.  The  patient  soon  lapses  into  a 
condition  of  insensibility,  with  a  slow  and  feeble,  or,  it  may  be,  rapid 
and  feeble,  action  of  the  heart  ;  slow  respiration,  shallow  and  quiet  or 
stertorous  ;  face  at  first  flushed,  but  soon  becoming  shrunken,  pallid, 
and  cyanosed ;  skin  wet ;  pupils  minutely  contracted  and  insensible  to 
stimulation  ;  unconsciousness  profound,  with  muscular  relaxation  and 
abolition  of  reflex  movements.  This  state  of  opium  narcosis  is  with  dif- 
ficulty distinguished  from  alcohol  narcosis,  from  cerebral  haemorrhage 
— especially  in  the  pons — and  from  uraemic  coma.  An  attentive  con- 
sideration must  be  given  to  all  available  facts  in  the  history  of  the 
case,  to  the  surroundings  of  the  patient,  and  to  the  odor  of  the  breath , 
or  other  excretions,  for  the  symptoms  of  one  of  the  states  above  men- 
tioned may  be  represented  in  another,  even  to  the  inequality  of  the 
pupils,  since  a  case  of  opium  narcosis  has  been  reported  in  which  such 
inequality  existed. 

There  are  no  characteristic  structural  alterations  produced  by  opi- 
um. The  brain  presents  the  appearance  known  as  the  "  wet  brain " 
by  pathologists  ;  the  subarachnoid  spaces  and  the  ventricles  contain  an 
abnormal  quantity  of  serum  ;  the  intra-cranial  veins  are  engorged,  and 
the  puncta  vasculosa  are  somewhat  more  numerous.  The  right  cavi- 
ties of  the  heart  and  the  large  venous  trunks  are  usually  distended 
with  soft  coagula.  These  appearances  are  largely  due  to  the  mode 
of  dying.  In  consequence  of  the  diminishing  frequency  of  the  respir- 
atory movements,  the  blood  is  imperfectly  decarbonized,  and  the  capil- 
lary circulation  of  the  lungs  is  impeded.  The  action  of  the  heart 
being  weak  and  the  resistance  a  fronte  increased,  it  is  obvious  that 
venous  stasis  must  take  place. 

It  is  necessary  now  to  consider  somewhat  more  minutely  the  na- 
ture and  degree  of  the  action  of  opium  on  the  different  organs  and 
systems  of  the  body.  It  will  save  space  and  avoid  repetitions  to 
study  these  actions  in  connection  with  the  several  principles  contained 
in  opium. 

THE  PHYSIOLOGICAL   ACTION  OF  THE  ALKALOIDS   OF  OPIUM. — 1. 


OPIUM.  631 

Morphine. — The  peculiar  powers  of  opium  are  represented  chiefly  in 
the  morphine  which  it  contains.  In  opium  of  good  quality  the  pro- 
portion of  morphine  is  from  ten  to  fifteen  per  cent.  The  actions  of 
the  other  principles  contained  in  opium  differ  widely  ;  and  as  they  all 
possess  some  activity,  the  sum  of  their  effects  must  so  far  influence  the 
result  that  the  powers  of  opium  and  morphine  must  vary  somewhat  in 
kind  as  well  as  in  degree.  One  sixth  of  a  grain  of  morphine  is  about 
equivalent  in  activity  to  one  grain  of  average  opium. 

In  general  terms,  it  may  be  stated  that  morphine  differs  from  opi- 
um in  the  following  respects  : 

Morphine  is  less  stimulating,  less  convulsant,  and  more  decidedly 
hypnotic  and  anodyne  than  opium. 

Morphine  constipates  less  and  affects  the  contractility  of  the  blad- 
der more  than  opium. 

Morphine  has  less  diaphoretic  action  and  produces  much  more  pru- 
ritus than  opium. 

The  physiological  action  of  morphine  is  best  studied  as  adminis- 
tered subcutaneously.  In  a  short  period — from  a  few  seconds  to  a  few 
minutes — after  the  insertion  of  an  ordinary  dose — one  sixth  to  one 
fourth  of  a  grain — under  the  skin,  the  symptoms  of  morphine  narco- 
sis begin.  A  sense  of  heat  and  flushing  of  the  face — after,  in  most 
subjects,  a  very  transient  pallor — fullness  of  the  head,  giddiness,  tin- 
nitus aurium,  and  frequently  nausea,  are  experienced.  Deep-seated 
epigastric  pain  is  often  felt,  and  loud  borborygmi  occur.  The  verti- 
go may  be  so  considerable  as  to  render  walking  uncertain  and  stag- 
gering, or  to  render  the  upright  position  impossible.  Injection  of 
the  conjunctivas  and  contraction  of  the  pupils  occur  at  the  same  time 
the  cerebral  effects  are  experienced.  The  lips  have  a  bluish  appearance, 
the  mouth  and  tongue  become  dry,  swallowing  is  painful,  and  the 
voice  has  a  husky  tone.  When  these  physiological  effects  are  produced, 
pain  and  spasm  are  relieved,  and  an  indescribable  feeling  of  content 
takes  possession  of  the  mind.  A  condition  of  somnolence  in  many 
persons,  in  others  of  extreme  wakef  ulness,  with  intense  mental  activity, 
is  experienced.  When  sleep  occurs,  it  is  usually  deep  but  not  calm, 
the  respirations  are  slow,  noisy,  and  labored.  Not  unfrequently  the 
sleep  is  disturbed  by  dreams  and  visions,  or  the  individual  passes  into 
a  somnambulistic  state,  from  which  he  is  aroused  with  difficulty.  The 
action  of  the  heart  is  diminished  in  frequency,  but  a  decided  rise 
takes  place  in  the  arterial  tension.  On  ophthalmoscopic  examination, 
a  marked  increase  in  the  vascularity  of  the  retina,  and  blurring  of  the 
papillae,  can  be  discerned. 

Soon  after  a  hypodermatic  injection  has  been  practiced,  itching  of 
the  nose,  and  often  of  the  whole  cutaneous  surface,  is  experienced. 
The  skin  is  at  first  dry,  but,  after  a  time,  diaphoresis  begins  and  is 
sometimes  profuse.  The  relaxation  of  the  skin  is  coincident  with  a 


032  CEREBRAL   SEDATIVES. 

fall  in  the  arterial  tension.  The  secretions  of  the  mucous  surfaces  are 
at  first  arrested,  as  well  as  those  of  the  skin.  If  the  morphine  be  ad- 
ministered after  a  full  meal,  digestion  is  suspended  for  a  time.  The 
intestinal  movements  are  also  arrested  for  a  short  period,  and  consti- 
pation is  therefore  produced  ;  but,  very  frequently  indeed,  no  change 
takes  place  in  the  time  in  which  the  alvine  discharges  occur,  or  in  their 
number.  Partly  in  consequence  of  the  increased  action  of  the  skin, 
the  quantity  of  urine  discharged  is  lessened,  and,  at  the  same  time, 
difficulty  is  encountered  in  its  emission.  When  the  desire  is  felt,  an 
interval  of  less  or  greater  duration  elapses  before  the  flow  begins,  and, 
as  the  contractile  power  of  the  bladder  and  of  the  ejaculatory  mus- 
cles is  diminished,  the  discharge  is  feeble  and  slow,  and  the  last  drops 
linger  in  the  urethra. 

With  the  decline  of  morphine  narcosis  a  majority  of  subjects,  prob- 
ably, experience  headache,  confusion  of  mind,  anorexia,  and  nausea. 

When  a  lethal  dose  of  morphine  has  been  administered  by  any 
mode,  profound  narcotism  quickly  ensues  ;  the  pulse  becomes  slow  and 
feeble,  or  rapid  and  feeble  ;  the  respirations  also  become  very  slow 
and  shallow  ;  the  skin  cold  and  sweating  ;  the  face  pale,  cyanosed,  and 
ghastly  ;  the  conjunctivas  deeply  injected  ;  the  pupils  minutely  con- 
tracted, and  reflex  movements  entirely  abolished.  Respiration  ceases 
before  the  action  of  the  heart,  as  a  rule,  but  in  some  instances  very 
sudden  death  ensues  from  paralysis  of  the  heart. 

Half  a  grain  is  the  smallest  dose  of  morphine  which  has  proved 
fatal  to  an  adult.  Five  cases,  according  to  Taylor,  have  been  recorded 
in  which  one  grain  of  the  muriate  caused  death. 

A  consideration  of  the  symptoms  produced  in  man  by  morphine, 
and  the  results  of  experiments  on  animals,  prove  that  it  chiefly  affects 
the  cerebro-spinal  functions.  In  the  lower  animals,  the  spinal  more  ; 
in  man,  the  cerebral  more  than  the  spinal  functions.  Morphine  first 
raises  and  afterward  lessens  the  action  of  the  heart  and  arteries  ;  first 
stimulates  the  pneumogastric  end-organs  and  cardiac  motor  ganglia, 
and  afterward  paralyzes  both.  It  causes  death  chiefly  through  paral- 
ysis of  the  muscles  of  respiration. 

2.  Codeine. — Next  to  morphine,  codeine  is  the  most  important  of 
the  constituents  of  opium.  These  two  alkaloids  agree  in  the  charac- 
ter but  not  in  the  degree  of  their  action.  As  regards  their  anodyne 
and  hypnotic  properties  and  their  toxic  power,  codeine  has  about  one 
fourth  the  effect  of  morphine. 

In  its  effects  on  the  nervous  system,  codeine  lessens  cerebral  activ- 
ity and  the  reflexes ;  causes  sleep  which,  as  compared  with  the  sleep 
due  to  morphine,  is  freer  from  disturbance ;  is  less  likely  to  induce 
after-headache  and  nausea  ;  and  the  various  effects  on  secretion  and 
excretion,  so  characteristic  of  morphine,  are  less  pronounced.  It  is 
said  not  to  affect  the  blood  pressure,  and  the  pulse  remains  unaltered, 


OPIUM.  G33 

unless  the  dose  is  a  toxic  one.  It  has,  apparently,  a  selective  action 
on  the  respiratory  apparatus,  but  it  is  only  by  considerable  doses  that 
the  respiratory  movements  are  retarded.  It  is  supposed  to  exert  a 
special  action  on  cough  through  its  influence  over  the  pneumogastric 
nerve.  Through  the  same  nerve  channel  it  is  probable  that  codeine 
is  effective  in  checking  that  metabolism  which  results  in  the  produc- 
tion of  glycosuria. 

The  best  salt  of  codeine  for  hypodermatic  injection  is  said  to  be 
the  phosphate.  The  alkaloid  itself  is  too  insoluble  for  subcutaneous 
administration,  and  of  the  salts  the  phosphate  is  both  more  freely 
soluble  and  less  irritating  at  the  point  of  insertion.  From  the 
therapeutical  standpoint  it  has  the  conspicuous  advantage,  as  com- 
pared with  morphine,  that  there  is  little  danger  of  a  "habit" 
forming. 

3.  Narcotine. — This  alkaloid  is  singularly  inappropriately  named. 
It  has  but  feeble  narcotic  power.  In  children  considerable  doses  pro- 
duce a  calmative  effect  and  drowsiness,  but  these  results  are  not  ob- 
served in  adults.  Experiments  on  animals  have  shown  that  narcotine 
is  a  convulsant.  While  pigeons  are  poisoned  only  by  two  or  three 
grains  of  morphine  administered  subcutaneously,  the  same  quantity 
of  narcotine  causes  fatal  convulsions.  The  reverse  is  true  in  man. 
Narcotine  is  allied  in  action  to  berberine,  and  alkaloids  of  that  group, 
so  far  as  the  effects  on  man  are  concerned  ;  and  to  thebaine,  picro- 
toxin,  strychnine,  and  brucine,  so  far  as  the  effects  on  animals  are 
concerned. 

Cotarnine. — By  oxidation  of  narcotine  an  alkaloid  is  produced 
which  is  known  as  cotarnine.  This  combines  with  acids  to  form  salts. 
The  hydrochloride  is  known  as  stypticine,  so  named  because  it  is  pos- 
sessed of  active  styptic  properties.  It  occurs  in  the  form  of  yellowish 
crystals,  freely  soluble  in  water  and  alcohol.  The  dose  ranges  from 
gr.  ss.  to  gr.  iij,  or  more. 

Cotarnine  hydrochloride  acts  on  the  nervous  system  of  organic  life, 
controlling  haemorrhage  by  contracting  the  vessels.  It  also  slows  the 
heart  and  raises  the  arterial  tension,  the  latter  because  it  stimulates 
the  constrictor  fibres  of  the  vessel  walls.  In  its  action  on  the  vascular 
system  it  resembles  hydrastinine,  but  it  seems  to  be  more  effective 
than  the  latter.  According  to  Gottschalk  (Therapeutische  Monats- 
hefte,  1895),  it  is  especially  indicated  in  congestive  dysmenorrhoea,  for 
it  not  only  controls  the  haemorrhage  but  moderates  the  suffering.  It 
should  be  given  some  days  in  advance  of  the  flow.  It  is  also  used 
with  success  in  the  haemorrhage  of  subinvolution  of  the  uterus,  in 
fibroid  tumors,  and  in  the  hemorrhages  of  the  climacteric  period. 
Besides  uterine  haemorrhage,  stypticine  should  act  favorably  in  pul- 
monary haemorrhage,  secondary  to  acute  hypersemia  of  the  lungs,  in 


G34  CEREBRAL   SEDATIVES. 

acute  congestion  of  the  brain,  and  in  similar  states  elsewhere.  From 
the  physiological  standpoint  it  is  indicated  in  incipient  inflammation 
of  organs. 

Cotarnine  hydrochloride,  or  stypticine,  may  be  administered  in  pill 
form,  or  in  solution,  or  in  combination  with  agents  acting  in  a  similar 
manner. 

4.  JVctrceine. — The  most  contradictory  observations  have  been  pub- 
lished on  the  action  of  this  principle.  By  Bernard,  Behier,  and  Eulen- 
burg  it  is  held  to  possess  remarkable  hypnotic  power,  and  to  be  free 
from  stimulating  and  convulsant  action  ;  by  Fronmuller,  Harley,  Da 
Costa,  Mitchell,  and  others,  it  is  considered  feeble,  if  not  inert.  The 
physiological  actions  of  narceine,  therefore,  remain  sub  judice.  Until 
further  researches  are  made  with  chemically  pure  narceine,  and  by 
competent  observers,  it  will  be  safer  to  give  no  opinion  on  the  subject 
of  its  actions  and  uses. 

The  other  alkaloids  of  opium  are  curiosities  of  chemical  and  physi- 
ological research,  and  may  be  dismissed  in  a  few  words. 

Cryptopine  is  in  a  much  greater  degree  than  narceine  an  hypnotic 
and  anodyne. 

Thebaine  has  a  strong  convulsant  action  in  animals. 

Various  circumstances  modify  the  action  of  opium.  These  are 
chiefly  age,  sex,  idiosyncrasy,  habitual  use,  and  certain  states  of  the 
system,  as  the  presence  of  pain,  uraemia,  etc. 

The  extremes  of  life  are  relatively  more  susceptible  to  the  action 
of  opium,  and  especially  is  the  susceptibility  to  its  action  great  in 
early  life.  Fatal  opium  narcosis  has  ensued  in  a  nursing  infant 
whose  mother  had  taken  a  medicinal  dose.  A  single  drop  of  lau- 
danum has  produced  lethal  effects  in  a  child  under  six  months  of 
age.  Women  are  more  easily  affected  by  opium  than  men,  and  they 
are  more  apt  to  be  thrown  into  a  condition  of  hysterical  excitement 
than  put  to  sleep.  Nausea,  vomiting,  headache,  and  depression  much 
more  frequently  occur  in  women  than  in  men.  As  a  rule,  there- 
fore— but  to  this  rule  there  are,  of  course,  numerous  exceptions — 
women  are  less  favorable  subjects  for  the  administration  of  opium 
than  men. 

More  than  age  or  sex  is  the  action  of  opium  influenced  by  idio- 
syncrasy. There  are  persons  so  easily  affected  by  it  that  the  mi- 
nutest quantity  will  cause  uncontrollable  vomiting,  faintness,  ver- 
tigo, and  alarming  prostration.  It  is  never  safe  to  administer 
morphine  hypodermatically  to  such  subjects,  unless  in  an  extremely 
small  dose. 

The  habitual  use  of  opium  diminishes  in  a  remarkable  degree  the 
susceptibility  to  its  action.  Numerous  instances  are  on  record  in  which 
a  pint  or  more  of  laudanum  has  been  taken  daily,  or  several  hundred 


OPIUM.  635 

grains  of  opium,  or  a  scruple  of  morphine.  The  author  has  met  with 
a  patient  who  took  a  scruple  of  morphine  a  day  subcutaneously.  When 
opium  is  given  by  the  stomach,  for  the  relief  of  a  chronic  painful 
disease,  to  maintain  a  constant  effect  increasing  doses  are  necessary. 
The  power  of  the  stomach  to  absorb  opium  is  doubtless  impaired  by 
frequent  repetition  of  the  dose,  and  in  consequence  of  the  local  action 
of  the  drug  on  the  nerves  of  the  stomach.  Besides  this,  the  suscep- 
tibility of  the  cerebro-spinal  system  steadily  declines.  The  proof  of 
these  statements  is  afforded  by  the  action  of  morphine  when  used  sub- 
cutaneously for  long  periods.  A  gradual  increase  of  the  dose  becomes 
necessary  in  order  to  produce  a  given  physiological  effect ;  but  the  in- 
crease is  much  slower  than  when  it  is  administered  by  the  stomach. 

Great  pain  lessens  the  influence  of  opium  upon  the  centers  of  con- 
scious impressions.  The  quantity  in  grains  is  of  much  less  importance 
than  the  quantity  as  measured  by  the  physiological  reactions.  Uraemia, 
or  the  retention  in  the  blood  of  urinary  excrementitious  matters,  is 
supposed  to  increase  the  narcotic  influence  of  opium  ;  but  some  facts, 
to  be  hereafter  presented,  render  it  probable  that  the  state  of  uraemia 
and  the  influence  of  opium  on  the  brain  are  antagonistic. 

THERAPY. — Stomach-pain,  whether  simply  neuralgic  (gastralgia), 
or  excited  by  the  presence  of  food  (irritative  dyspepsia),  or  due  to 
ulcer  or  cancer,  is  relieved  by  opium.  The  preparations  of  morphine 
are  better  than  the  crude  drug,  as  a  rule,  in  these  cases.  The  endermic 
application  is  an  excellent  mode  of  procuring  relief.  The  subcutane- 
ous injection,  practiced  in  the  epigastric  region,  is  still  more  effective. 
Morphine  is  frequently  combined  with  bismuth,  or  zinc,  or  silver  salts, 
in  painful  stomach  diseases.  $  Bismuthi  subcarb.,  vel  subnitrat., 
3  iij  ;  morphinae  sulph.,  gr.  j — grs.  ij  ;  pulv.  aromat.,  3  j.  M.,  ft.  pulv. 
no.  xij.  Sig.  :  A  powder  in  milk  before  each  meal.  The  following 
formula  is  also  useful,  notwithstanding  its  unchemical  relations  :  "ft 
Zinci  oxidi,  3  ss  ;  morphinae  sulph.,  gr.  j — grs.  ij.  M.,  ft.  pil.  no.  x. 
Sig. :  One  pill,  three  times  a  day,  before  each  meal.  A  half -grain  of 
the  oxide  of  silver  may  be  substituted  for  the  oxide  of  zinc  in  the 
above  formula. 

Inflammatory  pain,  due  to  corrosive  poisons,  to  peritonitis,  etc., 
requires  opium.  When  the  stomach  is  irritable,  and  the  symptoms 
urgent,  the  best  mode  of  using  the  remedy  is  the  hypodermatic  injec- 
tion of  morphine.  Many  kinds  of  nausea  and  vomiting,  stomachal  or 
reflex  in  origin,  are  arrested  by  opium  preparations.  In  vomiting  of 
cerebral  origin,  or  produced  by  uraemia,  or  caused  by  cirrhosis,  the 
use  of  opium  is  contraindicated.  When  vomiting  is  caused  by  irritant 
matters,  opium  is  prescribed  after  the  stomach  is  emptied.  The  vomit- 
ing which  accompanies  the  passage  of  biliary  or  renal  calculi,  dys- 
menorrhoea,  etc.,  is  best  relieved  by  opium.  Very  severe  cases  of 
Bea-sickness,  and  of  the  vomiting  of  pregnancy,  may  be  sometimes 


036  CEREBRAL   SEDATIVES. 

arrested  when  all  other  means  fail,  by  the  subcutaneous  use  of  a  mi- 
nute quantity  of  morphine  (one  twentieth  to  one  twelfth  of  a  grain). 

Nothing  is  more  common  than  the  prescription  of  opium  in  diar- 
rhoeal  diseases,  but  it  is  often  used  without  a  just  appreciation  of  the 
conditions  requiring  it.  In  acute  diarrhoea,  caused  by  irritating  ali- 
ments, such  astringent  laxatives  as  rhubarb,  or  mild  salines,  should 
precede  the  use  of  opium.  When  the  evacuations  are  watery,  the 
best  results  are  obtained  by  a  combination  of  opium  with  mineral 
acids,  or  acetate  of  lead.  In  acute  dysentery  opium  is  a  very  im- 
portant remedy,  but  it  is  often  injudiciously  employed.  If  there  be 
fever,  much  tenesmus,  and  the  stools  consist  of  mucus  and  blood,  the 
exhibition  of  opium  should  be  postponed  until  salines  have  emptied 
the  intestinal  canal  of  its  contents,  and  have  depleted  the  distended 
vessels.  An  excellent  method  of  administration,  especially  when  the 
dysenteric  inflammation  occupies  the  rectum,  is  an  enema  of  starch  or 
milk,  or  a  suppository,  containing  opium  in  some  soluble  form.  In 
chronic  dysentery  opium  is  indispensable.  It  is  usually  combined 
with  arsenic,  or  with  the  salts  of  silver,  copper,  or  zinc.  In  the 
chronic  dysentery  of  malarial  origin,  the  best  results  are  obtained  by 
a  combination  of  arsenic  and  opium,  according  to  a  formula  already 
given  ;  in  that  form  which  succeeds  to  the  acute  disease,  opium  and 
sulphate  of  copper,  or  zinc,  or  nitrate  of  silver,  or  vegetable  astrin- 
gents. 

Nothing  can  be  more  satisfactory  than  the  treatment  of  cholera- 
morbus  by  the  hypodermatic  injection  of  morphine.  It  is  always 
desirable  to  secure  the  expulsion  of  irritating  matters  before  resorting 
to  opiates.  For  an  ordinary  case  of  cholera-morbus  from  one  twelfth 
to  one  sixth  of  a  grain  of  morphine  suffices.  In  true  cholera  the 
utility  of  opium  is  most  evident  in  the  preliminary  diarrhoea,  but  is 
entirely  without  avail  in  the  stage  of  collapse.  Mischief  not  unfre- 
quently  results  from  its  use,  for  patients  emerging  from  the  condition 
of  collapse  are  either  directly  narcotized  by  the  opium  which  had  lain 
unabsorbed  in  the  stomach,  or  the  cerebral  symptoms  of  the  secondary 
fever  are  greatly  intensified  by  it.  In  cholera  infantum  opium  must 
be  used  with  caution,  if  not  avoided.  The  subjects  of  this  malady 
are  easily  narcotized,  and  the  nervous  system — an  unknown  morbid 
state  of  which  bears  some  close  relation  to  the  gastro-intestinal  dis- 
order— is  rendered  so  irritable  by  opium  that  the  symptoms  are  ag- 
gravated by  it. 

The  following  formula  embodies  a  truth  of  great  practical  impor- 
tance :  As  a  rule,  opium  does  harm  in  all  gastro-intestinal  maladies 
in  which  there  is  a  deficiency  in  the  proper  secretion,  or  a  suspension 
of  the  functions,  of  the  liver  and  kidneys. 

Opium  gives  a  degree  and  kind  of  relief  in  hepatic,  renal,  and 
saturnine  colic,  which  no  other  remedy  or  combination  of  remedies 


OPIUM.  637 

affords.  The  most  prompt  and  effective  form  in  which  the  remedy 
can  be  administered  is  the  hypodermatic  injection  of  morphine.  This 
relieves  the  pain,  and  relaxes  the  spasm  of  the  affected  tube,  and  at 
the  same  time  checks  the  depressing  vomiting  which  attends  these 
cases.  The  quantity  of  morphine  required  will  vary  from  one  fourth 
to  one  half  a  grain.  As  the  effect  is  immediate,  the  most  prudent 
practice  consists  in  the  administration  of  a  small  quantity  (one  sixth 
to  one  eighth  of  a  grain)  for  the  first  dose,  in  order  to  test  the  physi- 
ological capabilities  of  the  patient,  and  following  this  in  fifteen  min- 
utes with  a  dose  of  similar  size  if  the  first  is  well  borne  and  the  pain 
persist. 

Opium,  in  small  doses,  is  a  valuable  tonic  to  a  weak  and  dilated 
heart.  When  administered  simultaneously  with  digitalis,  it  obviates 
one  of  the  dangers  which  may  be  caused  by  that  agent.  In  the  so- 
called  passive  haemorrhages,  in  which  not  only  is  the  blood  altered  in 
quality  but  the  tension  is  low,  small  doses  of  opium  sustain  the  powers 
of  life,  and  by  increasing  the  arterial  tension  lessen  the  transudation 
through  the  vessel-walls.  Under  these  circumstances,  the  dose  of 
opium  should  not  as  a  rule  exceed  five  minims  of  the  tinctures,  and  it 
should  generally  be  given  in  combination  with  ergot,  digitalis,  tannic 
and  gallic  acids,  acetate  of  lead,  etc. 

The  important  observation  was  made  by  Bernard,  and  afterward 
illustrated  and  confirmed  by  Nussbaum,  that  the  hypodermatic  injec- 
tion of  morphine,  administered  before  the  inhalation  begins,  prolongs 
the  stage  of  chloroform  narcosis  with  a  less  quantity  of  the  anaesthetic, 
diminishes  the  danger  of  cardiac  paralysis,  and  prevents  the  after-nau- 
sea and  depression. 

Opium  is  the  most  important  agent  which  we  possess  in  the  treat- 
ment of  various  inflammations.  Its  efficacy  depends  upon  several  fac- 
tors :  it  relieves  pain,  quiets  restlessness,  and  thus  removes  from  the 
inflammatory  process  one  of  its  most  important  elements,  viz.,  an  irri- 
table and  paretic  state  of  the  nerves  of  the  affected  part.  Besides 
these  effects,  opium  raises  the  tonicity  of  the  vessels,  helps  to  maintain 
the  continuity  of  the  blood-current,  and  hinders  the  migration  of  the 
white  corpuscles  of  the  blood.  It  is  especially  in  inflammations  of  the 
serous  membranes  that  its  highest  utility  is  manifest,  e.  g.,  pleuritis, 
peritonitis,  arachnitis.  Good  reasons  exist  for  believing  that  the  hy- 
podermatic injection  of  morphine  will  sometimes  cut  short  (jugulate) 
these  maladies,  if  administered  just  at  their  onset.  If  the  period  for 
obtaining  such  a  fortunate  result  has  passed,  the  course  and  duration 
of  these  diseases  can  be  greatly  modified  by  the  judicious  use  of  opium. 
The  quantity  of  opium  required  will  be  determined  by  the  effect ;  the 
pain  should  be  relieved,  the  pupils  somewhat  contracted.  A  full  dose 
should  be  administered  at  the  beginning  of  treatment  (two  to  three 
grains  of  opium — a  half  grain  of  morphine),  and  a  given  physiological 


038  CEREBRAL   SEDATIVES. 

effect  be  maintained  by  the  regular  use  of  smaller  doses.  Pain  is 
probably  the  surest  guide,  for  the  existence  of  pain  indicates  that  de- 
cided opium  narcosis  has  not  been  attained. 

In  peritonitis,  whether  puerperal,  traumatic,  or  the  extension  of 
intestinal  inflammation,  no  fact  of  therapeutics  is  better  established 
than  the  curative  power  of  opium.  Besides  its  immediate  influence 
over  the  inflammatory  process,  its  indirect  action,  in  maintaining  the 
necessary  quietude  of  the  intestines,  is  of  the  greatest  service.  In 
arachnitis,  pachymeningitis,  basilar  meningitis,  there  are  clinical  facts 
which  tend  to  show  that  small  doses  of  some  opiate  preparation  really 
accomplish  more  than  any  other  remedies.  The  author  is  convinced 
that  we  possess  no  means  of  treatment  of  cerebro-spinal  meningitis  so 
effective  as  the  opiate  treatment.  The  same  rule  as  to  the  quantity 
required,  as  that  given  for  peritonitis,  should  be  observed  :  that  quan- 
tity of  opium  should  be  administered  which  will  relieve  the  pains  and 
rigidity.  The  best  results  are  obtained  by  the  hypodermatic  injection 
of  morphine.  When  effusion  takes  place,  and  stupor  and  coma  ensue, 
the  utility  of  opium  is  ended. 

In  parenchymatous  inflammations,  experience  has  shown,  opium  is 
much  less  useful.  When  pain  is  a  prominent  symptom,  it  can  be  em- 
ployed to  relieve  it ;  in  small,  stimulant  doses,  it  may  be  given  to 
maintain  the  action  of  the  heart.  In  pneumonia  opium  is  a  remedy  of 
very  doubtful  utility.  Its  narcotic  action  certainly  disposes  to  pul- 
monary congestion,  although  it  may  be  cautiously  used  to  allay  pain  and 
moderate  cough.  Although  this  was  the  general  professional  opinion, 
and  is  now  largely  held,  there  are  those  who  entertain  very  different 
views  regarding  the  utility  of  opium  in  pneumonia.  Thus,  Prof.  A.  L. 
Loomis,  of  New  York,  maintains  that  the  disease  may  be  aborted,  or 
at  least  decidedly  modified  in  severity,  by  the  subcutaneous  injection 
of  morphine  in  the  first  stage  (congestion)  of  this  disease. 

In  fevers — typhoid,  typhus,  and  eruptive  fevers — opium  was  for- 
merly much  more  frequently  prescribed  than  at  present.  The  cold 
baths,  antipyretics,  and  more  favorable  hygienic  influences,  have  less- 
ened the  violence  and  diminished  the  mortality  from  fevers.  The 
maniacal  excitement  and  the  low,  muttering  delirium  are  not  so  fre- 
quently observed  now  as  formerly,  and  hence  the  use  of  opium  in  these 
affections  has  greatly  declined.  The  discovery  of  chloral  has  also  di- 
minished the  use  of  opium  as  an  hypnotic.  Nevertheless,  when  there 
is  much  restlessness,  wakefulness,  subsultus,  and  delirium,  opium  may 
render  important  service.  When  the  delirium  is  of  the  low,  mutter- 
ing kind,  a  small  quantity  of  morphine  (one  eighth  to  one  sixth  of  a 
grain)  may  suffice  to  procure  quiet  and  refreshing  sleep.  When  the 
delirium  is  violent,  combination  of  tartar-emetic  with  opium,  on  the 
plan  of  Graves,  may  have  a  very  happy  effect.  Or  opium  may  be 
combined  with  belladonna,  or  chloral — the  former  when  the  condition 


OPIUM.  639 

is  one  of  great  depression,  the  latter  when  the  delirium  and  wakeful- 
ness  are  excited  in  character.  In  measles  and  scarlet  fever,  when  there 
is  a  condition  of  profound  depression,  the  eruption  being  tardy  in 
making  its  appearance,  and  is  dusky  in  hue  and  ill-defined,  beneficial 
results  are  experienced  from  the  use  of  opium,  especially  when  com- 
bined with  camphor. 

A  threatened  paroxysm  of  intermittent  fever  may  be  aborted  by 
the  hypodermatic  injection  of  morphine  (one  fourth  of  a  grain).  This 
practice  has  a  high  degree  of  importance  in  the  pernicious  intermit- 
tents,  when  time  is  not  afforded  for  an  effective  use  of  quinine.  The  fe- 
brile heat  of  intermittent  and  remittent  fevers  may  be  diminished,  and 
the  sweating  stage  induced  earlier,  by  the  use  of  opium  in  moderate 
doses  (ten  minims  of  the  deodorized  tincture  every  two,  three,  or  four 
hours).  The  addition  of  morphine  to  quinine  enables  the  latter  to  be 
better  borne  by  the  stomach,  counteracts  some  of  its  unpleasant  effects 
on  the  brain,  and  increases  its  therapeutical  power.  When  no  contra- 
indication to  the  use  of  morphine  exists,  it  is  good  practice  to  combine 
it  with  quinine  in  the  treatment  of  intermittent  and  remittent  fevers. 

Narcotine  has  decided  antiperiodic  power,  and  may  be  given  as  a 
substitute  for  quinine  when  reasons  exist  to  prevent  the  use  of  the  lat- 
ter. From  five  to  ten  grains  of  pure  narcotine  may  be  administered. 
As  an  antiperiodic  it  ranks  after  arsenic,  salicine,  and  even  apiol. 

As  an  hypnotic  opium  is  very  frequently  used  in  affections  of  the 
nervous  system.  The  stimulant  properties  of  crude  opium,  or  its  offi- 
cial preparations,  render  it  less  serviceable  than  morphine  in  the 
group  of  cases  generally  requiring  an  hypnotic.  There  can  be  no 
doubt  that  remarkable  curative  results  have  followed  the  hypodermatic 
injection  of  morphine  in  acute  mania.  The  following  are  the  indica- 
tions for  the  use  of  morphine  in  mental  disorders  :  prolonged  wakeful- 
ness,  maniacal  excitement,  persistent  refusal  of  food,  drink,  or  medi- 
cine, destructive  and  suicidal  tendencies.  As  respects  individual 
subjects,  the  state  of  the  arterial  tension  furnishes  a  guide  to  the  use 
of  morphine.  If  the  tension  of  the  arterial  system  is  low,  a  small  dose 
is  required.  When  the  pulse  is  quick,  and  the  arterial  tension  high,  a 
large  dose  of  morphine,  by  over-excitation,  causes  paresis  of  the  sym- 
pathetic, and  thus  reduces  action,  an  indication  for  the  full  influence 
of  the  agent.  Large  doses  of  morphine,  when  given  subcutaneously, 
require  the  utmost  circumspection  in  maniacal  cases,  especially  in 
obese  and  aged  subjects.  Besides  acute  mania,  excellent  results  have 
followed  from  the  use  of  morphine  in  lypemania  (Krafft-Ebing,  Voi- 
sin),  in  chronic  mania,  and  melancholia.  Probably  the  best  effects 
have  been  witnessed  from  opium  in  melancholia.  In  this  mental  dis- 
order, which  is  a  condition  of  depression,  the  best  form  for  the  admin- 
istration of  opium  is  the  tincture,  and  the  dose  required  is  the  stimu- 
lant and  not  the  narcotic  dose.  The  author  is  impelled  to  add  the 
43 


640  CEREBRAL   SEDATIVES. 

caution  so  well  expressed  in  the  following  words  by  Maudsley  :  "It 
will  be  well  to  have  in  mind  that  neither  opium  by  the  mouth,  nor 
morphine  hypodermically  injected,  will  always  quench  the  fury  of 
acute  mania,  and  that  successive  injections  of  morphine,  followed  by 
brief  snatches  of  fitful  sleep,  have  been  followed  also  by  fatal  collapse." 

It  was  formerly  held  that  large  and  increasing  doses  of  opium  were 
necessary  for  the  cure  of  delirium  tremens,  the  theory  being  enter- 
tained that  to  procure  sleep  was  to  insure  recovery.  It  is  now  known 
that  to  re-establish  digestion  and  to  support  the  powers  of  life  by  suit- 
able nutrients  are  in  a  large  proportion  of  cases  the  only  means  needed 
to  quiet  delirium  and  to  cause  sleep.  Opium,  if  used  at  all,  must  be 
given  cautiously.  Chloral  has  to  a  large  extent  taken  its  place  as  an 
hypnotic  in  this  disease,  but  cases  are  not  unfrequently  met  with 
in  which  morphine  agrees  better,  and  is  more  effective  in  inducing 
quiet. 

Some  cases  of  sunstroke,  coup  de  soleil,  or  "thermic  fever,"  are 
rapidly  cured  by  the  hypodermatic  injection  of  morphine.  When  the 
patient  is  able  to  swallow,  good  effects  follow  the  conjoined  admin- 
istration of  tincture  of  opium  and  brandy.  The  cases  benefited  by 
this  treatment  are  characterized  by  pallor  of  the  face  and  weakness  of 
the  heart — heat  exhaustion. 

Epilepsy  and  epileptiform  seizures  may  be  sometimes  prevented  by 
the  timely  administration  of  morphine  hypodermatically.  This  treat- 
ment is  best  adapted  to  epilepsy,  the  attacks  of  which  occur  at  night, 
to  petit  mal,  and  to  convulsive  tic.  It  is  improper  in  epileptoid  seiz- 
ures due  to  tumor  or  other  coarse  organic  lesion  of  the  brain.  In* 
suitable  cases,  this  treatment  procures  most  decided  amelioration  in 
the  condition  of  the  patient,  but  may  induce  the  opium  habit. 

The  remarkable  fact  has  been  demonstrated  by  Loomis,  of  New 
York,  that  we  have  in  the  hypodermatic  injection  of  morphine  the 
most  important  agent  for  the  cure  of  urcemic  convulsions,  puerperal 
and  non-puerperal.  It  is  true  this  mode  of  treatment  had  been  origi- 
nally practiced  by  Scanzoni,  but  Loomis  has,  more  especially,  drawn 
attention  to  its  real  power  and  utility.  "  The  most  uniform  effect  of 
morphine  so  administered  is,  first,  to  arrest  muscular  spasms  by  coun- 
teracting the  effect  of  the  uraemic  poison  on  the  nerve-centers  ;  second, 
to  establish  profuse  diaphoresis  ;  third,  to  facilitate  the  action  of  ca- 
thartics and  diuretics,  especially  the  diuretic  action  of  digitalis." 

In  chorea  Trousseau  has  carried  the  administration  of  morphine  to 
an  extraordinary  extent.  He  restricts  its  use  to  severe  cases,  which 
appear  to  have  a  singular  insusceptibility  to  the  action  of  opium  even 
in  enormoiis  doses.  When  the  jactitations  are  incessant,  preventing 
sleep,  or  persisting  in  spite  of  sleep,  the  utility  of  morphine  is  very 
great.  It  is  most  effective  when  combined  with  chloral.  In  these  se- 
vere cases  of  chorea,  the  only  limit  to  the  quantity  of  morphine  is  the 


OPIUM.  641 

effect  produced.  It  is  evident,  from  the  experiences  of  Trousseau, 
that  very  large  doses  are  required,  and  that  curative  effects  are  thus 
obtained  to  which  small  doses  are  entirely  inadequate.  The  subcu- 
taneous method  is  more  efficient  than  the  stomach  administration. 

In  tetanus  and  hydrophobia  the  use  of  morphine  has  been  chiefly 
palliative.  M.  Demarquay  has,  however,  applied  morphine,  by  deep 
injection  into  the  tetanized  muscles,  with  greater  success  than  hereto- 
fore. He  carries  the  needle  deeply  into  the  tetanized  muscles,  and,  if 
possible,  to  the  point  of  entrance  of  the  nerves.  He  injects  in  this 
way  the  masseters,  the  sterno-cleido-mastoid,  the  neck  and  sacro-lum- 
bar  muscles,  etc.  The  relaxation  of  the  muscles  of  mastication  thus 
induced  permitted  the  nourishment  of  the  patients.  Of  three  cases 
thus  treated  during  the  siege  of  Paris  two  recovered  and  one  died,  but 
the  death  was  due  to  pyaemia  and  not  to  tetanus. 

The  most  important  uses  of  opium  and  its  various  preparations  are 
in  the  relief  of  pain.  In  surgical  practice  its  administration  is  indis- 
pensable to  prevent  or  mitigate  shock,  to  quiet  pain,  and  to  check  in- 
flammation. To  particularize  on  these  points  would  require  an  epit- 
ome of  surgery  for  illustration.  Before  the  administration  of  chloro- 
form, morphine  should  be  injected  hypodermatically,  to  diminish  the 
dangers  of  the  inhalation  and  to  secure  relief  to  the  after-pain  of  the 
surgical  operation.  Nothing  is  more  universal  in  surgical  practice 
than  the  administration  of  an  opiate  after  an  operation  of  any  magni- 
tude, for  the  objects  above  named. 

The  most  signal  service  is  rendered  by  opium  and  its  preparations 
in  the  various  neuralgice.  The  most  effective  mode  of  administration 
is  by  subcutaneous  injection,  and  the  remedy  should  be  inserted  in  the 
neighborhood  of  the  affected  nerve,  notwithstanding  that  relief  is  af- 
forded by  the  injection  at  any  point.  In  tic-douloureux,  brachialgia, 
cardialgia,  gastralgia,  hepatalgia,  nephralgia,  sciatica,  and  pelvic  neu- 
ralgice,  immediate  relief  is  afforded  by  this  remedy,  and  the  relief  is 
not  temporary  and  palliative  merely,  but  curative  in  numerous  instances. 
It  appears  to  be  especially  curative  in  sciatica.  It  is  a  remarkable  fact 
that  morphine  inserted  under  the  skin,  and  especially  in  the  neighbor- 
hood of  affected  nerves,  exerts  a  curative  power  which  it  does  not  at  all 
have  when  administered  by  the  stomach.  An  efficient  method  of  using 
morphine  in  the  treatment  of  neuralgiae,  according  to  Brown-Sequard, 
consists  in  applying  it  in  a  finely-divided  state  to  the  derma,  denuded 
by  a  blister.  Laf  argue  proposed  the  method  of  inoculation,  which  con- 
sists in  inserting  morphine  into  the  skin  by  means  of  a  lancet-puncture. 
These  clumsy  and  painful  processes  are  by  no  means  equal  to  the  hypo- 
dermatic method. 

The  enchanting  sense  of  relief  to  suffering  wrought  by  opiates,  and 
especially  by  the  subcutaneous  use  of  morphine,  leads  to  the  morphine- 
habit.  It  is  a  singular  fact  that  in  these  cases  the  pains  which  were 


642  CEREBRAL    SEDATIVES. 

cured  by  the  remedy  return  when  it  is  withdrawn,  and  other  painful 
sensations  appear  of  an  even  more  distressing  kind.  In  practicing  the 
hypodermatic  method  for  a  long  period  in  severe  cases  of  neuralgia, 
the  utmost  care  should  be  used  to  avoid  the  morphine-habit. 

In  the  neuroses  of  the  respiratory  organs,  great  relief  is  often  af- 
forded by  the  use  of  opium  in  some  of  its  forms.  No  remedial  agent 
will  so  quickly  cut  short  a  paroxysm  of  asthma  as  the  hypodermatic 
use  of  morphine.  The  paroxysms  of  difficult  breathing  which  occur  in 
emphysema  are  also  readily  relieved  in  the  same  way.  But  there  is 
great  danger  of  establishing  the  opium-habit  in  these  chronic  cases. 
In  an  allied  disease — hay-fever,  hay-asthma,  or  autumnal  catarrh — 
the  hypodermatic  use  of  morphine  is  quite  as  effective  as  in  spasmodic 
asthma.  An  incipient  catarrh  may  be  aborted  by  a  full  dose  of  Do- 
ver's powder,  taken  at  the  very  outset  of  the  inflammation.  Morphine 
and  quinine  combined  are  rather  more  effective  than  Dover's  powder 
in  these  cases.  Opium,  or  some  of  its  preparations,  enter  into  the  com- 
position of  expectorant  mixtures  to  allay  cough. 

The  hypodermatic  injection  of  morphine  has  been  shown  to  possess 
a  high  degree  of  utility  in  cases  of  dilated  heart  with  difficult  breath- 
ing, and  general  oedema.  The  eighth  to  the  sixth  of  a  grain  suffices  for 
this  purpose.  The  effect  it  has  is  to  quiet  and  regulate  the  action  of 
the  heart,  to  allay  the  distress  of  breathing,  and  to  permit  rest  and 
sleep  in  the  recumbent  position.  An  occasional  dose  only  is  necessary 
(two  or  three  times  a  week). 

Opium  is  a  very  important  addition  to  our  resources  in  the  treat- 
ment of  diabetes.  It  must  be  given  in  considerable  doses,  as  Pavy  has" 
shown.  From  six  to  twelve  grains  a  day  are  necessary,  in  order  to  pro- 
duce a  decided  impression.  It  checks  the  bulimia — the  inordinate  ap- 
petite— allays  thirst,  diminishes  the  flow  of  urine  and  the  excretion  of 
sugar,  and,  probably,  arrests  or  prevents  the  changes  in  the  nervous 
system  which  accompany  or  are  causative  of  this  disease.  Although 
many  cases  are  decidedly  ameliorated,  it  can  not  be  said  that  any  have 
been  cured  by  opium.  Codeine,  an  alkaloid  of  opium,  seems  to  be 
more  effective  in  this  disease  than  the  crude  opium  or  any  of  its  prepa- 
rations. It  must  be  given  in  full  doses.  Besides  checking  the  waste, 
it  apparently  exercises  an  influence  over  the  central  nerve-changes,  and 
thus  has  a  curative  action  as  well  as  merely  palliative. 

EXTERNAL  USES  OF  OPIUM. — A  solution  of  morphine  in  distilled 
water  is  an  excellent  astringent  anodyne  in  conjunctivitis,  and,  com- 
bined with  atropine,  in  iritis.  $  Morphinae  sulph.,  grs.  iv — grs.  viij  ; 
aquae  destil.,  f  j.  M.  Sig. :  A  few  drops  to  be  put  into  the  eye  as  neces- 
sary. IJ  Morphinae  sulphatis,  grs.  iv  ;  zinci  sulphatis,  grs.  ij  ;  aquae 
destil.,  |  j.  M.  Sig.:  Lotion  for  iritis  and  other  inflammatory  affec- 
tions of  the  eye.  The  last  formula,  omitting  the  zinc,  is  an  excellent 
application  in  earache,  the  external  meatus  being  filled  with  it,  and  in 


OPIUM.  643 

toothache,  a  few  drops  on  cotton  being  placed  in  the  hollow  of  the 
tooth, 

Local  inflammatory  swellings,  painful  in  character,  can  be  relieved 
somewhat  by  poultices  containing  laudanum.  Frictions  with  laudanum 
are  serviceable  in  lumbago,  sciatica,  myalgia,  and  similar  superficial 
painful  affections.  An  infusion  of  opium  (  3  j — Oj),  applied  hot,  is  an 
excellent  application  to  inflamed  joints,  inflamed  testicle,  etc. 

ON  THE  COMBINED  USES  OF  OPIUM  AND  BELLADONNA,  MORPHINE, 
AND  ATROPINE. — The  conjoined  use  of  these  agents  is  so  important  a 
subject  from  the  point  of  view  of  practical  therapeutics,  that  the  author 
purposes  to  consider  it  under  this  head.  Although  a  physiological  an- 
tagonism as  respects  a  part  of  their  action  unquestionably  exists,  it  does 
not  extend  throughout  their  whole  range  of  influence  in  the  organism. 
The  balance  of  actions  furthermore  produces  results  which  neither  is 
capable  of  singly.  Hence  the  importance  of  a  more  direct  presentation 
of  these  points  than  has  been  heretofore  given. 

Both  act  on  the  brain,  atropine  causing  delirium,  hallucinations,  and 
disturbed  sleep  ;  morphine  producing  stupor,  somnolence,  hebetude  of 
mind.  Both  relieve  pain,  but  this  effect  is  much  greater  in  the  case  of 
morphine.  Both  produce  disorders  of  motility,  staggering,  difficulty 
of  co-ordination  of  muscular  movements,  vertigo,  confusion  of  mind, 
and  headache.  The  reciprocal  influence  exerted  upon  each  other,  when 
they  are  administered  together,  modifies  in  a  remarkable  manner  their 
physiological  effects. 

Morphine  corrects  the  illusions  and  phantasms  produced  by  atro- 
pine. In  small  doses  (e.  g.,  one  ninety-sixth  of  a  grain)  atropine  in- 
creases the  hypnotic  power  of  morphine,  with  the  result  of  causing  a 
less  disturbed  and  more  nearly  normal  sleep  than  is  produced  by  mor- 
phine alone.  If,  however,  the  quantity  of  atropine  be  in  excess  of 
what  is  necessary  to  establish  the  physiological  balance  in  the  cere- 
brum, it  overrides  the  action  of  morphine  and  asserts  its  own  peculiar 
power  of  inducing  phantasms,  illusions,  and  hallucinations. 

The  pain-relieving  power  of  morphine  is  rather  increased  than  di- 
minished by  atropine.  The  disorders  of  motility  are  enhanced  by  the 
mutual  reactions  of  the  two  agents.  The  after-headache,  vertigo, 
nausea,  and  depression  of  the  heart's  action  caused  by  morphine,  are 
to  a  large  extent  prevented  by  the  conjoined  administration  of  atro- 
pine. When  a  large  quantity  of  opium,  or  morphine,  is  given  by  any 
of  the  modes  of  administration,  its  immediate  depressing  effects  are 
counteracted  by  the  simultaneous  use  of  belladonna  or  atropine. 
Morphine  produces  contraction  of  the  pupil,  and  a  tetanic  condition 
(according  to  Graefe)  of  the  muscle  of  accommodation  ;  atropine 
causes  dilatation  of  the  pupil  and  contraction  of  the  ciliary  muscle. 
When  used  together  these  effects  may  be  precisely  balanced.  It  re- 
quires but  a  minute  quantity  of  atropine  to  overcome  the  action  of 


G44  CEREBRAL    SEDATIVES. 

morphine  on  the  pupil.  When  these  effects  on  the  pupil  are  balanced, 
it  does  not  follow  that  the  muscle  of  accommodation  is  in  a  normal 
condition,  for  visual  defects  remain.  Morphine  prevents  the  contrac- 
tion of  the  arterioles  produced  by  atropine,  and,  as  a  necessary  conse- 
quence, the  subsequent  relaxation  of  the  muscular  fiber. 

Morphine  depresses  the  action  of  the  lungs  ;  atropine  is  a  powerful 
respiratory  stimulant.  Morphine  produces  pallor  of  the  surface,  and 
reduces  the  external  temperature  ;  atropine  causes  redness  and  injec- 
tion of  the  skin,  and  elevation  of  the  body-heat.  In  some  experiments 
the  author  ascertained  that  while  atropine  alone  raised  the  pulse  to 
105  from  72,  atropine  and  morphine  combined  depressed  the  pulse  of 
the  same  subject  to  60. 

Both  morphine  and  atropine  produce  dryness  of  the  mucous  mem- 
brane of  the  mouth  and  fauces.  Morphine  suspends,  and  atropine  in- 
creases, the  peristaltic  movements.  The  sickness  and  nausea  caused 
by  morphine  are,  to  a  considerable  extent,  lessened  or  prevented  by 
atropine. 

Morphine  lessens  and  atropine  increases  the  functional  activity  of 
the  kidneys  ;  on  the  skin  their  effects  are  opposed  ;  hence,  when  used 
in  combination,  the  urinary  secretion  is  rather  increased  than  dimin- 
ished by  them.  Both  produce  dysuria. 

THEKAPEUTICAL  APPLICATIONS  OF  OPIUM  AND  BELLADONNA. — 
Whenever  opium  is  used  to  relieve  pain,  to  procure  sleep,  to  relax 
spasm  —  there  being  no  inflammatory  action  present  —  belladonna 
should  be  combined  with  it,  unless  some  contraindication  should  exist 
to  the  action  of  the  latter.  This  formulated  expression  is  more  espe- 
cially applicable  to  the  hypodermatic  use  of  morphine. 

In  the  various  psychical  disorders,  in  which  the  general  condition 
is  sthenic,  opium  or  morphine  should  be  used  alone.  When  power  is 
deficient,  the  forces  depressed,  the  temperature  rather  below  than 
above  the  normal,  belladonna  or  atropine  should  be  combined  with  the 
opium  or  morphine.  For  the  relief  of  insomnia  the  combined  action 
of  these  agents  is  much  more  effective  than  either  singly.  The  pro- 
portion in  which  the  alkaloids  should  be  used  is  about  as  follows  : 
T!T» — T^TT  °f  a  grain  °f  atropine  to  £  and  £  of  a  grain  of  morphine. 

In  the  various  convulsive  disorders  in  which  opium  or  morphine 
may  be  used,  especially  hypodermatically,  atropine  should  be  combined 
with  it. 

The  neuralgias  are  best  treated  by  morphine  and  atropine  com- 
bined, for  the  following  reasons  :  the  combination  is  more  effective, 
the  after-unpleasant  effects  of  either  are  prevented  to  a  considerable 
extent. 

The  neuroses  of  the  respiratory  organs,  of  the  abdominal  viscera, 
etc.,  are,  as  a  rule,  more  successfully  treated  by  morphine  and  atropine 
in  combination,  than  by  either  separately. 


OPIUM.  645 

In  surgical  diseases  and  operations  of  various  kinds,  the  combina- 
tion of  morphine  and  atropine  has  most  important  and  varied  applica- 
tions, among  which  may  be  enumerated  :  to  render  safer  and  to  pro- 
long ether  or  chloroform  narcosis  ;  to  prevent  or  relieve  shock;  to 
save  suffering  /  to  relax  muscles  ;  to  facilitate  operative  procedures, 

The  combined  administration  of  morphine  and  atropine  is  of  the 
greatest  service  in  obstetric  practice  :  to  relieve  the  teasing  pains  of 
the  first  stage  ;  to  procure  sleep  in  the  course  of  an  exhausting  labor ; 
to  quiet  after-pains  ;  to  facilitate  the  performance  of  various  obstetric 
operations  ;  to  arrest  puerperal  convulsions. 

Authorities  referred  to  : 

ALBERS,  DR.  J.  H.  F.     Virchow^s  Archiv,  Band  xxvi,  p.  229. 

ALLBUTT,  DR.  T.  C.     The  Practitioner,  vol.  iii,  p.  342.     Ibid.,  vol.  v,  p.  327. 

ANSTIE,  DR.  F.  E.    Stimulants  and  Narcotics,  American  edition.    Article  Alcoholismus, 
Reynolds' s  System  of  Medicine.     The  Practitioner,  vol.  i,  No.  1,  etc. 

ASCHE,  DR.     Schmidffs  Jahrbucher,  Band  cxxv,  pp.  331-337. 

BARTHOLOW,  DR.  ROBERTS.     Manual  of  Hypodermatic  Medication,  fourth  edition. 

BERNARD,  CLAUDE.     Bulletin  General  de  Therapeutique,  vol.  Ixxvii,  p.  241,  et  seq. 

IBID.     Archives  Generates  de  Medecine,  1864. 

Bois,  DR.  A.     De  la  Methode  des  Injections  Sous-cutanees,  Paris,  1864,  p.  17. 

COURTENAY,  DR.  E.  M.      West  Riding  Lunatic  Asylum  Reports,  vol.  ii,  p.  254. 

DA  COSTA,  DR.  J.  M.     Pennsylvania  Hospital  Reports,  1868. 

DEMARQUAY,  DR.     Bulletin  General  de  Therapeutique,  October  15,  1871,  p.  229,  et  seq. 

ERLENMEYER,  DR.  A.     Die  subcutanen  Injectionen  der  Arzneimittel,   dritte  Auflage, 
Neuwied,  1866. 

EULENBURG,  DR.  A.    Die  hypodermatiscJien  Injectionen  der  Arzneimittel,  zweite  Auflage, 
Berlin,  1867,  p.  96,  et  seq. 

IBID.     Lehrbuch  der  functionellen  Nervenkrankheiten,  Berlin,  1871,  p.  166,  etc. 

FLUCKIGER  AND  HANBURY.     Pharmacographia,  p.  40,  et  seq. 

FRONMULLER,  DR.     Klinische  Studien  uber  die  schlafmachende  Wirkung  der  narkotischen 
Arzneimittel,  Erlangen,  1869. 

HARLEY,  DR.  JOHN.     The  Old  Vegetable  Neurotics. 

HUNTER,  CHARLES.     On  the  Speedy  Relief  of  Pain  and  other  Nervous  Affections  by 
means  of  the  Hypodermic  Method,  Churchill,  London,  1865. 

HUSEMANN,  DRS.  AUG.  UND  THEOD.     Die  PJlanzenstoffe,  p.  Ill,  et  seq. 

HUSEMANN,  DR.  THEODOR.     Handbuch  der  gesammten  Arzneimittellehre,  Berlin,  1875, 
zweiter  Band,  p.  1055,  et  seq. 

HUTCHISON,  DR.  JAMES  H.     Pennsylvania  Hospital  Reports. 

KRAFFT-EBING,  DR.  R.  VON.     Bulletin  General  de  Therapeutique,  January  30,  1870, 
p.  474. 

LAWSON,  DR.  HENRY.     Sciatica,  Lumbago,  and  Brachialgia,  London,  1872. 

LOOMIS,  DR.  A.  L.     Lectures  on  Diseases  of  the  Respiratory  Organs,  Heart,  and  Kid* 
neys,  New  York,  1875,  p.  450. 

MAUDSLEY,  DR.  H.     The  Physiology  and  Pathology  of  the  Nervous  System,  and  Rey- 
nolds1 s  System  of  Medicine. 

MEDICO-CHIRURGICAL  TRANSACTIONS,  vol.  1,  p.  561,  et  seq. 

MITCHELL,  DR.  S.  WEIR.   American  Journal  of  Medical  Sciences,  1869-'70,  also  in  con 
junction  with  Morehouse  and  Keen. 

IBID.     Injuries  of  Nerves  and  their  Consequences. 

NOTHNAGEL,  DR.  HERMANN.     Handbuch  der  Arzneimittellehre,  p.  1,  et  seq. 


646  CEREBRAL   SEDATIVES. 

REISSNER,  DR.     Bulletin  General  de  Therapeutique,  January  30,  1870,  p.  89. 

ROBERTSON,  DR.  C.  LOCKHART.     The  Practitioner,  May,  1 869,  p.  272. 

ROSENTHAL,  M.     KUiiik  der  Nervenkrankhciten,  Stuttgart,  1875. 

STILLE,  DR.  ALFRED.     Epidemic  Meningitis,  and  Therapeutics  and  Materia  Medica. 

TAYLOR,  DR.  A.  S.      On  Poisons,  third  edition,  London,  1875,  p.  547. 

TROUSSEAU,  A.     Clinique  Medicate,  vol.  ii,  p.  196. 

WARD,  DR.  J.  BYWATER.      West  Riding  Lunatic  Asylum  Reports,  vol.  i,  p.  152. 

WOLFF,  DR.  0.  J.  B.     Archiv  fur  Psychiatric  und  Nervenkrankheiten,  Band  ii. 

Humulus. — Hops.  The  strobiles  of  Humulus  lupulus  Linn<3  (Nat. 
Ord.  Urticacece,  Cannabinece). 

Lupulinum. — Lupuline.  The  glandular  powder  separated  from 
the  strobiles  of  H.  lupus.  Lupuline,  Fr.  ;  Hopfendrusen,  Ger. 

Infuswn  Humuli. — Infusion  of  hops  (  f  ss — Oj).  Dose,  a  teacup- 
ful  or  more.  (Xot  official.) 

Tinctura  Humuli. — Tincture  of  hops  (twenty  parts  to  one  hun- 
dred). Dose,  3  ss —  ?  ij. 

Oleoresina  Lupulini. — Oleo-resin  of  lupuline.  Dose,  in,  v  —  3  ss 
or  more. 

Extractum  Lupulini  Fluidum. — Fluid  extract  of  lupuline.  Dose, 
3  ss—  3  ij. 

COMPOSITION. — Hops  contain  lupuline  (described  above),  a  tannio 
acid,  an  essential  oil  composed  in  part  of  valerol,  trimethylamine,  and 
a  liquid  volatile  alkaloid,  lupuline  (?). 

PHYSIOLOGICAL  ACTIONS. — Hop  is  an  aromatic  stomachic  tonic, 
and  as  such  promotes  the  appetite  and  digestive  power.  It  is  slightly 
astringent  also.  The  action  of  the  heart  is  somewhat  increased,  the 
cutaneous  circulation  excited,  and  diaphoresis  produced. 

In  a  very  slight  degree,  hop  first  causes  cerebral  excitement,  fol- 
lowed by  calm  and  a  disposition  to  sleep.  Experience  has  shown  that 
it  possesses  some  anaphrodisiac  property,  and  lessens  the  functional 
activity  of  the  testes  and  the  apparatus  of  erection. 

THERAPY. — As  a  stomachic  tonic  hop  is  quite  as  serviceable  as 
many  more  rare  and  costly  medicines.  It  is  useful  in  atonic  dyspepsia, 
simple  flatulent  colic,  and  mild  diarrhceas. 

The  power  of  a  hop  pillow  to  quiet  the  mind  and  to  induce  sleep 
seems  to  be  well  established,  but  its  influence  is,  doubtless,  largely  due 
to  imagination  and  the  association  of  ideas.  The  tincture  of  lupuline 
and  the  oleo-resin  are  useful  remedies  in  mild  cases  of  delirium  tremens. 
They  serve  a  double  purpose — as  a  stomachic  tonic  and  cerebral  seda- 
tive. A  combination  of  fluid  extract  or  tincture  of  lupuline  and  tinc- 
ture of  capsicum  is  probably  the  best  substitute  for  alcoholic  stimulants, 
when  the  habit  of  their  use  is  to  be  discontinued.  $  Ext.  lupulinse  fluid., 
tinct.  capsici,  aa  §  j.  M.  Sig.  :  One  or  two  teaspoonfuls  as  necessary. 
The  condition  known  as  horrors,  or  the  wakefulness  and  excitement 
which  just  precede  the  attack  of  delirium  tremens,  may  often  be  quite 
removed  by  free  use  of  this  combination. 


LACTUCARIUM.— BROMIDES.  647 

Nocturnal  seminal  losses  may  be  reduced  in  frequency  by  the  use 
of  lupuline,  of  which  the  best  preparation  for  this  purpose  is  the  oleo- 
resin.  Chordee  is  said  to  be  prevented  by  the  use  of  lupuline,  but  the 
author  has  been  quite  disappointed  in  his  attempts  to  relieve  this  state 
by  this  remedy. 

A  hop  poultice  or  bag  is  a  domestic  remedy  for  internal  pains  and 
inflammation,  especially  of  the  abdominal  organs.  A  quantity  of  hops 
is  sewed  into  a  muslin  bag,  dipped  in  hot  water,  and  then  laid  over 
the  affected  region.  It  forms  a  light  fomentation,  which  owes  its 
virtues  rather  to  the  heat  and  moisture  than  to  the  anodyne  qualities 
of  the  hops. 

Lactucarium. — Lactucarium.  The  concrete  milk-juice  of  Lactuca 
virosa  Linne  (Nat.  Ord.  Compositce).  (U.  S.  P.)  Dose,  gr.  v —  3  j. 

Tinctura  Lactucarii. — Dose,  3  ss —  3  ij. 

Syrupus  Lactucarii. — Dose,  3  j —  3  iij. 

COMPOSITION. — Lactucarium  contains  several  organic  substances 
and  eight  to  ten  per  cent  of  inorganic  matter.  It  yields  about  fifty- 
eight  per  cent  of  lactucerine  or  lactucone,  an  inodorous,  tasteless 
neutral  substance,  a  crystallizable  bitter  principle,  lactucine,  and  lac- 
tucic  acid. 

PHYSIOLOGICAL  ACTION,  AND  THERAPY. — The  soporific  quality  of 
lettuce  is  known  to  all  who  eat  this  vegetable.  Notwithstanding  this 
universal  experience,  careful  experiments  have  shown  that  lactucarium 
possesses  a  very  feeble  hypnotic  quality,  if  it  be  not  entirely  inert.  It 
is  only  used  as  a  substitute  for  opium  and  its  alkaloids  when  these 
disagree.  The  sirup  of  lactucarium  is  prescribed  to  relieve  cough, 
but  it  is  better  employed  as  a  vehicle  for  more  powerful  agents  of  the 
class  of  expectorants. 

Bromides. — Ammonii  Bromidum. — Ammonium  bromide.  Bro- 
rnure  d'ammonium,  Fr.;  Bromammonium,  Ger.  Colorless,  transpar- 
ent, prismatic  crystals,  or  a  white,  granular  salt,  becoming  yellow  on 
long  exposure  to  air,  odorless,  having  a  pungent,  saline  taste,  and  a 
neutral  reaction.  Soluble  in  1-5  part  of  water  and  in  150  parts  of 
alcohol  at  60°  Fahr. ;  in  0'7  part  of  boiling  water.  Dose,  gr.  x —  3  ss, 
or  more,  well  diluted. 

Calcii  Bromidum. — Calcium  bromide.  A  white,  granular  salt, 
very  deliquescent,  odorless,  having  a  pungent,  saline,  and  bitter  taste, 
and  a  neutral  reaction.  Soluble  in  0'7  part  of  water  and  in  1  part  of 
alcohol.  Dose,  3j — 3  ij. 

Camphora  Monobromata. — (For  description,  see  article  CAMPHOEA.) 
Ethyl  Bromide. — (For  description,  see  article  ^THER.) 
Lithii  Bromidum. — Lithium  bromide.      A  white,  granular  salt, 
very  deliquescent,   odorless,   having   a  very  sharp,  somewhat   bitter 


C48  CEREBRAL   SEDATIVES. 

taste,  and  a  neutral  reaction.  Very  soluble  in  water  and  in  alcohol. 
Dose,  gr.  v — 3ij. 

Potassii  Bromidum. — Potassium  bromide.  JSromure  de  potas- 
sium, Fr. ;  Brornkaliuvn,  Ger.  Colorless,  translucent,  cubical  crystals, 
permanent  in  dry  air,  odorless,  having  a  pungent,  saline  taste,  and  a 
neutral  reaction.  Soluble  in  1*6  part  of  water  and  in  200  parts  of 
alcohol  at  60°  Fahr.  Dose,  3j—  3  ij. 

Sodii  Bromidum. — Sodium  bromide.  Small,  colorless,  or  white 
monoclinic  crystals,  or  a  crystalline  powder,  permanent  in  dry  air, 
odorless,  saline  taste  and  neutral  reaction.  Soluble  in  1*2  parts  of 
water  and  13  parts  of  alcohol.  Dose,  3  j —  3  ij. 

ANTAGONISTS  AND  INCOMPATIBLES. — Acids,  acidulous  and  metallic 
salts  are  incompatible  with  bromides  of  ammonium  and  potassium,  and 
nitrous  ether  with  the  former.  The  physiological  actions  of  the  bro- 
mides are  antagonized  by  cold,  digitalis,  belladonna,  ergot,  and  other 
agents  which  energize  the  vaso-motor  nervous  system. 

SYNEBGISTS. — Opium,  chloral,  and  remedies  belonging  to  the  same 
group,  promote  the  action  of  the  bromides  on  the  brain  ;  and  aconite, 
veratrum  viride,  gelsemium,  etc.,  increase  the  depressing  effect  of  the 
bromides  on  the  circulatory  system. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  a  bromide  is  bitter  and 
saline.  In  a  short  time  after  it  is  swallowed,  the  characteristic  taste 
returns  to  the  mouth,  owing  to  the  outward  diffusion  of  a  portion  of 
that  administered.  The  tactile  sense  of  the  fauces,  as  also  the  muscu- 
lar movements  in  the  act  of  swallowing,  are  diminished  by  long-con- 
tinued use  of  the  bromides. 

Sixty  grains  of  the  bromide  of  potassium  or  sodium,  and  a  less 
quantity  of  the  ammonium  salt,  will  in  some  persons  produce  slight 
nausea  and  diarrhoea ;  in  others,  a  sense  of  coolness  in  the  epigastric 
region  ;  but  in  many,  provided  the  salt  is  properly  diluted,  no  effect 
on  the  stomach.  Gastric  catarrh  is  undoubtedly  one  of  the  evil  results 
which  may  follow  the  protracted  administration  of  the  bromides  in 
considerable  doses. 

These  are  diffusible  substances,  and  hence  pass  quickly  into  the 
blood.  When  large  doses  are  administered  and  insufficiently  diluted, 
it  is  probable  that  no  inconsiderable  portion  escapes  absorption,  for 
they  can  be  detected  in  the  intestinal  mucus  and  in  the  faeces. 

Very  obvious  effects  on  the  action  of  the  heart,  on  the  respiration, 
and  on  the  animal  temperature,  are  produced  by  the  bromides  if  admin- 
istered in  considerable  quantity.  These  functions  are  depressed,  but 
the  depression  is  much  less  evident  as  to  temperature  ;  hence,  in  order 
to  determine  this  result,  most  careful  observations  are  necessary.  The 
author  has  ascertained  that  two  drachms  of  bromide  of  potassium  wilj 
lower  the  temperature  in  a  healthy  adult  from  one  fifth  to  one  half  a 
degree  ;  the  respirations  from  two  to  five,  and  the  pulse  from  ten  to 


BROMIDES.  649 

twenty  beats  per  minute.  These  effects  are  more  pronounced  in  ani- 
mals, as  ascertained  by  the  administration  of  lethal  doses.  In  man 
the  number  of  the  cardiac  pulsations  is  not  only  reduced,  but  their 
force  is  diminished,  and  the  tension  of  the  arterial  system  is  lowered. 

A  transient  excitement,  intoxication,  giddiness,  in  some  persons  an 
anxious  mental  state,  are  produced  by  one  or  several  large  doses.  As 
a  rule,  slight  somnolence',  and  sounder  and  more  refreshing  sleep  result, 
provided  no  disturbing  element  intervenes.  The  pupil  is  not  affected 
in  its  size  and  sensibility  to  luminous  impressions  in  an  adult  man  by 
a  dose  of  one  hundred  and  twenty  grains.  When  long  continued,  the 
hypnotic  effect  is  much  more  pronounced,  and  a  constant  drowsiness 
is  experienced.  The  sensibility  to  pain,  but  especially  the  sensibility 
to  tactile  impressions,  is  lowered  by  the  bromides  at  all  accessible 
points  of  the  mucous  membrane,  and  of  the  skin — notably  of  the  plan- 
tar surfaces  of  the  hand  and  foot.  The  diminution  of  the  sensibility 
of  the  mucous  membranes  is  in  part  due  to  a  local  action  of  the  salt 
as  it  is  being  eliminated. 

Motility  is  impaired  by  the  long-continued  use  of  the  bromides  in 
man,  and  in  animals  paralysis  of  the  muscles  ensues.  If  injected  into 
the  tissues  of  a  limb,  paralysis  of  motion  and  sensibility  begins  in  that 
member.  In  man  the  impaired  motility  is  probably  due  to  other  fac- 
tors as  well  as  to  the  action  of  the  bromides  on  the  muscular  tissue, 
viz.,  to  the  cutaneous  anaesthesia,  and  to  an  anemia  of  the  co-ordi- 
nating centers,  in  consequence  of  which  their  functional  power  is 
lowered. 

A  very  notable  effect  of  the  bromides — chiefly  bromide  of  potas- 
sium— is  the  diminution  of  the  sexual  feeling  and  of  the  power  of 
erections  produced  by  it.  This  fact  has  been  established  by  abundant 
clinical  evidence.  The  result  is  not,  however,  produced  with  equal 
facility  in  all  cases,  and  considerable  doses  are  necessary  in  any  case. 

Prolonged  administration  of  the  bromides  develops  a  peculiar  state, 
to  which  the  term  bromism  is  applied.  This  condition  of  chronic  poi- 
soning differs  from  the  effects  of  a  few  medicinal  doses  in  the  extent 
and  intensity,  but  not  in  the  character,  of  the  symptoms.  The  follow- 
ing were  the  symptoms  of  bromism,  as  observed  in  an  epileptic  boy,  to 
whom  two  drachms  of  the  bromide  of  potassium  had  been  administered 
daily  for  a  month  :  extreme  pallor  and  anaemia,  dilated  pupils,  acne  on 
face,  forehead,  and  shoulders  ;  a  fetid,  bromine  breath  ;  slow  and 
feeble  action  of  the  heart ;  breathlessness,  and  quickened  pulse  on 
slight  exertion  ;  cool  hands  and  feet  ;  a  general  subjective  sense  of 
coldness  ;  movements  in  walking  tremulous  and  uncertain  ;  diminu- 
tion of  the  tactile  sensibility  of  both  cutaneous  and  mucous  surfaces  ; 
fauces  dry,  and  the  reflex  movements  sluggish  ;  swallowing  somewhat 
difficult ;  antaphrodisia  and  complete  relaxation  of  the  genitals  ;  mind 
weak,  manifested  in  silly  conduct  and  unmeaning  laughter. 


650  CEREBRAL   SEDATIVES. 

Various  mental  symptoms  are  in  some  subjects  produced  by  the 
long-continued  use  of  the  bromides.  Weakness  of  mind,  without  per- 
version of  intellection,  is  a  very  constant  result  of  the  continued  use  of 
large  doses.  Headache,  confusion  of  mind,  and  a  peculiar  intoxica- 
tion, had  long  ago  been  observed  to  follow  the  use  of  the  bromide  of 
potassium  in  even  moderate  doses  (Puche).  A  form  of  mental  de- 
rangement, with  hallucinations  of  a  melancholic  character,  has  been 
observed  by  Hammond  and  others,  and  in  a  few  instances  a  pleasura- 
ble intoxication,  with  exalted  ideas,  has  been  produced  (Bannister). 

The  pallor  and  anaemia  of  bromism  are  due  to  several  causes  :  to 
the  diminished  action  of  the  heart ;  slowness  of  the  capillary  circula- 
tion, and  consequent  interference  in  the  metamorphosis  of  tissue  ;  de- 
rangement of  digestion  and  assimilation  in  consequence  of  gastric  ca- 
tarrh ;  and  diminished  blood-supply  to  the  cerebro-spinal  axis.  The 
disorders  of  voluntary  movement,  the  uncertain  gait,  the  apparent 
defects  of  co-ordination,  are  variously  explained  ;  but,  they  are  doubt- 
less made  up  of  several  factors,  of  which  the  cutaneous  anaesthesia  is 
the  most  influential.  The  bromides  possess  the  power  to  destroy  or 
impair  the  irritability  of  the  motor  and  sensory  nerves,  and  the  con- 
tractility of  muscle,  and  to  these  effects  must  be  attributed  in  part  the 
disorders  of  voluntary  movement  noted  above. 

It  is  very  obvious  that  the  bromides  depress  certain  organic  func- 
tions :  they  diminish  the  action  of  the  heart,  lower  the  animal  tem- 
perature, and  lessen  the  blood-supply  to  various  organs.  These  re- 
sults can  only  be  accomplished  by  a  sedative  influence  on  the  sympa-  < 
thetic  system.  Some  very  accurate  observers  have  maintained  that  in 
this  action  lies  all  of  the  physiological  power  of  the  bromides  (Rey- 
nolds, Amory). 

EFFECTS  OF  THE  BROMIDES  COMPARED. — There  is  a  general  corre- 
spondence in  the  actions  of  the  different  bromides.  As  respects  their 
influence  on  the  pulse,  body-heat,  and  respiration,  the  author's  com- 
parative experiments  have  demonstrated  that  these  agents  stand  to 
each  other  in  the  following  order  :  bromide  of  sodium,  bromide  of 
lithium,  bromide  of  potassium,  bromide  of  ammonium.  Very  notable 
differences  exist  between  the  bromide  of  ammonium  and  the  others, 
due,  undoubtedly,  to  the  character  of  the  base. 

The  author's  experiments  on  animals  further  demonstrated  the  fol- 
lowing :  bromide  of  potassium  possesses  the  most  toxic  power,  and 
bromide  of  sodium  the  least.  The  bromide  of  lithium  is  first,  the 
bromide  of  sodium  second,  and  the  bromide  of  potassium  third,  in 
hypnotic  power.  As  respects  the  influence  of  these  agents  severally 
on  the  reflex  faculty  of  the  spinal  cord,  it  may  be  stated  that  none  of 
them  possess  the  power  to  abolish  the  reflex  faculty  except  when  ad- 
ministered in  sufficient  quantity  to  produce  lethal  effects.  Consid- 
ered from  this  point  of  view,  the  bromides  may  be  grouped  as  fol 


BROMIDES.  651 

lows  :  bromide  of  ammonium,  bromide  of  potassium,  bromide  of  lith- 
ium, bromide  of  sodium. 

The  elimination  of  the  bromides  takes  place  through  the  mucous 
membrane  of  fauces,  intestinal  canal,  and  bronchi,  through  the  skin, 
but  chiefly  by  the  kidneys.  The  rate  of  elimination  varies,  but  is 
usually  slow,  several  days  being  occupied  in  its  diffusion  outwardly 
from  the  blood. 

THERAPY. — In  some  kinds  of  vomiting  the  bromides  are  most  ser- 
viceable. The  form  of  vomiting,  to  the  treatment  of  which  they  are 
best  adapted,  is  the  reflex  and  the  cerebral — as  the  vomiting  of  cere- 
bral congestion,  sea-sickness,  pregnancy,  etc.  They  are  contra-indi- 
cated in  all  cases  of  vomiting  due  to  primary  gastric  disturbance. 

In  the  abdominal  neuroses,  of  which  cholera  infantum  is  a  type, 
the  bromides  are  often  highly  effective,  as  the  author  has  long  known, 
and  as  Spender  has  lately  advocated  ;  but,  according  to  the  author's 
observation,  it  is  useless,  if  not  injurious,  when  defective  alimentation 
is  the  cause  of  the  attacks,  and  is  serviceable  just  in  proportion  to  the 
degree  in  which  an  irritable  state  of  the  nervous  system  dominates 
the  gastro-enteric  disturbance.  When  the  cause  of  the  attacks  is 
heat,  or  reflex  irritation  of  the  fifth  pair,  as  in  teething,  or  cerebral 
congestion,  very  excellent  results  are  obtained  from  the  use  of  the 
bromide  of  potassium.  IJ  Potassii  vel  sodii  bromidi,  3  ij  ;  syrup, 
simplicis,  §  ss  ;  aquae  menthse  pip.,  3  jss.  M.  Sig.  :  A  teaspoonful 
every  hour  or  two.  The  author  has  had  excellent  results  from  the  use 
of  the  bromides  in  the  flatulent  colic,  the  restlessness,  and  crying  fits 
of  infants.  IJ  Potassii  vel  sodii  bromidi,  3  j ;  ol.  anisi,  T\[  ij  ;  mucil. 
acaciae,  aquae  menthae  pip.,  aa  f  j.  M.  Sig.  :  A  teaspoonful  every 
half -hour  until  relief  is  experienced. 

Increased  action  of  the  heart  (hyperkinesis)  due  to  irritation  of  the 
sympathetic,  as,  for  example,  such  as  occurs  in  exophthalmic  goitre,  is 
calmed  by  the  bromides.  The  irregular  and  too  frequent  action  of  the 
heart,  occurring  in  hysterical  subjects  of  plethoric  constitution,  is 
generally  relieved  in  the  same  way  ;  but  the  bromides  are  contraindi- 
cated  in  all  cases  dependent  on  anaemia.  Disturbed  action  (overac- 
tion)  of  the  heart,  with  cerebral  hyperaemia,  is  frequently  most  ad- 
vantageously treated  by  a  combination  of  digitalis  and  a  bromide  :  IJ 
Inf.  digitalis,  f  iv  ;  potassii  bromidi,  §  ss —  f  j.  M.  Sig.  :  A  table- 
spoonful  morning  and  evening. 

Da  Costa  has,  in  several  publications,  strongly  urged  the  use  of 
the  bromide  of  ammonium  in  acute  rheumatism.  Doubtless,  other 
bromides  (potassium,  sodium,  lithium)  would  be  as  effective,  and  are 
certainly  much  less  disagreeable.  The  author  has  used  the  bromide  of 
lithium  with  considerable  apparent  success,  in  subacute  rheumatism,  in 
rheumatic  gout,  and  to  remove  the  stiffness  and  nodosities  of  joints  re- 
maining after  attacks  of  the  above-named  rheumatic  affections.  The 


652  CEREBRAL  SEDATIVES. 

wakefulness,  delirium,  and  hyperpyrexia,  which  sometimes  complicate 
rheumatism  and  gout,  are  best  treated  by  bromide  of  lithium,  pain 
being  relieved  by  morphine  if  necessary. 

It  has  been  stated  that  the  bromides,  especially  bromide  of  ammo- 
nium, diminish  the  deposition  and  hasten  the  retrograde  metamorphosis 
of  the  fat  in  obesity.  Undoubtedly  these  agents  increase  waste,  but 
they  do  so,  chiefly,  in  consequence  of  a  severe  gastric  catarrh  which 
they  set  up. 

Rabuteau  has  proposed  the  use  of  the  bromides  as  eliminating 
agents  in  cases  of  mercurial,  cupric,  or  saturnine  poisoning.  These 
agents,  more  efficiently  than  the  iodides,  combine  with  the  deposited 
minerals,  convert  them  into  soluble  combinations,  and  thus  cause  their 
elimination.  The  best  results  are  probably  obtained  by  a  combination 
of  the  bromide  and  iodide  of  potassium. 

The  most  important  therapeutical  applications  of  the  bromides  of 
potassium,  sodium,  lithium,  etc.,  are  in  the  treatment  of  cerebral  dis- 
orders from  overaction.  The  bromides  acting  on  the  heart  slow  its 
movements,  and,  on  the  vaso-motor  nerves,  diminish  the  intra-cranial 
blood-supply.  The  best  results  are  obtained  in  the  treatment  of  cases 
in  which  there  is  no  anaemia  on  the  one  hand,  or  inflammatory  re- 
action on  the  other  ;  cases  in  which  the  intra-cranial  blood-supply  is 
in  excess,  because  the  vaso-motor  regulating  centers  are  wanting  in 
activity.  The  most  typical  representation  of  this  condition  is  seen  in 
wakefulness  from  cerebral  overwork.  No  clinical  fact  is  more  con- 
spicuous than  that  the  bromide  of  potassium  will  relieve  wakefulness 
of  this  kind.  The  hypnotic  action  of  the  bromides  is  not  a  certain' 
action  like  that  of  chloral,  nor  like  that  of  morphine  under  appropriate 
conditions  ;  considerable  mental  excitement  and  an  active  cerebral 
congestion  may  entirely  prevent  the  hypnotic  effect.  Wakefulness 
from  mental  worry,  fatigue,  unrest  of  the  peripheral  nerves  (fidgets), 
and  similar  causes,  will  generally  be  relieved  by  the  bromides.  For 
this  purpose  a  cumulative  action  is  generally  desirable,  effected  by  giv- 
ing a  dose  of  fifteen  grains  before  each  meal,  and  one  of  thirty  grains 
on  retiring.  The  manner  in  which  the  hypnotic  action  of  the  bromides 
is  limited  by  certain  states  of  the  intra-cranial  circulation  is  well  ex- 
hibited in  delirium  tremens.  In  the  condition  of  nervous  excitement 
and  wakefulness  which  precedes  the  delirium,  and  which  is  known  as 
"  horrors,"  the  action  of  the  bromide  is  most  satisfactory  ;  it  quiets 
the  restlessness  and  induces  sleep.  For  this  purpose  considerable 
doses  are  necessary — a  drachm  every  four  to  six  hours.  When,  how- 
ever, delirium  tremens  is  fully  developed,  this  remedy  is  much  less 
efficient,  and  frequently  fails  altogether  to  produce  sleep.  It  is  more 
serviceable  in  the  first  than  in  subsequent  attacks  of  horrors,  and  its 
utility  diminishes  as  the  structural  alterations  of  chronic  alcoholismug 
increase. 


BROMIDES.  653 

In  some  cases  of  maniacal  excitement  the  bromides  produce  excel- 
lent effects,  but  they  very  frequently  fail  without  apparent  reason. 
In  acute  mania  accompanied  by  heat  of  head,  injected  conjunctivas, 
and  restlessness,  refreshing  sleep  may  follow  the  administration  of  one 
full  dose  ;  but  the  remedy  fails  more  frequently  than  it  succeeds.  In 
puerperal  mania  of  the  sthenic  form,  with  rather  quick  and  full  pulse, 
hot  head,  and  injected  conjunctivas,  the  author  has  witnessed  excellent 
results  from  the  use  of  the  bromide  of  potassium  ;  but  it  has  rather 
increased  the  delusions  and  the  depression  when  the  type  of  the  case 
was  melancholic,  with  systemic  weakness  and  anaemia.  A  similar  ex- 
perience has  been  had  in  the  use  of  the  bromides  in  hypochondriasis 
and  melancholia.  These  forms  of  mental  trouble  are  most  usually 
accompanied  by  bodily  weakness,  and  are  rather  increased  by  the  use 
of  the  bromides  ;  but  it  occasionally  happens  that  these  agents  give 
an  amount  of  relief  afforded  by  no  other  drug  or  combination  of 
drugs.  It  is  impossible  to  indicate,  in  the  present  state  of  our  knowl- 
edge, the  particular  cases  in  which  the  bromides  may  be  serviceable, 
but  the  author  ventures  to  express  the  opinion  that  the  state  of  the 
intra-cranial  circulation,  which  may  be  ascertained  on  ophthalmoscopic 
examination,  will  furnish  the  true  guide.  It  need  hardly  be  ob- 
served that  the  bromides  are  useless  when  wakefulness  is  dependent 
on  pain. 

Some  kinds  of  neuralgia  are  much  benefited  by  the  bromides.  The 
congestive  form  of  migraine,  or  sick-headache,  is  generally  quickly 
dispelled  by  one  or  more  full  doses.  The  form  of  migraine  in  which 
it  acts  almost  as  a  specific  is  that  characterized  by  a  flushed  face, 
throbbing  temples,  injected  conjunctivas,  eyes  intolerant  of  light.  The 
bromides  often  give  great  relief  in  the  fugitive  nerve-pain  of  hysteri- 
cal women  ;  but  they  are  quite  ineffectual  in  neuralgia  fixed  in  a 
nerve,  as,  for  example,  in  trigeminal  neuralgia,  sciatica,  etc.  The 
bromide  of  potassium  is  often  quite  successful  in  ovarian  neuralgia, 
and  in  the  nervous  unrest  which  grows  out  of  ungratified  sexual  in- 
stinct in  men  and  women. 

Very  remarkable  results  have  been  obtained  by  the  use  of  large 
doses  of  bromide  of  potassium  in  tetanus.  H.  C.  Wood  gives  a  tabular 
statement  of  fifteen  cases  which  he  has  collected,  in  which  the  bromide 
of  potassium  was  the  chief  or  the  only  agent  used,  and  of  these  but 
two  died.  No  results  equal  to  this  have  been  achieved  by  any  other 
agent,  not  even  by  Calabar  bean.  In  order  to  succeed  with  this 
remedy  it  must  be  given  in  large  doses  (  3  j  every  three  or  four  hours). 
A  combination  with  chloral  is  also  highly  effective,  but  these  agents 
exert  a  powerfully  depressing  action  on  the  heart. 

Cases  of  strychnine-poisoning  have  been  reported  cured  by  full 
doses  of  the  bromide  of  potassium.  One  case  is  narrated  by  Dr. 
Gillespie  in  which  three  grains  of  strychnine  were  taken,  and  the  lethal 


G54  CEREBRAL    SEDATIVES. 

effects  were  obviated  by  one  ounce  of  bromide  of  potassium  in  divided 
doses. 

No  therapeutical  fact  is  better  established  than  the  influence  of 
bromide  of  potassium  over  epilepsy  and  epUeptiform  seizures.  But 
the  curative  power  of  this  agent  in  epilepsy  has  numerous  limitations. 
It  has  been  well  ascertained  that  bromide  of  potassium  is  most  valu- 
able in  those  cases  of  epilepsy  characterized  by  frequent  and  violent 
convulsive  seizures.  Epileptiform  attacks,  dependent  on  the  presence 
of  a  tumor  or  other  coarse  organic  lesion  of  the  brain,  are  usually 
suspended  by  the  use  of  this  agent,  although  the  neoplasm  is  un- 
affected in  its  growth  and  development.  It  is  a  curious  circumstance 
that  attacks,  nocturnal  exclusively,  are  less  amenable  to  the  bromide- 
treatment  than  those  which  occur  in  the  daytime. 

Cases  of  the  petit  mal,  or  epileptoid  seizures,  in  which  there  is  tempo- 
rary loss  of  consciousness  without  convulsion,  or  with  a  transient  spasm 
of  the  facial  muscles,  etc.,  are  as  a  rule  not  so  much  benefited  as  are 
cases  of  the  grand  mal.  Hysterical  convulsions  (hystero-epilepsy)  are 
benefited  by  the  bromide  in  the  degree  in  which  they  partake  of  the 
nature  of  true  epilepsy.  Simple  hysterical  convulsions  are  rarely  im- 
proved even  by  a  course  of  this  medicine.  It  has  been  repeatedly 
shown,  as  was  first  observed  by  Sir  Charles  Locock,  that  the  bromides 
are  especially  efficacious  in  cases  of  epilepsy  of  sexual  origin. 

Although  the  bromide  of  potassium  is  less  effective  in  the  epilepsy 
of  childhood  than  of  adults,  it  is  an  excellent  remedy  in  infantile  con- 
vulsions dependent  on  reflex  irritation.  After  the  removal  of  the  irri- 
tation the  convulsive  attacks  may  continue,  but  they  can  be  arrested 
by  the  use  of  the  bromides.  The  cerebral  congestion  which  precedes 
the  convulsive  seizure  may  be  relieved  by  this  agent,  and  the  threat 
ened  attack  averted.  The  author  is  convinced  that  the  convulsions 
which  attend  tubercular  meningitis  may  be  prevented  by  the  bromide, 
but  this  agent  exerts  no  curative  influence  in  this  fatal  malady. 

In  the  present  state  of  our  knowledge  it  is  not  possible  to  indicate 
with  any  degree  of  certainty,  besides  the  points  mentioned  above,  the 
kind  of  cases  in  which  a  successful  result  may  be  expected  from  the 
bromide  treatment.  If  no  improvement  be  manifest  after  several 
weeks  of  treatment,  and  if  bromism  be  induced,  the  case  must  be  re- 
garded as  an  unfavorable  one  for  this  treatment.  Brown-Sequard 
thinks  that  the  cropping  out  of  an  "  acne-like  eruption  on  the  face, 
neck,  shoulders,"  etc.,  is  an  evidence  that  the  bromide  is  proving  cura- 
tive, and  he  even  asserts  that  there  is  "a  positive  relation  between 
the  intensity  of  the  eruption  and  the  efficacy  of  the  remedy  against 
epilepsy."  According  to  Voisin,  the  abolition  of  reflex  nausea — ascer- 
tained by  passing  a  spoon  as  far  back  as  the  epiglottis,  without  causing 
attempts  at  vomiting — is  an  indication  of  the  successful  action  of  the 
remedy.  Furthermore,  he  regards  the  following  physiological  effects 


BROMIDES.  655 

as  evidence  of  curative  power  :  "  Hypnotic  manifestations,  general  las- 
situde, an  easy  and  rapid  disappearance  of  reflex  nausea,  and  antaphro- 
disiac  action." 

Certain  cases  of  epilepsy,  in  which  the  bromide  of  potassium  fails  to 
afford  relief,  are  greatly  benefited  by  strychnine.  From  this  circum- 
stance it  has  been  concluded  that  the  former  agent  is  most  serviceable 
in  cases  in  which  a  condition  of  hyperaemia  of  the  brain  exists,  and 
that  the  latter  agent  produces  the  best  effects  when  a  condition  of 
cerebral  anaemia  is  present. 

Various  important  considerations  are  connected  with  the  adminis- 
tration of  the  bromides  in  epilepsy.  The  daily  dose  required  varies 
from  half  a  drachm  to  four  drachms,  the  limit  of  the  quantity  admin- 
istered being  determined  by  the  effect  produced.  The  occurrence  of 
bromism  and  the  arrest  of  the  seizures  are  the  evidences  that  a  suffi- 
cient quantity  has  been  introduced  into  the  organism.  According  to 
the  author's  experience,  forty  grains  of  the  bromide,  dissolved  in  water 
and  given  before  each  meal,  or  three  times  a  day,  and  if  required  a 
double  dose  at  bedtime,  is  an  amount  of  the  medicine  which  it  is  rarely 
necessary  to  exceed.  When  the  convulsive  attacks  have  ceased,  a  sin- 
gle dose  of  sixty  grains  at  bedtime  will  generally  suffice  ;  but  this  re- 
sult must  not  be  interpreted  too  favorably,  and  the  remedy  discon- 
tinued, for  an  immense  experience  has  now  demonstrated  that  security 
against  a  return  of  the  attacks  can  only  be  attained  by  a  continuance 
of  the  remedy  for  two  or  more  years  after  all  indications  of  epilepsy 
have  disappeared.  After  the  continuous  use  nightly  of  the  remedy 
for  a  year,  the  dose  may  be  so  far  diminished  as  to  give  it  on  alternate 
nights.  Should  the  attacks  recur  after  temporary  cessation,  larger 
doses  are  required  as  a  rule. 

The  long-continued  use  of  the  bromide  of  potassium  may  produce 
very  serious  symptoms  of  bromism.  The  remedy  must  then  be  greatly 
reduced  in  amount  or  be  discontinued,  and  tonics  and  restoratives  ad- 
ministered until  the  organism  recovers  its  tone.  When  there  is  much 
susceptibility  to  the  action  of  the  bromides,  it  is  generally  better  to 
prescribe  the  bromide  of  sodium.  This  salt  is  equally  effective  in  epi- 
lepsy, while  it  is  much  less  depressing  in  its  effects.  It  is  not  unfre- 
quently  desirable  to  administer  iron  during  a  course  of  bromides.  The 
author  has  had  excellent  results  from  the  following  :  ]J  Potassii  bro- 
midi,  f  j  ;  ferri  bromidi,  gr.  vj  ;  aquae,  §  vj.  M.  Sig.  :  A  tablespoon- 
ful  three  times  a  day.  Echeverria  has  made  the  observation  that  tak- 
ing strong  coffee  with  the  meals  hinders  the  development  of  bromism. 
The  troublesome  and  very  disfiguring  acne  may  be,  in  part  at  least, 
prevented  by  the  conjoined  administration  of  arsenic  (three  to  five 
drops  of  liq.  potassii  arsenitis).  Brown-Sequard,  with  that  fondness 
for  complex  combinations  which  he  has  always  exhibited,  recommends 
the  following  formula  for  epilepsy  :  r>  Potassii  bromidi,  f  j ;  ammo- 
44 


656  CEREBRAL    SEDATIVES. 

riii  bromidi,  3  ijss  ;  potassii  iodidi,  3j;  potassii  bicarb.,  3ij  ;  infus. 
calumbffi,  3  vj.  M.  Sig.  :  A  teaspoonful  before  each  meal,  and  three 
teaspoonfuls  at  bedtime.  There  is  probably  no  advantage  in  this  com- 
bination, and  it  is  execrable  as  regards  taste.  It  is  true  sometimes 
better  results  are  obtained  from  a  combination  of  bromides  than  from 
the  bromide  of  potassium  alone.  It  is  always  advisable  to  combine 
the  iodide  of  potassium  with  the  bromides,  when  there  is  reason  to 
suspect  syphilitic  cerebral  lesions,  or  when  degenerate  changes  may 
appear  to  be  taking  place. 

Vaso-motor  disturbances,  elsewhere  than  intra-cranial,  are  relieved 
by  the  bromides.  "  Such  symptoms  are,  for  example,  sudden  numb- 
ness, coldness,  deadness,  or  pricking  sensations  in  one  or  more  limbs  ; 
sudden  distressing  but  indefinable  feelings  in  the  epigastrium,  abdo- 
men, or  hypogastrium  ;  or  sensations  akin  to  rigor,  with  much  anxiety 
and  palpitation,  or  '  fluttering,'  of  the  heart.  In  such  cases  it  may  be 
observed  that  the  local  circulation  is  interfered  with  ;  that,  for  exam- 
ple, the  pulse  in  one  arm  becomes  faltering,  irregular  in  force  and 
rhythm,  occasionally  intermitting,  while  that  in  the  other  arm  may 
remain  unaltered,  and  the  beat  of  the  heart  may  maintain  its  normal 
character." 

The  painful  flushings  of  the  face,  and  the  sense  of  fullness  in  the 
head,  which  occur  so  frequently  at  the  climacteric  period  in  women, 
may  often  be  removed  by  the  bromides. 

Certain  of  the  respiratory  neuroses  are  greatly  relieved  by  the 
bromides.  Laryngismus  stridulus,  when  present,  may  be  suspended 
by  the  prompt  use  of  full  doses,  and  the  tendency  to  frequent  recur-' 
rence  of  the  attacks  obviated  by  the  steady  and  continued  use  of  mod- 
erate doses  of  this  remedy.  It  may  be  combined  with  chloral :  5, 
Potassii  bromidi,  3  ij  ;  chloral,  hydratis,  3  ss  ;  syrup,  tolu.,  §  ss  ;  aquae, 
§  jss.  M.  Sig. :  A  teaspoonful  every  half-hour.  The  bromides  greatly 
relieve  the  spasmodic  element  of  whooping-cough,  but  they  do  not  ap- 
pear to  shorten  the  duration  of  the  disease.  A  combination  such  as 
given  above,  for  a  child  of  two  years,  may  be  prescribed  in  whooping- 
cough  during  the  spasmodic  stage,  and  in  proportionally  larger  quan- 
tity for  older  children. 

In  spasmodic  asthma  very  great  relief  is  sometimes  afforded  by  the 
use  of  bromides,  but  these  remedies  lose  their  effect  very  quickly. 
The  best  results  are  obtained  from  a  combination  of  the  bromide  with 
the  iodide  of  potassium  :  IJ  Potassii  bromidi,  |  j  ;  potassii  iodidi,  f  ss  ; 
aquae,  f  iv.  M.  Sig. :  A  teaspoonful  in  sufficient  water  every  half- 
hour  or  hour. 

Cough  which  is  merely  reflex  (stomachal,  intestinal,  renal,  uterine, 
ovarian)  can  usually  be  cured  by  the  bromides.  It  is  said  that  a  gar- 
gle of  the  bromide  of  potassium  will  diminish  the  cough  of  phthisis. 
The  author  has  ascertained  that  it  is  only  occasionally  that  such  a  for- 


BROMIDES.  657 

tunate  result  can  be  achieved  in  this  way.  Such  a  diminution  of  the 
sensibility  of  the  fauces  can  be  produced  by  a  few  large  doses  of  the 
bromide  of  potassium,  that  this  expedient  has  been  proposed  to  facili- 
tate laryngoscopy  and  rhinoscopy. 

In  certain  neuroses  of  the  genito-urinary  organs,  male  and  female, 
excellent  results  have  been  obtained  by  the  use  of  the  bromide  of  potas- 
sium. Abnormal  sexual  excitement  and  nocturnal  seminal  emissions 
may  be  checked  by  this  remedy.  The  condition  of  plethora  is  the  in- 
dication for  the  bromide.  When  the  sexual  organs  are  much  relaxed, 
the  erections  feeble,  and  the  seminal  fluid  watery,  especially  if  there 
be  such  a  constant  stillicidium  of  semen  as  to  constitute  the  so-called 
diurnal  losses,  the  bromide  of  potassium  does  harm.  The  more  nearly 
nocturnal  seminal  losses  approach  the  physiological  type,  the  more 
effective  the  bromides.  As  they  act  by  diminishing  the  blood-supply 
to  the  erectile  organs,  it  is  obvious  that  they  are  contraindicated  when 
there  is  debility,  and  when  the  erections  are  feeble.  They  prove  com- 
pletely successful  when  the  erections  are  normal  as  to  character,  but 
teasing  and  persistent.  The  various  nervous  disturbances  growing 
out  of  unsatisfied  sexual  desire  are  quieted  by  these  agents.  As  a 
rule,  nymphomania  and  satyriasis  dependent  on  cerebral  lesions  are 
not  diminished  or  prevented  by  the  bromides. 

Bromide  of  potassium,  in  full  doses,  has  been  proposed  for  the 
relief  of  chordee.  The  result  is  generally  disappointing,  but  occa- 
sionally relief  is  experienced  from  it.  Very  large  doses  ( 3  j  every 
four  hours)  are  necessary. 

Menorrhagia,  dependent  on  ovarian  irritation,  is  usually  promptly 
arrested  by  these  agents.  Sometimes  metrorrhagia,  even  when  due  to 
a  fibroid,  is  remarkably  improved  by  their  use,  but  success  is  not  in- 
variable. 

Various  functional  nervous  disorders  associated  with,  or  dependent 
on,  derangements  of  the  sexual  system — for  example,  such  as  are 
grouped  together  under  the  term  spinal  irritation — are  treated  with 
occasional  success  by  the  bromides.  It  is  to  be  noted,  however,  that 
a  condition  of  general  anaemia  or  local  spinal  anaemia,  which  usually 
coexists,  is  a  contraindication  to  the  use  of  these  agents.  They  are 
useful  in  proportion  to  the  degree  of  plethora  present. 

LOCAL  USES  OF  BROMIDES. — Epithelioma  of  the  face  has  been 
cured  by  applying  to  the  ulcerated  surface  bromide  of  potassium  in 
fine  powder.  A  solution,  gr.  x — gr.  xx  to  an  ounce  of  water,  is  a 
useful  application  for  allaying  the  itching  in  pruritus,  prurigo,  and 
similar  conditions,  and  the  powder  dusted  over  the  surface  is  an  effec- 
tive remedy  for  eczema,  old  ulcers,  etc. 

ACIDTTM  HYDROBROMICTJM  DILUTUM. — Diluted  hydrobromic  acid. 
A  liquid  composed  of  ten  per  cent  of  absolute  hydrobromic  acid 
and  ninety  per  cent  of  water.  A  clear,  colorless  liquid,  odorless, 


658  CEREBRAL   SEDATIVES. 

having   a   strongly   acid   taste,  and   an  acid   reaction.     Dose,  HI  xx 

—  3  ij- 

Hydrobromic  acid  has  many  of  the  properties  of  the  bromides,  and 
can  therefore  be  substituted  for  the  latter  in  some  cases.  In  the  treat- 
ment of  epilepsy,  the  acid  is  far  inferior  to  the  bromides.  In  spas- 
modic cough  it  has  proved  very  useful.  In  angina  pectoris,  or  car- 
diac irregularities  due  to  acidity  of  the  stomach,  it  is  highly  useful, 
given  before  meals.  The  tinnitus,  dizziness,  and  headache  caused  by 
quinine  may  be  largely  diminished,  if  not  wholly  prevented,  by  the 
addition  of  hydrobromic  acid  to  the  solutions  containing  the  former, 
or  by  giving  the  latter  some  time  after.  The  after-nausea  and  depres- 
sion caused  by  morphine  may  be  obviated  by  the  simultaneous  or  sub- 
sequent administration  of  hydrobromic  acid, 

Authorities  referred  to  : 

ANSTIE,  DR.  F.  E.  Neuralgia  and  the  Diseases  that  resemble  it,  English  edition,  p. 
185. 

BANNISTER,  DR.  H.  M.  The  American  Journal  of  Neurology  and  Psychiatry,  vol.  i, 
p.  369. 

BARTHOLOW,  DR.  R.  The  Bromides:  their  Physiological  Effects  and  Therapeutical 
Uses,  Fisk-Fund  Prize,  Providence,  1871. 

BILL,  DR.  J.  H.     American  Journal  of  the  Medical  Sciences,  July,  1868. 

BROWNE,  DR.  J.  C.  The  Action  of  the  Bromide  of  Potassium  on  the  Nervous  System 
Pamphlet. 

BROWN-SEQUARD,  DR.  C.  E.     Functional  Nervous  Affections,  Part  i,  p.  35. 

CLARKE  AND  AMORT.  The  Physiological  and  Therapeutical  Action  of  the  Bromide  of 
Potassium  and  the  Bromide  of  Ammonium,  Boston,  1872. 

DA  COSTA,  DR.  J.  M.     American  Journal  of  the  Medical  Sciences,  April,  1871. 

DAMOURETTE  ET  PELTET.     Bulletin  General  de  Therapeutigue,  vol.  Ixiii,  p.  296. 

DAT,  DR.  ALBERT.     Methomania,  Boston,  1867,  p.  30. 

ECHEVERRIA,  M.  GONZALES.     On  Epilepsy,  p.  316. 

ECLENBURG  UNO  GuTTMANN.  Schmidfs  Jahrbucher  der  gesammten  Median,  vol 
cxxxvii,  p.  158. 

GILLESPIE,  DR.  CHARLES.     American  Journal  of  the  Medical  Sciences,  October,  1870. 

HAMMOND,  DR.  WILLIAM  A.     On  Wakefulnets. 

IBID.     The  Psychological  Journal. 

LABORDE,  DR.  J.  V.     Archives  de  Physiologic  Normale  et  Pathologique,  May,  1868. 

LEWIZKY,  ACTS  KASAN.      Virchow's  Archiv  fur  pathologische  Anatomie,  1868,  p.  183. 

PLETZER,  M.  Schmidt1  s  Jahrbucher  der  gesammten  Medicin,  Band  cxxxix,  p.  166,  No. 
8,  1868. 

RABUTEAU,  M.     Gazette  Hebdomadaire,  March  19,  1868. 

RETNOLDS,  DR.  J.  RUSSELL.     The  Practitioner,  July,  1868. 

SPENDER,  DR.  J.  KENT.     The  British  Medical  Journal,  1884. 

VOISIN,  A.     Bulletin  General  de  Therapeutique,  vol.  Ixxi,  p.  102. 

WILLIAMS,  DR.  S.  W.  D.  On  the  Efficacy  of  the  Bromide  of  Potassium  in  Epilepsy, 
etc.,  Churchill,  1865. 

Bromofonn. — As  respects  its  chemical  constitution  bromoform  is  a 
terbromide  of  formyl,  as  chloroform  is  a  terchloride  of  formyl.  If  for 
the  chlorine  in  chloroform  bromine  is  substituted,  the  resulting  com- 


BROMOFORM.  659 

pound  is  bromoform.  It  is  a  transparent,  colorless,  oily  liquid,  having 
an  ethereal  odor,  a  sweetish  taste,  and  a  specific  gravity  more  than 
twice  that  of  chloroform,  or  2'9.  It  is  slightly  soluble  in  water,  and 
freely  in  alcohol  and  ether.  When  exposed  to  the  light  it  becomes 
brownish  in  color  and  bromine  fumes  are  given  off.  The  dose  ranges 
from  two  minims  for  an  infant  to  three  to  five  minims  from  two  years 
up  to  five,  and  in  the  same  proportions  for  older  children,  and  for 
adults  ten  to  fifteen  minims,  three  or  four  times  a  day.  It  is  best  ad- 
ministered to  children  in  sirup,  to  adults  in  capsules. 

As  regards  physiological  action,  bromoform  corresponds  closely 
to  the  other  bromides.  It  acts  on  the  reflex  centers  to  inhibit  their 
functions,  and  also  on  the  centers  of  conscious  impressions  to  induce 
sleep  and  insensibility  to  pain.  It  is,  therefore,  an  anaesthetic,  like  its 
congener,  chloroform,  but  it  is  too  dangerous  to  be  so  utilized.  It  less- 
ens the  depth  and  frequency  of  the  respiratory  movements,  and  also 
the  force  and  tension  and  rate  of  the  pulse,  ultimately  in  sufficient 
quantity  paralyzing  both. 

Bromoform  is  not  actively  toxic.  Some  cases  of  poisoning  by  acci- 
dent and  overdoses  have  been  reported,  but  they  were  restored  by  the 
use  of  stimulants  and  the  antagonists  of  the  cardiac  and  respiratory 
depression  (Stepp). 

The  indications  for  the  therapeutical  employment  of  bromoform 
are  the  same  as  for  the  alkaline  bromides,  but  experience  has  shown 
that  there  is  a  special  field  for  its  powers.  The  evidence  of  its  utility 
in  the  treatment  of  whooping-cough  is  conclusive.  Stepp,  who  was 
the  first  to  make  use  of  this  remedy,  reports  on  one  hundred  cases  in 
which  it  proved  to  moderate  the  violence  and  shorten  the  duration  of 
the  disease  without  a  failure.  The  duration  of  the  treatment  varied 
somewhat,  but  it  ranged  from  two  to  four  weeks.  The  number  of  par- 
oxysms began  to  diminish  after  a  few  days'  treatment.  Lo'wenthal, 
assistant  in  Senator's  clinic  in  Berlin,  also  tried  it  in  one  hundred 
cases  of  whooping-cough,  and  with  most  gratifying  results.  The  first 
symptom  to  yield  was  the  vomiting,  and  in  three  to  five  days  the  nose- 
bleed ceased,  and  the  paroxyms  of  coughing  rapidly  lessened  in  num- 
ber and  severity.  Schippers,  who  prescribed  the  remedy  in  no  less 
than  two  hundred  and  fifty  cases,  concludes  that  bromoform  in  the  in- 
dicated doses  is  free  from  harm,  that  it  diminishes  the  number  and 
severity  of  the  paroxysms,  stops  the  vomiting  and  the  nasal  haemor- 
rhage, and  materially  shortens  the  duration  of  the  disease.  Dr. 
Fischer,  of  New  York,  also  reports  favorably  on  the  effects  of  bromo- 
form in  whooping-cough,  which  he  maintains  is  the  best  remedy  hith- 
erto proposed  for  the  relief  of  this  disease. 

Bromoform  is  an  admirable  remedy  for  ordinary  coughs  from 
catarrhal  affections  of  the  broncho-pulmonary  mucous  membrane.  In 
combination  as  follows  it  is  now  much  prescribed  by  French  physi- 


060  CEREBRAL   SEDATIVES. 

cians  :  $  Bromoformi,  3  ij  ;  codeinae  sulph.,  gr.  viij  ;  acet.  scillse, 
§  ss.  ;  syr.  tolu,  §  iijss.  M.  Sig.  :  A  teaspoonful  every  four  hours 
for  an  adult.  For  a  child,  the  quantity  of  bromoform  and  codeine 
should  be  one  fourth  to  one  eighth  of  these  amounts  respectively. 

Bromoform  is  an  effective  remedy  for  the  relief  of  the  cough  of 
phthisis.  It  may  be  combined  in  the  form  given  below,  and  used  by 
inhalation  as  a  remedy  for  the  cough  of  phthisis :  IJ  Bromoformi, 
3  j  ;  pyridin.,  3  ij  ;  ethyl,  bromidi,  3  v.  M.  Sig. :  Ten  to  twenty 
drops  by  inhalation.  The  administration  may  be  made  by  dropping 
on  a  handkerchief,  or  on  a  sponge  placed  in  a  small  funnel  or  in  a  vial. 
The  patient  should  be  directed  to  inhale  the  vapor  frequently  if  the 
cough  is  troublesome,  or  several  times  a  day  if  an  impression  is  to  be 
made  on  the  local  disease.  There  is  reason  to  believe  that  this  combi- 
nation approaches  the  dignity  of  a  curative  agent,  since  under  its  use 
the  bacillus  is  inhibited,  even  destroyed. 

Bromoform  has  also  been  used  with  more  or  less  success  in  other 
spasmodic  diseases,  as  asthma,  singultus,  laryngismus  stridulus,  etc. 
A  severe  attack  of  asthma  may  be  aborted  by  the  subcutaneous  injec- 
tion of  five  minims.  As  it  is  not  irritating  to  the  tissue,  this  procedure 
may  be  resorted  to  without  risk  of  subsequent  mischief,  besides  the 
immediate  distress  accompanying  the  subcutaneous  injection  of  an 
ethereal  compound,  which,  however,  is  of  short  duration. 

The  author  has  had  good  effects  from  its  administration  in  cases 
of  headache,  in  vertigo  from  reflex  causes,  and  in  various  abnormal 
sensations  in  the  head  belonging  to  neurasthenia.  In  certain  cases  of 
intestinal  catarrh  with  reflex  vertigo  and  occipital  headache  it  has 
apparently  done  much  good.  It  well  deserves  a  trial  in  hepatic  colic, 
in  renal  colic,  and  in  the  colic-like  attacks  that  occur  during  the  course 
of  chronic  intestinal  catarrh. 

As  a  remedy  having  the  properties  of  a  bromide,  and  possessing 
by  combination  with  formyl  certain  sedative  powers,  bromoform  is  a 
promising  expedient  for  epilepsy,  and  already  some  experiences  have 
shown  it  to  be  well  worthy  of  attention.  The  more  recent  the  epilep- 
tic seizures,  the  more  promising  the  remedy.  It  is  also  an  efficient 
remedy  in  the  treatment  of  excitement  in  the  insane.  Dr.  Angrisani 
employs  for  this  purpose  a  solution  of  bromoform  in  glycerin  flavored 
with  oil  of  cinnamon,  and  begins  with  a  dose  of  fifteen  minims,  in- 
creased to  thirty  minims  if  desired.  The  sedative  effect  is  rapidly 
manifested,  and  no  unpleasant  after-effects  have  been  observed  except 
some  diarrhoea,  which  was  readily  controlled.  It  follows  from  these 
observations  that  bromoform  may  be  utilized  in  place  of  the  bromides 
of  the  alkaline  bases  in  cases  in  general  to  which  these  are  applicable. 

Authorities  referred  to : 

FISCHER,  DR.     The  New  York  Medical  Record,  September  6,  1890. 
LOWENTHAL,  DR.     Berliner  klinische  Wochenschrift,  No.  23,  1890. 


BROMAL.— BROMAL   HYDRATE.— BROMALIN.— FORMANILIDE.  661 

NEUMANN,  DR.     Therapeutische  Monatehefte,  July,  1890. 
SCHIPPERS,  DR.     Jbid.,  December,  1890,  and  January,  1891. 
STEPP,  DR.     Deut.  medicin.  Wochenschrift,  Nos.  31  and  44,  1889. 

Bromal. — In  this  form  bromal  is  a  heavy  liquid,  oily  in  consistence, 
and  of  a  pungent  flavor  and  taste.  In  chemical  constitution  it  is  tri- 
brom-acetaldehyd.  On  the  addition  of  water  it  forms  a  hydrate,  and 
as  thus  constituted  is  employed  in  medicine. 

Bromal  Hydrate  occurs  in  white  crystals,  deliquescent  on  exposure, 
pungent  in  taste,  and  having  a  chloral  odor.  It  is  soluble  in  water 
and  the  ordinary  menstrua,  and  is  incompatible  with  alkaloids.  Dose, 
gr.  ij  to  gr.  x,  in  solution. 

Bromalin. — Brom-ethyl-formin. — This  occurs  in  laminated  crystals, 
colorless,  or  in  a  whitish  crystalline  powder.  It  is  soluble  in  water, 
and  can  be  administered  in  capsules  or  wafers,  or  in  an  ordinary  pow- 
der ;  the  dose  ranges  from  gr.  xv  to  3ij. 

Bromamide. — Tribromaniline  Hydrobromate. — This  is  a  colorless, 
odorless,  and  tasteless  substance  occurring  in  needles.  Readily  vola- 
tilizes. Dose  is  from  three  to  ten  grains,  several  times  a  day. 

We  have  in  the  last  four  products  combinations  in  which  the  effects 
of  bromine  are  modified  and  enhanced.  Bromal  is  not  employed  in 
that  form,  but  as  bromal  hydrate,  and  has  had  good  effects  in  insom- 
nia, chorea,  epilepsy,  and  similar  nervous  affections.  Bromalin,  the 
third  member  of  the  group,  has  been  brought  forward  more  especially 
as  a  substitute  for  potassium  bromide  in  the  treatment  of  epilepsy. 
It  may  be  used  more  widely  on  the  same  ground,  and  in  the  various 
maladies  to  the  treatment  of  which  potassium  bromide  has  hitherto 
been  applied.  Bromamide  has  been  utilized  in  rheumatic  fever,  chronic 
rheumatism  and  neuralgia,  and  as  an  analgesic  and  antipyretic  of  con- 
siderable activity. 

Formanilide  (phenylformamide)  has  affinities  in  composition  and 
mode  of  action  with  bromoform.  It  is  obtained  by  combining  with 
the  aid  of  heat  aniline  with  ethyl  formate.  It  crystallizes  in  the  form 
of  prisms  and  is  freely  soluble  in  water.  A  twenty-per-cent  solution 
dropped  on  the  tongue  causes  a  strongly  pungent  sensation,  which  is 
followed  by  analgesia  and  pallor  of  the  mucous  membrane,  and  this 
anaesthetic  effect  is  maintained  from  one  to  two  hours.  Preisach  has 
also  tested  its  action  on  the  mucous  membrane  of  the  larynx,  and  com- 
plete analgesia  was  induced  by  it  in  a  few  minutes,  remaining  for 
several  hours.  Dr.  Meisels  has  also  experimentally  ascertained  that 
the  mucous  membrane  of  the  urethra  is  similarly  affected  by  it.  By 
Touszk  it  has  been  found  to  possess  the  same  antipyretic  and  analgesic 
action  as  the  most  valuable  members  of  the  fatty  and  aromatic  series 
of  synthetical  products.  Some  transient  lowering  of  the  heart's  action 
and  some  slight  systemic  depression  have  been  observed. 


G(32  MOTOR   DEPRESSANTS. 

AGENTS  WHICH  DEPRESS  THE  MOTOR  FUNCTIONS 
OF  THE  SPINAL   CORD  AND  SYMPATHETIC. 

Conium. — Hemlock.  The  full-grown  fruit  of  Conium  maculatum 
Linnu  (Nat.  Ord.  Umbelliferce),  gathered  while  yet  green.  Cigue,  Fr.; 
Schierling,  Ger. 

Extraction  Conii  Alcoholicum.  —  Alcoholic  extract  of  conium. 
Dose,  gr.  j — gr.  v. 

Extractum    Conii  Fluidum.  —  Fluid   extract   of   conium.     Dose, 

TTl,  ij TTl,  V— TT),  Xl. 

Tinctura  Conii. — Tincture  of  conium.  Dose,  TH.X —  3  j.  (Not  offi- 
cial.) 

The  preparations  of  conium  are  very  uncertain  in  strength.  It  is 
pretty  well  established  that  the  extracts  are  nearly,  if  not  quite,  inert. 
The  best  preparations  are  the  fluid  extract  and  alkaloid. 

COMPOSITION. — The  special  powers  of  hemlock  are  due  to  a  pecul- 
iar alkaloid  (canine).  This  is  an  oily,  limpid  liquid,  having  a  strong 
alkaline  reaction,  a  peculiar  odor  resembling  the  urine  of  mice,  and  a 
specific  gravity  of  0*88.  It  probably  exists  in  the  plant  in  the  form  of 
the  malate ;  but,  by  some  authorities,  the  acid  with  which  it  is  com- 
bined is  supposed  to  be  an  acid  peculiar  to  conium,  the  coneic  acid. 
Conine  is  associated  with  ammonia,  and  another  crystallizable  alkaloid, 
conhydrine. 

Conine  is  quickly  decomposed  by  heat.  Exposed  to  the  air,  it  is 
soon  converted  into  a  brownish  resin,  and  becomes  inert.  Hence  it  is* 
that  the  preparations  of  conium  possess  but  little  activity,  and  are  so 
frequently,  indeed  entirely,  wanting  in  physiological  and  therapeutical 
effects.  It  is  better,  therefore,  to  administer  the  alkaloid,  which,  be- 
ing soluble  in  alcohol,  may  be  administered  in  that  menstruum,  or  it 
may  be  converted  into  an  acetate  and  dissolved  in  a  mixture  of  alco- 
hol and  water.  It  is  to  be  noted,  also,  that  different  specimens  of 
conine  differ  remarkably  in  activity  ;  hence,  whenever  a  new  prepara- 
tion is  begun,  the  minimum  dose  should  be  first  administered  until  its 
real  power  is  ascertained  (Burman). 

Conine. — Dose,  gr.  -fa — gr.  -fa — gr.  -fa,  or  in  minim-doses  from  TTI  -fa 
— ill  ij.  Half  a  minim  of  conine  (pure)  is  about  equivalent  in  activ- 
ity to  3  j  of  the  best  succus  conii.  The  chlorhydrate  and  especially 
bromhydrate  of  conine  are  greatly  to  be  preferred,  not  only  to  the  pure 
alkaloid,  but  to  any  of  the  preparations  of  conium.  The  bromhydrate 
crystallizes  in  the  form  of  colorless,  prismatic  needles,  which  are  freely 
soluble  in  water  and  also  in  alcohol,  have  but  little  taste,  and  no  odor 
(Mourrut).  The  dose  of  this  salt  ranges  from  -fa  of  a  grain  to  £,  £, 
even  1  grain.  It  is  not  actively  toxic.  By  reason  of  this  fact,  its 
freedom  from  a  disagreeable  taste  or  odor,  and  its  solubility,  the  brom- 


CONIUM.  663 

hydrate  is  a  most  desirable  preparation  for  administration,  either  by 
the  stomach  or  hypodermatically. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies  and  tannic 
acid  are  chemically  incompatible.  Physiologically  considered,  the  ac- 
tions of  conium  are  antagonized  by  nux-vomica  and  its  alkaloids  strych- 
nine and  brucine,  by  picrotoxin,  and  the  tetanizing  agents  in  general. 

SYNERGISTS. — Gelsemium,  tobacco,  veratrum  viride,  aconite,  me- 
thyl-strychnium,  hydrocyanic  acid,  and  curara,  increase  the  action  of 
conium. 

PHYSIOLOGICAL  ACTIONS. — The  preparations  of  conium  possess  a 
considerable  degree  of  acridity,  and  are  therefore  apt  to  produce  gas- 
tric irritation,  nausea,  and  vomiting.  These  results  sometimes  follow 
the  subcutaneous  injection  of  conine.  The  active  principles  readily 
diffuse  into  the  blood.  What  changes,  if  any,  they  induce  in  the  blood 
are  quite  unknown.  It  is  probable  that  they  limit  the  power  of  the 
red  blood-globules  to  convey  oxygen  to  the  tissues  on  which  they  have 
a  selective  action — the  motor  nerves. 

When  an  active  dose  of  conine  is  administered,  weakness  of  the 
legs  and  a  sense  of  weight  and  fatigue  of  these  members  are  first 
experienced.  The  eyelids  become  heavy  and  droop  somewhat,  and 
double  vision,  or  confused  vision,  a  feeling  of  torpor  of  the  mind,  and 
giddiness,  follow.  Speech  is  also  affected  as  respects  vocal  utterance, 
but  the  memory  for  words  and  the  faculties  of  mind  generally  are  un- 
impaired. When  the  dose  is  a  lethal  one,  paralysis  of  the  voluntary 
muscles — first  of  the  inferior  extremities — ensues  ;  there  is  consider- 
able vertigo,  the  mind  is  torpid  and  indifferent  but  not  perverted, 
speech  and  vision  are  lost,  the  respiration  becomes  labored  and  slow 
from  paralysis  of  the  respiratory  muscles,  and  death  occurs  from  as- 
phyxia, the  action  of  the  heart  continuing  until  after  respiration  has 
ceased.  The  mind  remains  unclouded  to  the  last,  except  when  delirium 
ensues  from  carbonic-acid  poisoning.  Convulsive  movements  generally 
occur  in  animals  from  retention  of  carbonic  acid  in  the  blood,  and  in 
man  sometimes  local  convulsive  movements.  Sensation  is  unaffected 
until  near  the  close,  but  a  subjective  sense  of  numbness  is  experienced 
in  the  feet  and  legs,  without  actual  impairment  of  the  functions  of  the 
sensory  nerves.  The  body  temperature  is  decidedly  lowered,  and  in  a 
direct  ratio  to  the  amount  of  the  paralysis. 

The  physiological  effects  of  conine,  even  when  produced  by  decid- 
edly large  medicinal  doses,  are  hindered  if  not  entirely  prevented  by 
active  exercise.  When  the  muscular  weakness,  the  heaviness  and 
sense  of  fatigue  in  the  legs  are  first  experienced,  if  resisted  and  muscu- 
lar movements  are  carried  on,  these  sensations  disappear,  and  the 
whole  duration  of  the  physiological  effects  is  much  shortened. 

The  action  of  conine  is,  primarily  and  chiefly,  on  the  end-organs  of 
the  motor  nerves  ;  the  nerve-trunks  next  lose  their  excitability,  and 


664  MOTOR   DEPRESSANTS. 

by  an  extension  of  the  paralysis  the  spinal  cord  is  at  last  involved. 
The  muscular  irritability  remains  unaffected.  According  to  M.  Veri- 
go,  the  paralysis  proceeds  from  the  spinal  cord,  outwardly,  to  the  ter- 
minal filaments  of  the  motor  nerves.  But  it  is  probable  that  this 
experimenter  operated  with  a  preparation  of  conine  containing  methyl- 
conium,  which  has  been  shown,  by  Crum  Brown  and  Fraser,  to  affect 
first  the  motor  columns  of  the  spinal  cord. 

Xo  constant  and  characteristic  post-mortem  appearances  seem  to 
be  produced  by  conine.  The  left  cavities  of  the  heart  are  found  empty, 
and  the  right  distended,  but  these  are  products  of  the  mode  of  dying, 
and  are  not  directly  due  to  the  action  of  the  poison.  The  blood  is 
generally  fluid,  and  the  coagula  are  soft. 

Elimination  takes  place  by  various  channels,  chiefly  by  the  kidneys. 
Conine  has  been  found  in  considerable  quantity  in  the  liver,  lungs,  and 
spleen. 

That  the  conium  of  our  time  was  employed  by  the  ancients,  can 
hardly  be  doubted  by  any  one  who  will  read  the  account  of  the  death 
of  Socrates  from  the  Athenian  state  poison.  This  remarkable  story, 
which  has  descended  to  us  in  Plato,  bears  all  the  indications  of  veri- 
similitude, and  its  delineation  of  the  effects,  as  the  symptoms  success- 
ively manifested  themselves,  are  just  as  we  see  them  now,  in  the  action 
of  conium  on  animals,  and,  as  Harley  has  described  them,  as  occurring 
in  his  own  person.  Socrates  continued  his  sublime  discourse  after  the 
poison  had  been  swallowed,  thus  showing  that  his  mental  powers  had 
not  been  clouded — not  certainly  till  near  the  end,  when,  as  we  now 
know,  carbonic-acid  narcosis  comes  on.  Plato  described  the  slowly- 
developing  paralysis,  beginning  below  and  ascending — the  mental 
powers  of  Socrates  remaining  unimpaired  until  near  the  end,  when  his 
commands  were  laid  on  his  disciples  to  sacrifice  a  cock  to  ^Esculapius, 
which  was  a  return  to  the  superstitions  of  the  age,  after  having  con- 
demned them  in  the  course  of  his  ethical  disquisitions  before  the  youth 
of  Athens,  for  which  he  now  underwent  the  extreme  penalty  of  the  law. 

THERAPY. — Formerly  the  preparations  of  conium  were  much  used 
for  a  supposed  discutient  or  resolvent  action  in  glandular  enlargements, 
and  in  certain  kinds  of  tumors.  But,  since  it  has  been  shown  that  the 
preparation  chiefly  employed  for  this  purpose  (the  extract)  is  practi- 
cally inert,  the  supposed  cures  effected  in  this  way  are  justly  regarded 
as  examples  of  the  post  hoc.  Influenced  by  the  same  considerations, 
conium  was  supposed  to  have  an  alterant  and  anodyne  action  in  cancer. 
But,  since,  in  the  progress  of  physiological  research,  it  has  been  shown 
that  conium  affects  the  motor  and  not  the  sensory  nerves,  it  is  no  longer 
employed  to  relieve  the  pains,  or  to  arrest  the  growth  and  diffusion,  of 
cancer.  It  is  right  to  add,  however,  that  able  practitioners  hold  that 
the  discutient  and  resolvent  powers  of  conium  are  well  established  in 
clinical  experience  (Stille). 


CONIUM.  665 

The  true  uses  of  conium  are  those  deduced  from  a  consideration  of 
its  physiological  actions.  As  it  lowers  the  functional  activity  of  the 
motor  nervous  system,  it  is  indicated  in  those  cases  of  disease  in  which 
motor  activity  is  in  excess.  Very  valuable  results  have  been  obtained 
by  the  use  of  conine  in  mania,  administered  with  the  view  of  subduing 
excessive  motor  excitement.  Its  real  utility  consists  in  quieting  mus- 
cular agitation,  and  thus  preventing  emaciation  and  maniacal  exhaus- 
tion. It  is  considered  to  be  most  suitable  to  the  treatment  of  acute 
mania,  without  organic  brain-lesion  (Burman).  The  dose  required  for 
this  purpose  is  if\,  ss — HI  iij,  or  subcutaneously,  commencing  with  one 
tenth  of  a  minim,  and  gradually  increasing  it  until  some  characteristic 
physiological  effects  are  produced. 

The  succus  conii  has  been  used  by  Harley  and  others  with  success 
in  chorea.  The  special  object  for  which  it  is  used  in  this  malady  is  to 
quiet  the  excessive  muscular  agitation  ;  but,  in  order  to  accomplish 
this  result,  a  sufficient  quantity  must  be  administered  to  produce  distinct 
physiological  effects.  To  quiet  muscular  agitation  is  not  alone  suffi- 
cient to  cure  chorea  ;  a  suitable  hygiene,  proper  alimentation,  and  re- 
storative agents,  are  indispensable.  Some  cases  of  paralysis  agitans 
are  remarkably  benefited  by  conium,  but  it  is  of  little  avail  in  cases  of 
sclerosis,  or  when  important  structural  alterations  have  occurred.  Co- 
nine is  certainly  indicated  in  tetanus,  hydrophobia,  and  strychnine- 
poisoning,  but  hitherto  it  has  not  succeeded,  probably  because  in- 
ert preparations  were  employed.  The  author  has  ascertained  that 
in  animals  conine  rather  hastens  than  retards  the  lethal  effects  of 
strychnine. 

In  whooping-cough,  asthma,  and  laryngismus  stridulus,  good  effects 
have  been  obtained  by  the  use  of  conium,  carried  to  the  point  of  in- 
ducing its  characteristic  physiological  effects.  A  priori,  the  best  re- 
sults might  be  expected  from  the  use  of  conium  in  epilepsy,  but  it  is 
by  no  means  comparable  to  the  bromides.  According  to  Echeverria, 
conium  is  serviceable  in  those  cases  of  epilepsy  "  attended  by  cerebral 
derangement  and  vertigo." 

The  state  of  blepharospasm,  which  accompanies  strumous  oph- 
thalmia, is  relieved  by  considerable  doses  of  conium.  It  is  neces- 
sary in  the  treatment  of  this,  as  of  other  motor  disorders,  to  give 
a  sufficient  quantity  of  conium  to  produce  sensible  physiological 
effects. 

The  subcutaneous  injection  of  conine  may  be  practiced  instead  of 
the  stomach  administration,  in  all  of  the  forms  of  disease  for  which 
this  remedy  is  prescribed.  By  Burman  this  mode  of  administration 
has  been  practiced  with  much  success  in  the  treatment  of  acute  mania  / 
by  Pletzer,  in  asthma  ;  by  Erlenmeyer,  in  emphysema  and  angina  pec- 
toris  ;  by  Lorent,  in  pneumonia  and  pleuritis  ;  and  by  Eulenburg,  in 
blepharospasm.  A  marked  decrease  in  the  pulse-rate,  and  in  the  tern 


666  MOTOR   DEPRESSANTS. 

pernture,  has  been  observed  to  follow  the  hypodermatic  injection  of 
conine  in  these  diseases.  The  rational  indication  for  the  use  of  conine 
in  pneumonia  and  pleuritis  is,  to  give  the  organs  physiological  rest  by 
inducing  a  paretic  state  of  the  respiratory  muscles. 

A  solution  of  bromhydrate  of  conine  is  greatly  preferable  to  any 
form  of  the  alkaloid,  for  all  purposes,  but  especially  for  subcutaneous 
injection.  The  following  will  prove  useful :  IJ  Conine  bromhydratis, 
gr.  viij  ;  aquae,  vel  aquae  chloroformi,  §  j.  M.  Sig. :  Ten  minims  con- 
tain one  sixth  of  a  grain.  As  Tiryakian  and  also  Tuloup  have  shown, 
the  effects  of  this  agent  decline  by  repetition,  and  hence  the  dose  must 
be  increased  every  few  days.  Two  doses  every  twenty-four  hours  will 
usually  be  sufficient  to  maintain  a  constant  effect.  By  the  authors 
above  mentioned,  by  Dujardin-Beaumetz,  Prevost,  Rochefontaine,  and 
others,  it  is  asserted  to  be  very  effective  in  spasmodic  affections,  espe- 
cially of  the  respiratory  organs — in  whooping-cough,  asthma,  dyspnoea, 
laryngismus  stridulus,  spasm  of  the  glottis,  hiccough,  etc.  It  has  been 
used  with  success  in  tetanus  by  Chisolm  and  by  Cory. 

Conine  and  Morphine. — The  effects  of  conine  are  in  every  way 
heightened  by  morphine.  These  agents  have  been  very  successfully 
employed  in  acute  mania,  conjointly  administered  subcutaneously. 
K  Conine  acting  on  the  purely  motor  centers,  in  a  sedative  manner, 
and  morphine  acting  in  a  similar  way  on  the  sensori-motor  and  ideo- 
motor  centers,  it  follows,  as  a  fair  corollary,  that  the  combination  of 
the  two,  in  subcutaneous  injection,  should  lead  to  effects  directly  an- 
tagonistic to  the  condition  of  maniacal  excitement ;  and,  such  being 
in  fact  the  case,  they  may  be  thus  used  together  with  very  great  sue* 
cess  in  the  treatment  of  mania."  When  nerve-pain  and  muscular 
spasm  coexist,  the  best  results  may  be  expected  from  the  combined 
administration  of  morphine  and  conine. 

Authorities  referred  to : 

BFRMAN,  DR.  J.  WILKIE.     West  Riding  Lunatic  Asylum  Reports,  vol.  ii,  p.  1. 
CURTIS,  DR.  EDWARD.     The  Medical  Record,  Nos.  ccxxxvii,  ccxxxviii,  1875. 
ERLENMEYER,  DR.  A.     Die  subcutanen  Injectionen,  p.  74. 
EFLENBURG,  DR.  A.     Die  hypodermatische  Injectionen,  p.  239. 
FLUCKIGER  AND  HANBURY.     Pharmacographia,  p.  266. 
HARLEY,  DR.  JOHN.     Old  Vegetable  Neurotics,  English  edition,  etc. 
HUSEMANN,  DR.  THEODOR.     Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  925. 

HUSEMANX,  DRS.  THEOD.  UNO  AUG.     Die  Pflanzenstojfe. 
KOLLIK.ER,  PROF.  DR.  A.     Virchow's  Archiv,  Band  x,  p.  228. 
LORENT,  DR.  E.     Die  hypodermatischen  Injectionen,  p.  42. 
PELVET  ET  DAMOCRETTE.     Archives  Generates,  sixieme  serie,  tome  vi,  p  87. 
PELTZER,  M.     Quoted  by  Eulenburg,  supra, 
TAYLOR,  DR.  A.  S.     On  Poisons,  third  edition,  p.  731. 
VON  PRAAG,  L.     ScIunidCs  Jahrbucher  der  gesammten  Medicix,. 
M.     The  Practitioner,  vol.  vii,  p.  58. 


CURARA.  667 

Curara,  or  Woorara. 

HISTORY. —  There  are  no  official  preparations.  The  substances 
known  under  this  name  vary  much  in  purity,  and  differ  in  origin. 
True  curara  is  a  poisonous  substance,  prepared  by  the  Indian  tribes  of 
certain  districts  of  South  America,  and  known  under  the  names  woo- 
rara,  urari,  wurali,  etc.  A  specimen  examined  by  Mitchell  and  Ham- 
mond consisted  of  two  distinct  preparations  named  respectively  carro* 
val  and  vao,  the  former  more  closely  corresponding  to  the  European 
specimens.  Curara  is  obtained  for  the  most  part  from  several  plants 
of  the  Strychnos  family,  as  Strychnos  toxifera,  S.  cogens,  and  from 
Paulinia  cururu.  An  extract  from  these  plants,  it  is  supposed,  is 
mixed  with  the  venom  of  certain  poisonous  reptiles,  and  possibly  with 
other  animal  substances.  As  the  arrow-poison  of  different  tribes  differs 
not  only  in  strength,  but  in  the  character  of  the  effects  produced  by 
them,  it  is  certain  that  they  are  derived  from  different  sources.  That 
which  is  now  obtained  in  commerce  as  curara,  and  which  agrees  in  the 
main  with  the  description  of  Bernard,  is  the  substance  referred  to  in 
this  article. 

COMPOSITION. — Curara  occurs  in  small,  irregular  masses,  of  a  dark- 
brownish  color,  somewhat  slimy,  and  looking  like  a  dried  vegetable 
extract.  The  mass  is  in  part  soluble  in  water,  and  the  undissolved 
residue  is  composed,  for  the  most  part,  of  starch-granules,  vegetable 
cells,  oil-drops,  and  other  vegetable  structures  (Mitchell  and  Ham- 
mond). The  existence  of  an  alkaloid  in  curara  had  been  suspected  by 
Boussingault,  but  it  was  not  actually  discovered  until  1865,  when  it 
was  isolated  by  Preyer  (curarine).  The  estimates  formed  of  its  ac- 
tivity vary  :  by  Preyer  it  was  held  to  be  twenty  times  stronger  than 
the  crude  drug,  but  by  Beigel  only  six  times  ;  but  these  differences  are 
readily  accounted  for  in  the  varying  qualities  and  activity  of  curara. 

Curarine,  one  of  the  alkaloids,  is  crystallizable,  deliquescent,  and 
forms  with  acids  salts,  which  are  also  crystallizable.  The  dose  will 
range  from  y^-g-  gr.  to  -fa  gr.  by  the  stomach — from  -^^  gr.  to  j-J-g-  gr. 
when  administered  subcutaneously.  A  larger  quantity  may  be  neces- 
sary when  distinct  physiological  effects  are  to  be  produced. 

Another  alkaloid  has  since  been  discovered  by  Bohm,  and  to  this 
he  has  assigned  the  name  curine. 

The  dose  of  woorara  or  curara,  the  crude  drug,  will  range  from  -fa 
gr.  to  ^  gr.  It  is  desirable  to  try  on  some  inferior  animal  the  activity 
of  any  new  specimen  before  using  it  on  man. 

ANTAGONISTS  AND  INCOMPATIBLES. — As  curara  is  a  paralyzer,  it  is 
antagonized  by  those  agents  which  act  in  the  opposite  manner  on  the 
spinal  cord.  From  the  physiological  standpoint,  strychnine  and  atro- 
pine  are  appropriate  antagonists,  opposing  the  tendency  to  death  by 
failure  of  respiration.  Remarkable  results  have  been  obtained  in  ani- 
mals by  artificial  respiration.  An  animal  will  recover  from  twice  the 


608  MOTOR   DEPRESSANTS. 

fatal  quantity,  if  respiration  be  kept  up  until  elimination  occurs,  which 
is  speedy.  As  in  the  case  of  the  other  alkaloids,  curarine  is  destroyed 
by  the  caustic  alkalies. 

SY^TERGISTS. — The  paralyzers  in  general,  especially  the  respiratory 
group,  promote  all  of  the  actions  of  curara. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  curara  is  bitter.  Applied 
to  the  unbroken  integument,  it  is  not  absorbed  ;  but  swallowed,  it  slow- 
ly diffuses  into  the  blood,  and  produces  characteristic  effects.  Vul- 
pian  finds  that  it  is  absorbed  more  rapidly  when  injected  into  muscular 
masses  than  when  simply  thrown  under  the  skin.  According  to  the 
observations  of  Voisin  and  Liouville,  made  on  man,  the  salivary,  nasal, 
and  lachrymal  secretions  are  increased.  It  is  probable  that  the  gastro- 
intestinal secretions  are  also  promoted.  The  rate  of  diffusion  into  the 
veins  from  the  stomach  varies,  but  it  takes  place  in  from  twenty  min- 
utes to  a  half -hour  ;  but  even  a  longer  time  than  this  may  be  required. 
The  action  of  the  heart  increases  ;  the  pulse  rises  a  number  of  beats 
and  may  be  dicrotic  ;  the  temperature  ascends  two  to  three  and  a  half 
degrees,  and  the  respirations  are  accelerated,  four  to  eight  times  per 
minute  being  added  to  the  usual  rate.  Voisin  and  Liouville  ventured 
on  the  exhibition  of  larger  doses  with  the  following  result :  the  symp- 
toms began  by  a  more  or  less  violent  chill ;  the  heart  beat  rapidly, 
reaching  140,  and  the  pulse  became  weak  ;  the  respiration  was  labored 
and  sighing  ;  the  temperature  rose,  and  double  vision,  sometimes  with 
mydriasis,  sometimes  with  myosis,  set  in.  The  legs  became  weak,  co- 
ordination was  destroyed,  and  the  vertical  position  could  not  be  main- 
tained. The  mind  continued  undisturbed.  The  paralysis  disappeared* 
after  a  short  time,  but  a  sense  of  fatigue  persisted  in  the  limbs  for 
some  hours.  The  increased  temperature  was  accompanied  by  the 
nsual  symptoms  of  fever — there  were,  besides  the  accelerated  pulse 
and  respiration,  headache,  thirst,  and  perspiration. 

It  was  by  means  of  curara  that  Bernard  demonstrated  the  exist- 
ence of  contractility  as  an  independent  endowment  of  muscular  tissue. 
Curara,  by  poisoning  the  end-organs  of  the  nerves  in  the  muscles,  sepa- 
rated these  organs,  and  thus  permitted  a  study  of  the  agency  of  each. 
In  all  classes  of  animals,  as  in  man,  curara  induces  paralysis  of  move- 
ments :  locomotion,  the  erect  posture,  breathing,  finally  the  heart's  ac- 
tion, are  arrested.  The  paralysis  induced  by  curara  is  not  due  to  an 
abolition  of  the  excitability  proper  to  the  motor  nerve-trunks,  but  to  a 
modification  set  up  in  the  terminals  of  the  intra-muscular  nerves.  This 
fact  is  proved  by  the  well-known  experiment  of  Bernard,  repeated  by 
Kolliker,  Zeleuski,  Vulpian,  and  numerous  other  experimentalists,  in 
which  a  frog  is  paralyzed  by  curara  in  all  parts  of  the  body  except 
one  limb  which  has  been  ligatured  to  prevent  the  access  of  the  poison 
to  it.  The  muscles  of  the  unpoisoned  limb  react  normally  to  stimula- 
tion, to  the  will,  and  to  reflex  impressions  from  distant  parts.  The 


CURARA.  669 

muscles  of  the  poisoned  parts  of  the  body  act  on  direct  stimulation, 
but  not  by  the  will  nor  by  any  direct  or  reflex  excitation  conveyed  by 
the  nerve.  The  paralysis  must  therefore  be  due,  as  above  stated,  to 
the  effect  of  the  poison  on  the  terminals  of  the  nerve  in  the  muscular 
tissue.  As  movements  can  be  induced  in  the  muscles  of  the  unpoi- 
soned  limb  by  irritation  of  the  skin  at  a  distant  point,  it  is  clear  that 
the  sensory  nerves  and  the  reflex  function  of  the  spinal  cord  continue 
active.  It  has  been  abundantly  demonstrated  that  in  curarized  ani- 
mals the  spinal  cord  preserves  its  functions  for  a  long  time.  If,  how- 
ever, a  large  quantity  of  the  poison  is  administered,  and  a  fatal  result 
prevented  by  artificial  respiration,  the  excitability  of  the  cord  is  at  first 
increased  but  afterward  paralyzed  (Von  Bezold,  Vulpian,  etc.).  The 
motor  and  sensory  nerve-trunks  are  also  finally  affected,  but  this  is  a 
secondary  action,  and  ascertainable  in  curarized  animals  only  by  main- 
taining artificial  respiration  a  sufficient  length  of  time.  It  follows,  then, 
that  all  parts  of  the  nervous  system  are  ultimately  paralyzed.  The 
action  begins  in  the  end-organs  of  the  motor  nerves,  and  then  grad- 
ually extends  to  all  parts,  if  the  dose  is  large  enough  and  life  is  main- 
tained by  artificial  respiration. 

Curara  also  acts  on  the  accelerator  nerves  of  the  heart,  at  first  stim- 
ulating and  afterward  paralyzing  them.  The  action  of  the  heart  is 
increased,  also,  by  the  paralyzing  effect  of  curara  on  the  terminals  of 
the  pneumogastric,  thus  removing  the  inhibition.  So  decidedly  is  the 
vagus  affected  by  full  doses  of  curara,  that  galvanic  irritation  does  not 
arrest  the  movements  of  the  heart  (Von  Bezold).  Notwithstanding 
the  increased  action  of  the  heart,  the  blood-pressure  is  lowered  by  cu- 
rara, due  doubtless  to  a  paralyzing  action  on  the  organic  muscular  fiber 
and  consequent  dilatation  of  the  vessels.  The  effect  of  curara  on  the 
sympathetic  is  variously  interpreted.  According  to  Vulpian,  the  iris 
contracts  on  changes  in  the  amount  of  light  falling  on  the  retina  in 
curarized  animals  ;  the  pupils  dilate  on  faradization  of  the  skin  ;  dila- 
tation of  the  vessels  of  the  posterior  members  and  an  elevation  of  tem- 
perature take  place  in  a  curarized  dog  on  f  aradizing  the  central  portion 
of  the  corresponding  sciatic  ;  very  energetic  reflex  contractions  of  the 
stomach,  intestines,  and  bladder  are  obtained  in  curarized  animals  by 
f  aradizing  the  skin  of  different  regions  of  the  body  (Vulpian).  These 
facts  indicate  that  curara  does  not  destroy  but  rather  stimulates  the 
functions  of  the  sympathetic.  Curara  acts  on  the  lymph-vessels  of 
frogs.  According  to  Tarchanoff,  the  liquid  which  accumulates  during 
curarization  grows  richer  in  leucocytes  ;  also  the  blood  contained  in 
the  vessels  becomes  more  concentrated,  the  relative  proportion  of  red 
globules  being  increased.  As  the  accumulation  of  leucocytes  takes 
place  in  the  lymph-sacs,  there  is  a  corresponding  diminution  of  them 
in  the  blood.  These  changes  are  due  to  the  paralysis  of  the  peripherio 
vessels  (Tarchanoff). 


670  MOTOR   DEPRESSANTS. 

Curara,  as  has  been  stated,  produces  an  obvious  rise  of  temperature 
in  the  extremities.  This  is  supposed  to  be  due  to  paralysis  of  the  pe- 
ripheral vessels.  In  the  interior  of  the  body,  however,  there  ensues  an 
equally  constant  decline  of  body-heat  (Tscheschichin,  Rohrig  und 
Zuntz).  This  lowering  of  the  central  temperature  is  due  to  the  loss 
of  heat  at  the  periphery  by  the  cooling  of  the  blood  detained  in  the 
superficial  vessels. 

Bernard  long  ago  ascertained  that  curarized  animals  became  dia- 
betic. It  seems  probable  that  this  result  is  due  to  the  paralysis  of  the 
vessels  of  the  liver.  On  the  other  hand,  Bock  and  Hoffmann  have  ap- 
parently demonstrated  that  the  production  of  glycosuria  is  the  result 
of  increased  activity  of  the  liver.  It  may  be  due  to  the  fact  that  the 
sugar  formed  does  not  undergo  oxidation,  for  Jolyet  has  ascertained 
that  in  curarized  animals  the  excretion  of  carbonic  acid  is  much  below 
the  amount  in  health.  By  reason  of  the  changes  in  the  vascular  sup- 
ply, curara  affects  the  functional  activity  of  various  organs.  The  in- 
creased production  of  saliva,  and  of  the  nasal  and  intestinal  secretions 
noted  at  the  outset,  is  due,  there  is  little  doubt,  to  this  fact. 

The  elimination  of  curara  takes  place  chiefly  by  the  kidneys,  but 
some  escapes  with  the  fasces  (Koch).  The  urine  of  a  curarized  animal 
will  poison  another  animal,  and  this  may  be  repeated  to  several  sub= 
jects.  The  retention  of  the  urine  charged  with  curara,  in  the  bladder, 
will  continue  the  effects  of  the  poison  by  reabsorption.  This  state- 
ment has  been  the  subject  of  considerable  controversy.  It  has  been 
denied  that  the  mucous  membrane  of  the  bladder  possesses  the  power 
to  absorb  again  into  the  circulation  poisons  dissolved  in  the  urine  in* 
the  process  of  excretion.  Brown-S6quard  appears  to  have  been  the 
first  to  prove,  by  direct  experiment,  that  alkaloids  could  be  thus  ab- 
sorbed, and  some  recent  observations  have  confirmed  the  accuracy  of 
his  experiments.  In  respect  to  curara,  as  to  other  organic  alkaloids, 
when  poisoning  occurs,  it  is  an  obviously  proper  expedient  to  keep  the 
bladder  empty,  if  necessary,  by  catheterization. 

THERAPY. — The  applications  of  curara  to  the  treatment  of  disease 
follow  from  the  results  of  the  physiological  study.  Being  a  motor  and 
not  a  sensory  paralyzer,  it  is  adapted  to  the  treatment  of  muscular 
cramp  and  spasm.  It  is  one  of  the  remedies  employed  against  strych- 
nine-poisoning, and  although  from  the  theoretical  standpoint  such 
treatment  may  seem  proper,  yet  in  actual  practice  it  has  not  succeeded. 
That  a  remedy  obtained  from  members  of  the  strychnos  family,  and  a 
paralyzer  in  action,  should  antagonize  strychnine,  is  a  remarkable  fact. 
In  the  process  of  preparation  employed  by  the  Indians,  it  is  in  a  high 
degree  probable  that  methyl  strychnium  is  formed,  and  this  substance, 
as  was  originally  sh'own  by  Crum-Brown  and  Fraser,  is  a  paralyzer, 
and  acts  precisely  like  curara.  Curara  has  been  used  with  a  limited 
measure  of  success  in  tetanus.  In  the  successful  cases — for  example, 


GELSEMIUM.  671 

that  narrated  by  Mr.  Spencer  Wells — large  doses  were  administered. 
According  to  the  statistics  of  Demme,  of  twenty-two  cases  of  tetanus 
treated  by  this  agent,  eight  recovered.  Other  methods  have  certainly 
succeeded  better.  Two  cases  of  hydrophobia  have  been  reported  in 
which  a  cure  followed  the  use  of  curara.  One  of  these,  reported  by 
Dr.  Watson,  was  examined,  and  the  diagnosis  confirmed  by  Dr.  Flint, 
of  New  York.  The  first  dose  was  T*g-  gr.,  and  subsequently  \  gr.  and 
-J-  gr.  were  given.  The  value  of  this  statement  is  impaired  by  the  fact 
that  the  different  specimens  vary  so  much  in  activity.  M.  Vella  has 
successfully  treated  a  case  of  tetanus  by  cutaneous  absorption  of  the 
agent ;  but  the  usual  mode  of  administration  has  consisted  in  the  sub- 
cutaneous injection.  This  subject,  as  M.  Vulpian  has  well  said,  has 
lost  its  interest  since  the  discovery  of  the  utility  of  chloral.  It  is  in 
a  high  degree  probable,  however,  that  curara  would  be  greatly  more 
successful  if  it  were  pushed  in  these  cases  to  obtain  its  full  physiologi- 
cal influence,  and  the  complete  suspension  of  the  spasms. 

By  Voisin  and  Liouville  curara  has  been  extensively  employed  as 
a  remedy  for  epilepsy.  The  facts  already  mentioned  in  regard  to  the 
action  of  this  agent  in  producing  febrile  phenomena  were  obtained 
from  the  experiences  with  epileptics.  They  find  that  attacks  may  be 
prevented,  and  the  condition  of  epileptics  much  improved,  by  the 
timely  administration  of  this  remedy. 

It  has  proved  useful  in  chorea,  in  tic-douloureux  (Beigel,  Du  Cazal), 
but  other  remedies  are  doubtless  better. 

Authorities  referred  to : 

BEIGEL,  DR.  H.     Journal  of  Anatomy  and  Physiology,  vol.  u,  p.  329. 

BERNARD,  CL.  Lecons  sur  les  Effets  des  Substances  Toxiquei  et  Medicamenteuses,  Paris, 
1857,  p.  238. 

BOHM,  DR.  R.  Beitrdge  zur  Physiologic,  1886,  p.  173.  Quoted  by  Virchow  undHirsch's 
Jahresbericht  for  1886. 

HAMMOND  AND  MITCHELL.  The  American  Journal  of  the  Medical  Sciences,  July,  1859. 
Experimental  Researches  regarding  Carroval  and  Vao. 

KOLLIKER,  A.  Virchow's  Archiv,  Band  x,  p.  3.  Physiologische  Untersuchungen  uber 
die  Wirkung  einiger  Gifle. 

RIEOEL,  DR.  FRANZ.  Centralblatt  f.  d.  med.  Wiss.,  1871,  p.  401.  Ueber  den  Einfluss 
des  Curare  auf  die  Korpertemperatur. 

TARCHANOFF,  M.  J.  Archives  de  Physiol.  Norm,  et  Path.,  January  and  February,  1875. 
De  r  Influence  du  Curare  sur  la  Formation  de  la  Lymphe  et  P Emigration  des  Globulet 
blancs  du  Sang. 

VOISIN  ET  LIOUVILLE.     Gaz.  Hebdom.,  Nos.  32-37,  1866. 

VULPIAN,  A.  Lecons  sur  V Action  Physiol.  des  Substances  Toxiques  et  Medicamenteuses, 
Paris,  1881,  pp.  193-422. 

WATSON,  DR.     American  Journal  of  the  Medical  Sciences,  July,  1876. 

ZELEUSKI,  DR.  Fire/tow's  Archiv,  Band  xxiv,  p.  362.  Zur  Frage  von  der  Musket 
irritabilitdt. 

Gelsemilim. — Yellow  jasmine.     The   rhizoma   and  roots  of 
mium  seinpervirens  (Linne)  Persoon  (Nat.  Ord.  Loganiacece). 

45 


672  MOTOR   DEPRESSANTS. 

Extraction  Gelsemli  Fluidum. — Fluid  extract  of  gelsemium.    Dose, 

m  ij— m  x- 

Tinctura  Gelsemii. — Tincture  of  gelsemium.     Dose,  TIJ,  v — m  xx. 

The  so-called  gelseminine  is  obtained  by  evaporation  of  the  tinc- 
ture, and  is  a  very  uncertain  preparation  ;  the  dose  is  gr.  ss — gr.  ij. 
It  is  only  used  by  the  eclectic  practitioners. 

Disappointment  is  frequently  experienced  from  the  use  of  gelse- 
mium preparations,  owing  to  the  fact  that  they  are  made  from  the 
dried  root.  In  the  process  of  drying,  even  spontaneously,  the  alkaloid 
disappears.  The  most  trustworthy  preparations  are  the  official,  pre- 
pared conscientiously  from  the  fresh  root. 

COMPOSITION. — Gelsemium  contains  a  very  powerful  alkaloid — yel- 
semine  or  gelsemina — and  gelsemic  or  gelseminic  acid,  by  some  said  to 
be  identical  with  cesculin  ;  but  Wormley  has  shown  the  fallacy  in  the 
evidence  on  which  this  statement  was  based,  and  Fredigke's  account 
of  gelsemic  acid  agrees  with  Wormley's  in  all  essential  particulars. 
It  contains  also  an  acrid  resin,  volatile  oil,  gallic  acid,  a  yellow  color- 
ing-matter, besides  some  other  unimportant  ingredients. 

Grelsemine. — In  its  pure  state  gelsemine  (gelsemia)  is  a  colorless, 
odorless  solid,  having  an  intensely  persistent,  bitter  taste.  It  has 
strongly  basic  properties,  completely  neutralizing  the  most  powerful 
acids,  forming  salts  of  which  the  sulphate,  nitrate,  chloride,  and  acetate 
are  freely  soluble  in  water  (Wormley).  Dose,  gr.  ^5 — gr.  ^ 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies  and  tan- 
nic  acid  are  chemically  incompatible.  As  respects  the  physiological 
actions,  gelsemium  is  antagonized  by  the  diffusible  stimulants,  by 
alcohol,  ammonia,  opium,  digitalis,  etc.  The  lethal  effects  are  best 
treated  by  emetics,  warmth,  alcoholic  stimulants,  by  faradization  and 
artificial  respiration,  by  morphine  subcutaneously,  and,  according  to 
Fredigke,  by  the  tincture  of  xanthoxylum  fraxineum. 

SYNEKGISTS. — Conium,  physostigma,  tobacco,  opium,  etc.,  when  ad- 
ministered with  gelsemium,  increase  its  effects  in  the  whole  sphere  of 
its  physiological  activity. 

PHYSIOLOGICAL  ACTIONS. — The  preparations  of  gelsemium  have  a 
bitter  and  somewhat  aromatic  taste,  and  a  narcotic  odor.  They  do  not 
produce  gastric  irritation.  The  active  substance,  being  crystalloidal, 
diffuses  into  the  blood  with  facility.  In  moderate  doses,  but  sufficient 
to  produce  decided  physiological  effects,  gelsemium  causes  a  feeling  of 
languor  and  mental  calm,  slowing  of  the  action  of  the  heart,  drooping 
of  the  eyelids,  dilatation  of  the  pupil,  and  some  feebleness  of  muscu- 
lar movements.  In  larger  doses  the  physiological  effects  are  as  fol- 
lows :  vertigo,  double  vision,  amblyopia,  paralysis  of  the  levator  pal- 
pebrae  so  that  the  upper  eyelid  can  not  be  raised,  dilated  pupil,  labored 
respiration  in  consequence  of  a  paretic  state  of  the  respiratory  muscles, 
slow  and  feeble  action  of  the  heart,  great  muscular  weakness,  and  sen- 


GELSEMIUM.  673 

sibility  to  pain  and  touch  much  reduced.  These  effects  are  produced 
in  about  a  half -hour  after  the  stomach  administration,  and  last  two  or 
three  hours,  when  they  subside.  When  lethal  doses  are  taken,  the 
above-described  symptoms  occur  in  a  more  intense  degree.  The  gait 
is  at  first  staggering,  but  the  power  of  muscular  movement  soon  ceases, 
and  a  sense  of  numbness  diffuses  over  the  body.  The  eyelids  close 
(paralysis  of  the  levator),  the  pupils  dilate  widely,  vision  is  lost,  and 
the  pupils  cease  to  respond  to  the  stimulus  of  light.  The  lower  jaw 
drops,  and  the  power  of  speech  is  lost  in  consequence  of  paralysis  of 
the  muscles  of  the  tongue.  The  respirations  are  labored,  shallow,  and 
irregular  ;  the  action  of  the  heart  weak,  feeble,  and  intermittent.  Gen- 
erally the  skin  is  covered  with  a  profuse  perspiration,  but  no  other 
evacuation  takes  place.  Death  occurs  from  asphyxia,  and  the  action 
of  the  heart  ceases  after  the  respiratory  movements.  Consciousness  is 
preserved  until  near  the  close,  and  until  carbonic  poisoning  ensues.  In 
one  instance  (Wormley)  extreme  restlessness  was  noted,  but  generally 
there  is  a  condition  of  calm,  a  soporose  state,  or  the  unconsciousness  of 
carbonic-acid  narcosis,  and  convulsions  never  occur. 

The  author's  investigations  have  demonstrated  that  gelsemium  is  a 
paralyzer  of  motility  and  sensibility  ;  that  sensibility  is  first  affected  in 
cold-blooded  animals  (frogs),  and  afterward  motility,  and  that  in  warm- 
blooded animals  the  motility  is  affected  before  sensibility.  As  respects 
the  seat  of  the  action,  the  author  has  ascertained  that  the  end-organs 
of  the  motor  nerves,  and  the  nerve-trunks,  do  not  lose  their  irritability, 
and  that  the  muscular  contractility  is  unimpaired.  "  Its  paralyzing 
effect  is  due  to  its  action  on  the  motor  center,  and  not  to  an  action  on 
the  peripheral  nerve-fibers.  It  acts  also  on  the  sensory  portion  of  the 
cord,  producing  at  last  complete  anesthesia  ;  but  this  effect  in  warm- 
blooded animals,  and  in  man,  is  toxic  only,  and  follows  the  paralysis  of 
the  motor  functions."  Applying  the  precise  observations  which  are 
made  on  animals  to  the  explanation  of  the  lethal  effects  which  have 
occurred  in  man,  we  are  conducted  to  the  following  conclusions  :  the 
disorders  of  voluntary  movement,  and  the  more  or  less  complete  pa- 
ralysis of  the  motor  and  of  the  sensory  functions,  are  due  to  the  effects 
of  gelsemium  on  the  motor  and  sensory  portions  of  the  cord,  the  func- 
tions of  the  sensory  columns  resisting  longer  the  action  of  the  poison. 
The  labored  respiration  is  due  to  the  paretic  state  of  the  respiratory 
muscles,  especially  of  the  diaphragm.  The  depressed  action  of  the 
heart  is  probably  secondary  to  the  diminished  respiration  movements, 
which  produce  this  result  by  impeding  the  flow  of  blood  through  the 
pulmonary  capillaries.  The  dilated  pupil,  the  double  vision,  the  ptosis, 
are  due  to  paralysis  of  the  third  pair. 

In  rabbits  and  cats  gelsemium,  in  lethal  doses,  affects  motility  in  a 
very  remarkable  manner  :  when  the  paralyzing  effects  are  becoming 
manifest — first  in  the  fore  extremities — these  animals  perform  a  series 


(574  MOTOR   DEPRESSANTS. 

of  backward  movements,  in  which  sometimes  a  complete  backward 
somersault  occurs.  In  pigeons,  general  muscular  tremors  precede  the 
backward  movements.  No  corresponding  acts  have  taken  place  in  the 
fatal  cases  observed  in  man.  A  very  considerable  reduction  of  tem- 
perature occurs  from  lethal  doses  in  warm-blooded  animals. 

The  author's  experimental  observations  on  the  physiological  actions 
of  gelsemium  have  since  been  fully  confirmed  by  Ott,  by  Ringer,  and 
by  O.  Berger,  in  an  elaborate  series  of  investigations.  The  study  of 
Ringer  and  Murrell  is  a  model  of  a  research  of  this  kind. 

THERAPY. — Gelsemium  is  indicated  in  those  maladies  in  which  an 
exaltation  of  function  has  taken  place  in  the  motor  and  sensory  spheres 
of  the  nervous  system.  Several  cases  of  tetanus  have  been  reported 
cured  by  this  remedy  ;  but  it  is  impossible  to  say  whether  these  were 
examples  of  post  hoc  or  propter  hoc.  A  priori  it  might  be  expected 
that  gelsemium  would  prove  serviceable  in  this  disease,  because  its  ac- 
tion on  the  spinal  cord  is  opposed  to  that  which  takes  place  in  tetanus. 
In  strychnine-poisoning  in  animals,  however,  the  tetanic  spasms  are  not 
prevented  by  the  administration  of  gelsemium.  In  mania,  with  great 
motor  excitement  and  wakefulness,  this  remedy  is  more  useful  than 
conium.  To  bring  about  the  best  results  from  its  administration,  doses 
of  sufficient  strength  must  be  given  to  produce  definite  physiological 
effects,  viz.,  dilated  pupil,  drooping  of  the  eyelids,  and  a  feeling  of 
languor.  In  the  condition  of  "  horrors  "  from  alcoholic  excess,  in  sim- 
ple wakefulness,  in  the  insomnia  which  results  from  over-excitement 
and  too  great  physical  activity,  cures  are  not  unfrequently  obtained 
by  the  use  of  gelsemium.  In  the  inflammatory  affections  of  the  me- 
ninges,  and  in  cerebro-spinal  meningitis,  sporadic  or  epidemic,  with  a 
decided  febrile  reaction,  this  agent  is  extremely  useful  in  small  doses 
(TIJ,  v  of  fluid  extract),  repeated  every  two  hours  so  as  to  maintain  a 
uniform  physiological  effect. 

Gelsemium  has  been  used  with  success  recently  in  the  treatment  of 
neuralgia  of  thejifth  nerve,  but  the  good  effects  of  the  remedy  in  the 
painful  affections  of  the  fifth  nerve  are  not  always  manifest  (Berger). 
Cases  cured  by  this  remedy  were,  doubtless,  not  instances  of  tic- 
douloureux,  but  nerve-pain  caused  by  cold,  rheumatism,  or  temporary 
excentric  irritation.  Intercostal  neuralgia,  sciatica,  and  especially  my- 
algia, are  frequently  cured  by  this  agent  (Jurasz)  ;  but  considerable 
doses  are  necessary — from  five  to  twenty  minims  of  the  fluid  extract 
every  three  hours  until  the  characteristic  drooping  of  the  eyelids,  dila- 
tation of  the  pupil,  and  muscular  languor,  manifest  themselves. 

In  convulsive  or  spasmodic  cough,  gelsemium  often  affords  remark- 
able relief.  It  is  beneficial  in  the  spasmodic  stage  of  whooping-cough, 
reflex  cough  from  irritation  of  the  laryngeal  nerves,  the  irritative 
cough  of  phthisis  with  scanty  expectoration,  and  the  nervous  cough  of 
hysterical  subjects.  In  some  cases  of  spasmodic  asthma  great  relief 


GELSEMIUM.  675 

is  afforded  by  gelsemium,  but,  as  is  the  case  with  all  other  remedies 
for  asthma,  it  frequently  fails  and  loses  its  good  influence  even  in  those 
cases  in  which  it  was  at  first  successful. 

The  author  has  witnessed  excellent  results  from  the  use  of  gelse- 
mium in  acute  inflammations  of  the  lungs  and  pleura.  In  pneumonia 
it  affords  rest  by  diminishing  the  activity  of  the  respiratory  function  ; 
it  allays  cough,  and,  by  depressing  the  cardiac  movements,  it  lessens 
stasis  of  the  pulmonary  capillaries  and  lowers  the  temperature.  It  is 
better  to  give  medium  doses  (i\\,  iij — TT[  v  of  the  fluid  extract),  every  two 
hours,  to  maintain  a  constant  effect  within  the  limits  of  safety.  It 
favors,  when  exhibited  in  this  way,  the  occurrence  of  an  early  crisis, 
and  assists  in  the  production  of  one  critical  evacuation — the  sweat.  A 
similar  mode  of  administration  should  be  pursued  in  pleuritis,  in  which 
its  use  is  equally  rational  and  effective. 

Very  great  relief  is  afforded  by  the  use  of  gelsemium  in  certain 
pelvic  disorders  in  women.  There  is  no  more  generally-useful  medi- 
cine in  ovarian  neuralgia.  The  pains  of  dysmenorrhcea  are  also  greatly 
alleviated  by  it.  The  evidence  is  conclusive  that  this  remedy  also 
suspends  after-pains,  and  it  is  held  by  some  good  observers  that  it 
quiets  the  "  nagging  "  pains  of  the  first  stage  of  labor.  In  these  dis- 
orders of  the  female  sexual  organs,  it  is  generally  necessary  to  admin- 
ister a  quantity  of  the  remedy  sufficient  to  produce  some  of  its  charac- 
teristic physiological  effects.  According  to  Bulkley,  it  is  an  effective 
remedy  for  the  relief  of  pruritus,  and  has  given  excellent  results  in  the 
treatment  of  eczema.  He  prescribes  from  three  to  ten  drops  of  the 
tincture,  giving  it  every  two  or  three  hours  until  some  of  its  charac- 
teristic effects  appear. 

The  first  empirical  use  of  gelsemium  was  in  the  treatment  of  the 
remittent  or  so-called  bilious  fevers  of  the  South.  A  considerable  num- 
ber of  facts  have  been  accumulated,  which  show  that  this  remedy 
exercises  a  really  beneficial  influence  in  remittent  and  typo-malarial 
fevers.  It  is  not  an  action  of  specificity — like  quinine  in  intermittent 
and  remittent  fevers — and  it  is  doubtful  whether  this  supposed  bene- 
ficial effect  has  any  proper  basis. 

Authorities  referred  to  : 

BARTHOLOW,  DR.  ROBERTS.  Experimental  Investigations  into  the  Actions  and  Uses  of 
Gelsemium  Sempervirens.  The  Practitioner,  London,  vol.  v,  p.  200. 

BERGER,  DR.  0.     Berlin,  klin.  Wochenschrift,  Xos.  43  and  44,  18*75. 

BULKLEY,  DR.  L.  DUNCAN.     New  York  Medical  Journal,  May,  1881. 

FREDIGKE,  DR.  Annuaire  de  Tlierapeutique.  Articles — Acide  Gelseminique  and  Gel* 
semine. 

HOLMES,  M.     Du  Gelsemium  Sempervirens.     Annuaire  de  Therapeutigue,  1877,  p.  41. 

JURASZ,  DR.     Centralblatt  f.  d.  med.  Wissensch.,  No.  31,1875. 

OTT,  DR.  ISAAC.  On  Gelsemia,  pamphlet,  1865.  Also,  Philadelphia  Medical  Times, 
vol.  v. 

PORCHER,  DR.  FRANCIS  PETRE.     Resources  of  the  Southern  fields  and  forests,  p.  501, 


676  MOTOR    DEPRESSANTS. 

WORMLEY,  DR.  THEODORE.  A  Contribution  to  our  Knowledge  of  the  Chemical  Compo- 
sition of  Gelsemium  Sempervirens.  American  Journal  of  Pharmacy^  vol.  xlii,  January, 

1870. 

Arnicee  Flores. — Arnica-flowers.  The  flower-heads  of  Arnica  man- 
tana  Linne  (Nat.  Ord.  Compositce.) 

Arnicae  Radix. — Arnica-root.  The  rhizoma  and  roots  of  Arnica 
montana.  Racine  d"1  arnica,  Fr.  ;  Arnicawurzel,  Ger. 

JExtractum  Arnicce  Radicis. — Extract  of  arnica-root.  Dose,  gr.  j — 
gr.  iij. 

JExtractum  Arnicce  Radicis  Fluidum. — Fluid  extract  of  arnica-root. 
Dose,  TTI  v — TII  x. 

Tinctura  Arnicce  Radicis. — Tincture  of  arnica-root.  Dose,  TTJ,  x — 
Hi  xxx. 

Tinctura  Arnicce  JFlorum. — Tincture  of  arnica-flowers.  Dose,  TTI  x 
—  3  ss. 

COMPOSITION. — The  chemistry  of  arnica  has  not  as  yet  been  thor- 
oughly elucidated.  Walz  has  isolated  a  principle  (arnicine).  The 
root  contains  an  essential  oil  on  which  depends,  in  great  part,  its  physi- 
ological activity.  The  oil  is  a  complex  substance.  One  of  its  most 
important  constituents  is  trimethylamine,  or  an  analogous  principle. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  actions  of  arnica  are  an- 
tagonized by  ammonia,  alcoholic  stimulants,  opium,  camphor,  etc. 

SYNEBGISTS. — Aconite,  veratrum  viride,  digitalis,  and  arterial  seda- 
tives generally,  increase  the  effects  of  arnica. 

PHYSIOLOGICAL  ACTIONS. — Arnica  excites  considerable  irritation  of 
the  skin,  if  the  contact  be  sufficiently  prolonged.  It  produces  when 
swallowed  a  sense  of  heat  and  acridity  in  the  fauces,  and  increases  the 
flow  of  saliva.  It  is  decidedly  irritant  to  the  stomach,  and  causes  in 
large  doses  nausea  and  vomiting,  and  choleraic  diarrhoea.  Its  active 
principles  diffuse  into  the  blood.  In  small  medicinal  doses  arnica  in- 
creases the  action  of  the  heart  and  arteries,  and  excites  the  functions 
of  the  skin  and  kidneys.  In  large  doses,  probably  after  a  short  stage 
of  excitement,  depression  of  the  circulation,  of  the  respiration,  and  of 
the  animal  temperature,  ensues  ;  violent  headache  is  experienced,  the 
pupils  are  dilated,  and  paresis  of  the  muscular  system  comes  on.  In 
toxic  doses  arnica  paralyzes  the  nervous  system  of  animal  and  organic 
life,  and  death  ensues  in  a  condition  of  collapse. 

THEBAPY. — In  febrile  diseases  and  inflammations,  when  there  is 
sthenic  reaction,  arnica  in  full  doses  depresses  the  action  of  the  heart 
and  lowers  the  arterial  tension.  It  is,  therefore,  antipyretic.  For  the 
production  of  this  effect,  an  infusion  is  probably  a  better  preparation 
than  the  tincture.  When,  however,  in  febrile  diseases  there  is  present 
the  condition  of  asthenia,  small  doses  of  the  tincture  (five  minims)  are 
to  be  preferred.  That  this  remedy  will  produce  different  results,  in 


TRIMETHYLAMINE.  677 

small  or  large  doses,  need  not  occasion  surprise.  It  is  conceded  on  all 
sides  that  the  effects  of  opium  differ  according  to  the  size  of  the  dose, 
and  the  frequency  with  which  it  is  repeated. 

Good  results  have  been  obtained  from  the  use  of  arnica  infusion  in 
mania  and  melancholia.  The  tincture  of  arnica  is  exceptionally  ser- 
viceable in  delirium  tremens,  with  depression. 

In  rheumatism  and  rheumatic  gout,  very  decided  curative  effects 
are  sometimes  procured  from  arnica.  The  fact  that  it  contains  trime- 
thylamine  is  probably  the  true  explanation  of  its  utility  in  these  affec- 
tions. It  has  also  proved  very  efficacious  in  acute  eczema,  in  erysipe- 
las, and  other  cutaneous  affections  of  gouty  and  rheumatic  origin. 
Dysmenorrhcea  of  the  congestive  form,  acute  metritis,  and  other  acute 
pelvic  inflammations,  are  also  favorably  influenced  by  the  administra- 
tion of  arnica. 

The  tincture  of  arnica  has  a  popular  reputation  for  the  relief  of 
sprains,  bruises,  and  external  inflammations.  The  author  has  known 
violent  erysipelatous  inflammation  to  follow  its  application  to  a  sprained 
ankle.  It  is  extremely  doubtful  whether  the  good  effects  are  more  de- 
cided than  those  of  a  spirit-lotion.  The  infusion  or  decoction  does  not, 
it  is  said,  cause  local  irritation.  Planat  has  demonstrated  that  arnica 
is  a  remarkably  effective  application  to  boils.  He  directs  one  part  of 
the  extract  and  two  parts  of  honey  to  be  thoroughly  incorporated,  and 
the  paste  spread  on  some  adhesive  plaster,  leaving  a  margin  to  secure 
its  adhesion  to  the  skin.  The  plaster  is  renewed  every  twenty-four 
hours.  To  increase  the  effect,  Planat  gives  by  the  stomach  the  tinc- 
ture of  arnica. 

Authorities  referred  to  : 

HUSEMANN,  DR.  THKODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  978. 

PHILLIPS,  DR.  C.  D.  F.     Materia  Medico,  and  Therapeutics,  p.  305. 

PLANAT,  DR.  Proprietes  de  V Arnica.  ISAbeille  Medicals,  1880.  In  Annuaire  de  The- 
rapeutique,  1880. 

Trimethylamine. — (Unofficial.)  This  is  an  ammoniacal  substance, 
having  a  strong,  fishy  odor.  It  is  isomeric  with  propylamine,  which  is 
also  an  ammonia.  As  the  propylamine  of  commerce  is  a  mixture  of 
various  substances,  and  is  of  uncertain  composition,  trimethylamine 
only  should  be  used  (Spencer).  The  dose  of  trimethylamine  is  four 
to  eight  minims.  Its  disagreeable  taste  may  be  disguised  somewhat 
by  peppermint- water. 

PROPERTIES. — Trimethylamine  is  a  colorless  liquid,  having  the 
composition  C3H9N.  It  dissolves  freely  in  ether,  alcohol,  and  water, 
has  a  strong  alkaline  reaction,  and  is  inflammable. 

Chloride  of  Trimethylamine  is  a  stable  salt  which  crystallizes  in 
long  needles  ;  it  is  very  deliquescent,  and  its  solution  when  concen- 


678  MOTOR  DEPRESSANTS. 

trated  has  a  caustic  action  on  the  skin  and  mucous  membrane.  It  is 
free  from  odor,  except  when  heated  or  mixed  with  an  alkali,  when  the 
fishy  smell  is  evolved.  The  taste  of  a  solution  of  this  salt  is  alkaline, 
but  not  disagreeable  (Dujardin-Beaumetz).  Dose,  grs.  ij  to  grs.  v 
every  three  hours. 

ANTAGONISTS  AND  INCOMPATIBLES. — Chemically  trimethylamine  is 
incompatible  with  the  mineral  acids,  the  salts  of  the  metals,  the  alkalies 
(chlorides),  and  vegetable  infusions.  It  should  always  be  prescribed 
alone,  in  solution  in  some  aromatic  water.  Therapeutically,  it  is  an- 
tagonized by  the  stimulants,  opium,  belladonna,  digitalis,  etc. 

SYNERGISTS. — All  agents  depressing  the  vascular  system  and  the 
temperature  are  synergistic. 

PHYSIOLOGICAL  ACTIONS. — Applied  to  the  skin,  mucous  membrane, 
or  areolar  tissue,  trimethylamine  produces  decided  caustic  effects,  com- 
parable to  those  which  result  from  the  action  of  ammonia.  It  excites 
gastric  pain  when  taken  into  the  stomach  in  considerable  doses,  and 
will,  doubtless,  cause  a  high  degree  of  inflammation  if  incautiously  ad- 
ministered. The  most  characteristic  effects  are  the  lowering  of  the  ac- 
tion of  the  heart,  the  depression  of  the  temperature,  and  the  diminution 
in  the  amount  of  urea  excreted.  In  the  physiological  state  Dujardin- 
Beaumetz  found,  in  some  experiments  on  himself,  that  the  chloride  of 
trimethylamine  lessened  the  temperature  and  the  pulse,  but  these  re- 
sults were  much  more  decided  when  it  was  administered  in  cases  of 
acute  rheumatism.  The  influence  which  this  agent  has  on  the  excre- 
tion of  urea  is  still  more  remarkable.  The  observations  of  Dujardin- 
Beaumetz  show  that  a  gradual  but  considerable  decline  in  the  excre* 
tion  of  urea  is  a  constant  result  of  its  administration.  On  the  other 
hand,  Spencer  says  that  the  excretion  of  urea  is  sometimes  increased, 
and,  in  one  case  in  which  the  urinary  discharge  was  carefully  studied, 
the  urine  was  almost  trebled,  and  the  urea  more  than  doubled  by  the 
use  of  this  remedy.  If  the  diminution  of  the  amount  of  urea  were  a 
constant  result,  as  claimed  by  Dujardin-Beaumetz,  the  influence  which 
trimethylamine  has  on  the  body  temperature  might  be  due  to  an  in- 
terference with  the  combustion  process.  But  the  facts  do  not  as  yet 
justify  the  construction  of  a  theory  as  to  its  mode  of  action. 

THERAPY. — Thus  far  almost  the  only  application  made  of  trime- 
thylamine is  in  the  treatment  of  acute  rheumatism  and  gout.  In  some 
cases  it  appears  to  produce  almost  complete  relief  after  the  administra- 
tion of  a  few  doses,  but  generally  a  longer  time  is  required  (Awenarius, 
Dujardin-Beaumetz,  Spencer,  Leo).  It  moderates,  at  once,  the  fever 
and  the  joint-pain,  and  very  decidedly  shortens  the  duration  of  the  dis- 
ease. It  is  said  to  diminish  the  tendency  to  cardiac  complication. 

This  agent,  having  so  decided  an  influence  on  the  pulse,  tempera- 
ture, and  excretion  of  urea,  will  in  the  future  doubtless  be  applied  to 
the  treatment  of  other  maladies. 


PILOCARPUS.  679 

Authorities  referred  to  : 

BUCHHEIM,  DR.  ERWIN.  Ueber  das  Trimethylamin.  Schmidt's  Jahrbucher,  vol.  Ixxxiii, 
p.  13. 

DUJARDIN-BEAUMETZ,  DR.  Du  Chlorhydrate  de  Tnmethylamine  dans  le  Traitement 
du  Rhumatisme  Articulaire  Aigu.  Bulletin  General  de  Therapeutique,  vol.  Ixxxiv,  pp. 
337,  395. 

LEO,  DR.     Berliner  klinische  Wochenschrift,  1875. 

PETIT,  M.  A.  Sur  la  Trimethylamine.  Bulletin  General  de  Therapeutique,  vol.  Ixxxiv, 
p.  313,  et  seq. 

SPENCER,  DR.  W.  H.  On  the  Employment  of  Trimethylamine  in  Rheumatism,  and 
Gout.  The  Practitioner,  February  and  March,  1875. 

Pilocarpus. — Jaborandi.  The  leaflets  of  Pilocarpus  Selloanus  Eng- 
ler  (Nat.  Ord.  Rutacece,  Xanthoxyleaz). 

Infusum  Pilocarpi. — Infusion  of  pilocarpus  (  §  ij — Oj).  Dose,  §  ss 
—  §  ij.  (Not  official.) 

Extraetum  Pilocarpi  Fluidum.  —  Fluid  extract  of  pilocarpus. 
Dose,  3  ss  —  3  ij. 

Tinetura  Pilocarpi. — Tincture  of  pilocarpus  (  §  iv — Oj).  Dose, 
3  ss —  3  ij.  (Not  official.) 

COMPOSITION. — The  important  constituent  is  the  alkaloid — -pilocar- 
pine — which  possesses  the  physiological  properties  of  the  drug.  It 
combines  with  acids  to  form  salts.  The  salts  of  pilocarpine  crystallize 
in  the  oblique  system.  In  1880  another  alkaloid  was  discovered,  and 
to  this  the  name  jaborine  was  given  (Harnack  und  Meyer).  Subse- 
quent researches  fully  confirmed  this  (P.  Castaing).  These  alkaloids 
are  closely  related  in  composition  :  probably  identical,  but  having  a 
different  molecular  arrangement.  By  heat,  merely  by  concentration 
of  an  acid  solution,  pilocarpine  is  converted  into  jaborine  (Hans  Mey- 
er) ;  and  by  washing  with  absolute  alcohol  they  are  separated,  when 
united,  as  is  very  often  the  case  in  the  commercial  article.  As  these 
two  alkaloids  differ  very  greatly  in  properties,  it  is  not  surprising  that 
the  observations  made  with  pilocarpine  at  first  were  very  discrepant. 
Chemically  they  differ  in  that  the  salts  of  jaborine  do  not  crystallize, 
and  they  dissolve  more  easily  in  ether  and  less  easily  in  water.  Physi- 
ologically, they  differ  even  more  decidedly.  Jaborine  acts  like  atro- 
pine,  to  which  pilocarpine  is  a  physiological  antagonist. 

Pilocarpince  Hydrochloras. — Pilocarpine  hydrochlorate.  Minute, 
white  crystals,  deliquescent,  odorless,  having  a  faintly  bitter  taste 
and  a  neutral  reaction.  Very  soluble  in  water  and  in  alcohol,  but  al- 
most insoluble  in  ether  or  chloroform.  Dose,  gr.  ^ — gr.  ss. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies,  the  per- 
salts  of  iron,  and  the  salts  of  the  metals  generally,  are  chemically 
incompatible.  A  remarkable  antagonism  has  been  shown  to  exist 
between  pilocarpine  and  belladonna  (Ringer  and  Gould). 

SYNEKGISTS. — Aconite,  veratrum  viride,  gelsemium,  and  remedies 


680  MOTOR   DEPRESSANTS. 

\vhich  paralyze  the  vaso-motor  nervous  system,  promote  the  activity 
of  jaborandi. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  jaborandi  is  rather  hot  and 
pungent.  The  considerable  doses  of  the  crude  drug  required  to  pro- 
duce physiological  effects  excite  nausea  and  vomiting,  especially  if 
taken  on  an  empty  stomach.  It  has  been  shown,  however,  in  recent 
experiments,  that  these  results  follow  the  use  of  the  alkaloid  ;  hence 
it  may  be  concluded  that  not  bulk  alone  is  the  cause  of  the  gas- 
tric distress,  but  that  it  is  one  of  the  physiological  properties  of  the 
drug. 

The  active  principles  of  jaborandi  diffuse  readily  into  the  blood. 
In  about  ten  minutes  after  the  infusion  is  swallowed,  the  face,  ears, 
and  neck  become  deeply  flushed.  Simultaneously  perspiration  begins 
on  the  skin,  an  abundant  flow  of  saliva  takes  place,  the  nasal  and  bron- 
chial mucus,  and  the  tears,  are  increased,  and  watery  diarrhoea  may 
occur.  It  is  said  that,  when  the  salivary  secretion  is  greatly  increased, 
that  of  the  skin  is  relatively  less  so,  and  vice  versa  (F^reol),  but  this 
is  not  generally  admitted.  The  quantity  of  perspiration  poured  out 
by  the  skin  is  enormous — the  sweat  runs  from  the  body  and  soaks  the 
clothes.  The  quantity  of  saliva  discharged  is  also  very  great.  Ringer 
reports  that  in  two  of  his  cases  the  amount  of  saliva  was  respectively 
twenty-two  ounces  and  twenty-seven  ounces.  According  to  Petithau, 
the  sialogogue  effect  is  constant,  the  diaphoretic  action  is  somewhat 
less  certain,  and  the  diuretic  effect  uncertain.  These  conclusions  are 
in  accord  with  the  general  experience. 

The  action  of  the  heart  is  increased  by  jaborandi,  but  the  arterial 
tension  is  notably  diminished.  The  rise  in  the  pulse-rate  averages 
twenty  beats,  and  the  duration  of  this  effect  is  about  two  and  a  half 
hours.  A  very  distinct  fall  of  temperature  (0*5°  to  2°  Fahr.)  ensues 
when  the  sweating  begins,  and  this  decline  of  body-heat  is  maintained 
on  an  average  about  four  and  a  half  hours.  According  to  Robin,  Gil- 
let  de  Grandmont,  and  others,  a  transient  rise  of  temperature  precedes 
the  fall,  but  Ringer  and  Riegel  deny  the  accuracy  of  this  observation. 
In  some  subjects,  very  serious  symptoms  due  to  the  sudden  develop- 
ment of  extensive  pulmonary  oedema  have  been  observed  by  Thomas, 
Napier,  Sanger,  Jenkins,  and  others. 

The  nauseant  effects  of  pilocarpus  and  its  alkaloid  are,  it  is  prob- 
able, referable  to  the  action  which  it  exerts  on  the  muscular  layer  of 
the  stomach  and  intestines.  Very  active  movements  of  these  organs 
follow  its  administration,  and  even  a  tetanizing  action  is  observed. 
Secretion  of  the  mucous  membrane  is  increased,  due,  doubtless,  to 
stimulation  of  the  pancreas  and  the  glands  of  the  mucous  membrane 
(Harnack  und  Meyer,  Morat). 

The  effects  of  jaborandi  on  children,  according  to  Ringer,  are, 
singularly  enough,  much  less,  for  corresponding  doses,  than  on  adults, 


PILOCARPUS.  681 

as  respects  the  flushing,  the  sweating,  the  salivation,  and  the  tem- 
perature. 

More  or  less  drowsiness,  both  in  children  and  adults,  follows  the 
profuse  sweating,  and  pallor  succeeds  to  the  flushing.  Chilliness  is 
experienced  with  the  cessation  of  the  sweating  stage.  Languor  and 
debility  persist  for  some  hours  after  the  completion  of  the  effects. 
The  drowsiness  is  probably  not  due  to  a  direct  action  of  the  remedy 
on  the  cerebrum,  but  to  the  greatly-diminished  vascular  tonus,  and  to 
the  loss  of  fluid  from  the  vessels.  Vision  is  generally  affected.  The 
pupil  is  usually  contracted,  and  the  power  of  accommodation  is  im- 
paired. No  characteristic  or  constant  changes  in  the  fundus  of  the 
eye  have  been  observed  on  ophthalmoscopic  examination.  Locally  ap- 
plied to  the  eye,  jaborandi  causes  "  contraction  of  the  pupil,  tension  of 
the  accommodative  apparatus  of  the  eye,  with  approximation  to  the 
nearest  and  farthest  points  of  vision,  and  amblyopic  impairment  of 
vision  from  diminished  sensibility  of  the  retina."  The  eye  resumes  its 
normal  state  in  about  an  hour  and  a  half  (Tweedy). 

The  results  of  experiment  indicate  that  the  action  of  jaborandi  is 
paralyzant  of  the  vaso-motor  nervous  system.  The  flushing  of  the 
skin  is  doubtless  due  to  dilatation  of  the  arterioles,  and  the  increased 
action  of  the  heart  must  be  referred  to  the  same  cause.  The  sphygmo- 
graph  demonstrates  the  lowering  of  the  vascular  tension.  The  decline 
in  temperature  must  be  referred  chiefly  to  the  profuse  transpiration, 
but  the  depression  of  the  vascular  tonus  may  also  somewhat  influence 
this  result.  The  data  do  not  yet  exist  for  a  statement  of  the  mode  in 
which  jaborandi  excites  the  salivary  and  cutaneous  secretions.  It 
probably  affects  the  end-organs  of  the  excito-secretory  nerves  (Har- 
nack  und  Meyer,  Vulpian,  Dujardin-Beaumetz,  Grocco,  and  others). 

That  pilocarpus  stimulates  the  gravid  uterus  is  affirmed  by  many 
observers.  Vander  Neg  asserts  that,  when  injected  subcutaneously  or 
into  a  vein,  it  promptly  induces  uterine  contractions,  or  increases  the 
energy  of  those  already  existing.  Kleinwachter  reports  two  cases  in 
which  it  induced  premature  labor.  Three  injections  of  two  centi- 
grammes each  produced  this  result  in  one  case,  and  two  injections  suf- 
ficed in  the  other.  Dr.  Prochownick,  of  Hamburg,  also  reports  two 
cases  of  eclampsia,  in  which  the  hypodermatic  injection  of  hydrochlorate 
of  pilocarpine  inaugurated  labor  in  a  half -hour.  It  frequently  fails, 
even  in  considerable  doses,  to  have  this  effect.  Of  nine  reported  in- 
stances in  which  it  was  used  to  induce  premature  labor,  in  six  it  was 
successful  and  in  three  it  had  no  effect.  The  cases  in  which  uterine 
action  has  been  induced  were  chiefly  eclampsia,  and  hence  there  is  an 
important  source  of  fallacy. 

Elimination  of  the  active  constituents  of  jaborandi  probably  takes 
place  through  the  organs  whose  functions  are  so  powerfully  excited. 
It  is  a  remarkable  circumstance  that  the  amount  of  urea  passing  out 


682  MOTOR   DEPRESSANTS. 

in  the  sweat  caused  by  jaborandi  is  enormously  increased  over  the 
normal,  amounting  to  from  fifteen  to  seventeen  grains.  The  urine  is 
not  increased,  as  a  rule,  but  Gubler  apparently  demonstrated  that  small 
doses  frequently  repeated  had  a  distinct  diuretic  action.  His  theory 
is  based  on  the  notion  that,  being  a  universal  gland-stimulant,  if  the 
skin  is  not  directly  stimulated  and  the  fluids  directed  to  it,  the  kidneys 
will  be  acted  on.  In  some  instances  the  growth  of  hair  has  been  pro- 
moted by  the  subcutaneous  and  topical  application  of  pilocarpus  (Pren- 
tiss,  Andre,  and  others). 

The  experiments  which  have  demonstrated  the  existence  of  a  physi- 
ological antagonism  between  jaborandi  and  belladonna  have  thrown 
much  light  on  the  action  of  the  former.  When  the  heart  of  a  frog  is 
arrested  in  the  diastole  by  jaborandi,  it  immediately  recommences  its 
beat  when  atropine  is  subcutaneously  injected  (Langley).  When  the 
superior  ganglion  of  the  cervical  sympathetic,  and  the  lingual,  and  the 
pneumogastric  nerve  are  divided,  jaborandi  administered  causes  pro- 
fuse salivary  secretion  ;  but  this  action  is  at  once  antagonized  and 
the  secretion  arrested  by  the  injection  of  atropine.  These  agents, 
therefore,  are  exactly  opposed  as  respects  their  action  on  the  nerve- 
endings  in  the  salivary  glands  (Carville).  The  effects  of  one  grain  of 
atropine,  in  a  boy  poisoned  by  it,  were,  as  respects  the  state  of  the 
mouth  and  skin,  antagonized  by  thirty  grains  of  jaborandi.  In  three 
men  the  perspiration  and  salivation  caused  by  sixty  grains  of  jabo- 
randi were  arrested  by  the  subcutaneous  injection  of  -j-J-g-  of  a  grain  of 
atropine  (Ringer  and  Gould). 

Comparative  Action  of  Pilocarpine  and  Jaborine, — The  differ-1 
ences  in  physiological  action  between  these  alkaloids  are  infinitely 
greater  than  the  chemical.  There  does  not  exist  a  finer  illustration  of 
the  importance  of  molecular  arrangement  to  physiological  action. 
Given  two  alkaloids  having  the  same  ultimate  constituents,  their  actions 
become  antagonistic  by  reason  of  an  unknown  molecular  arrangement. 
Jaborine,  in  its  effects  on  the  heart,  lungs,  pupils,  and  salivary  glands, 
is  identical  with  atropine.  In  the  whole  range  of  physiological  antag- 
onisms, there  is  none  more  complete  than  that  existing  between  atro- 
pine and  pilocarpine.  As  in  some  specimens  of  pilocarpine — owing, 
doubtless,  to  faulty  pharmaceutical  processes — there  is  more  or  less 
jaborine,  it  is  no  longer  difficult  to  explain  how  some  observers  have 
differed  in  their  observations.  As  the  effect  of  pilocarpine  on  the  cir- 
culation and  the  sweat-glands  is  so  completely  antagonized  by  jaborine, 
it  is  in  a  high  degree  important,  in  prescribing  the  former,  to  secure  a 
specimen  free  from  the  latter. 

THERAPY. — Pilocarpus,  acting  as  it  does  on  the  salivary  glands,  has 
been  used  with  varying  success  in  mumps,  sometimes  succeeding  well, 
and  then  failing.  According  to  Testa,  if  used  in  time  it  may  arrest 
the  development  of  the  disease,  and  later  may  prevent  metastasis. 


PILOCARPUS.  683 

In  salivation  of  pregnancy,  it  has  succeeded  in  a  few  instances,  but 
more  frequently  fails  ;  atropine  is  generally  much  more  certain  and 
effective.  It  is  contraindicated  in  all  affections  of  the  gastro-intes- 
tinal  mucous  membrane,  and  in  weak  heart  due  to  disease  of  its  mus- 
cular substance,  or  of  its  contained  ganglia,  or  of  the  valves.  It  is  a 
remedy  of  great  value  in  cardiac  dropsy,  provided  the  contraindica- 
tions above  mentioned  do  not  exist  ;  its  therapeutic  power  being 
much  the  same  as  the  vapor,  hot-air  bath,  and  other  means  for  pro- 
moting free  diaphoresis.  The  effusions  of  recent  pleuritis,  hydro- 
thorax,  and  ascites,  have  been  quickly  removed  by  this  agent.  In 
asthma  with  profuse  expectoration  (humid  asthma),  and  in  bronchitis 
with  abundant,  non-purulent  exudation,  it  has  often  been  very  bene- 
ficial. It  must  be  used  with  caution,  or  not  at  all,  in  the  difficult 
breathing  due  to  dilatation  of  the  right  cavities  and.  great  venous 
trunks.  According  to  Berkhart,  pilocarpine,  injected  subcutaneously, 
arrests  the  most  violent  paroxysms  of  spasmodic  asthma,  and  the  re- 
lief persists  for  some  time.  It  is  equally  effective,  in  the  author's  ex- 
perience, in  singidtus  or  hiccough,  but  there  may  be  incurable  lesions 
underlying  the  spasm,  when,  of  course,  the  paroxysms  may  be  expected 
to  recur  again. 

Probably  the  most  conspicuous  good  results  from  the  administra- 
tion of  pilocarpine  have  been  obtained  in  eclampsia,  from  the  albumi- 
nuria  of  pregnancy,  of  scarlatina,  or  of  acute  Bright's  disease.  The 
powerful  action  on  the  sudoriparous  glands,  and  the  excretion  of  the 
urinary  solids  by  the  sweat,  are  the  causes  of  the  extraordinary  relief 
obtained  from  this  remedy  in  suitable  cases.  It  should  be  borne  in 
mind  that  pilocarpus  tends  to  excite  uterine  action,  and  hence  its  ad- 
ministration may,  under  some  circumstances,  be  improper  ;  but  in  most 
cases  this  effect  is  desired.  There  are,  however,  two  important  contra- 
indications :  a  weak  heart,  from  thinning  and  atrophy  of  the  walls  of 
the  organ,  or  from  fatty  degeneration,  and  a  tendency  to  pulmonary 
congestion  and  oedema.  In  some  instances,  in  a  few  minutes  after  the 
injection,  the  respiration  became  embarrassed  "by  congestion  and  oedema 
of  the  lungs  and  by  enormous  bronchial  secretion  (Sanger,  Napier,  G. 
Thomas).  It  may  be  well  to  mention  that  atropine,  subcutaneously, 
in  one  case  in  which  it  was  administered,  removed  these  symptoms  and 
saved  the  patient's  life.  In  renal  dropsy,  especially  scarlatinal,  there 
being  no  contraindication  in  the  state  of  the  heart,  it  is  a  remedy  of 
the  greatest  utility. 

Pilocarpine  has  proved  to  be  an  important  addition  to  the  re- 
sources of  the  ophthalmologist.  In  inflammatory  affections  with  effu- 
sion and  exudation  it  brings  about  resolution  and  absorption  (Wecker). 
According  to  Coursserant,  there  is  no  remedy  comparable  to  it  in 
the  amblyopia  of  alcoholism  and  of  tobacco-abuse.  It  has  produced 
excellent  results  in  detachment  of  the  retina,  chronic  iritis,  keratitis, 


684  MOTOR   DEPRESSANTS. 

haemorrhages  into  the  vitreous,  floating  bodies,  glaucoma,  atrophic, 
choroiditis,  haemorrhages  and  exudations  of  the  retina,  commencing 
atrophy  of  the  optic  nerves,  etc.  (Gillet  de  Grandmont,  Meyer,  Gub- 
ler,  Wecker,  and  others).  The  first-named  author  affirms  that  we 
find  in  pilocarpine  "  an  absolute  remedy  against  white  atrophy."  Be- 
ranger,  following  Gubler,  proposes  to  use  this  remedy  as  a  substitute 
for  eserine  in  certain  ocular  affections  requiring  a  myositic — an  effect 
produced  by  pilocarpine  when  instilled  in  the  eye.  It  has  been  used 
successfully  de  novo  and  as  a  substitute  for  eserine  in  certain  paralyses 
of  the  ocular  muscles — those  consecutive  to  the  fevers  and  other  acute 
diseases.  After  the  operation  for  cataract  extraction,  pilocarpine  is 
used  by  Chalot  to  prevent  exudations  and  other  inflammatory  changes. 
In  the  discussion  which  ensued  before  the  Geneva  Congress  where  this 
paper  was  read,  various  adverse  opinions  were  expressed  regarding  the 
exhibition  of  this  remedy  in  different  ocular  maladies.  Especially  was 
the  danger  emphasized — the  danger  in  cases  of  cardiac  and  arterial 
diseases,  and  of  pulmonary  engorgement. 

Ringer  has  used  jaborandi  with  success  to  increase  the  secretion  of 
milk.  As  the  milk-glands  correspond  in  structure  to  the  sudoriparous 
glands,  and  are  merely  differentiated  and  specialized  for  their  particu- 
lar office,  the  effects  of  this  drug  in  increasing  the  production  of  milk 
might  have  been,  a  priori,  expected.  The  author  has  used  recently  a 
fluid  extract  of  jaborandi  successfully  in  a  case  of  deficiency  in  the 
secretion  of  the  milk  of  a  nursing- worn  an.  But  Dr.  Max  Strumpf 
denies  that  it  has  such  power. 

In  two  cases  of  that  very  intractable  disorder,  diabetes  insipidus, 
or  polydipsia,  Laycock  has  used  jaborandi  with  the  effect  to  reduce 
the  quantity  of  urine  in  one  case  from  three  hundred  ounces  to  one 
hundred  and  twenty  ounces  per  diem,  and,  in  the  other,  from  one  hun- 
dred and  fifty-eight  ounces  to  ninety -eight  ounces  per  diem.  M.  Hu- 
chard  reports  the  cure  of  a  case  of  the  same  kind,  and  also  one  of 
glycosuria  •  on  the  other  hand,  Vulpian  declares  it  to  be  useless.  Mur- 
rell  has  found  it  to  be  useful  in  some  cases  of  the  sweats  of  phthisis 
and  of  other  nocturnal  sweats,  but  yet  far  inferior  to  atropine  and 
picrotoxin. 

In  scaly  skin  eruptions,  pilocarpus  has  good  effects  by  maintaining 
a  moist  state  of  the  skin.  It  is  the  most  efficient  remedy  for  alopecia 
which  we  possess.  In  the  treatment  of  this  affection  pilocarpine  may 
be  injected  subcutaneously,  or  the  fluid  extract  can  be  applied  locally. 
The  following  is  a  very  successful  topical  application  :  IJ  Ext.  pilo- 
carpi  fl.,  §  j  ;  tinct.  cantharidis,  f  ss  ;  lin.  saponis,  f  ijss.  M.  Sig.  :  The 
scalp  must  be  well  rubbed  with  this  lotion  daily.  In  prurigo  Pick 
had  success,  but  failed  in  psoriasis,  and  he  also  succeeded  in  two 
cases  of  pruritus  senilis  and  in  one  of  urticaria.  In  alopecia  pity- 
rodes,  he  had  good  results  in  ten  cases,  but  not  in  alopecia  areata. 


PILO  CARPUS.  685 

Pick  administered  one  sixth  of  a  grain  three  times  a  day  by  the 
stomach. 

Recently  Guttmann  has  brought  forward  pilocarpine  as  a  remedy 
for  diphtheria.  He  reports  having  successfully  treated  eighty-one 
cases  without  a  single  death,  but  these  extraordinary  results  have  not 
been  confirmed.  Numerous  observations  have  been  published,  but  out 
of  the  mass  of  cases  and  reports  we  can  select  only  some  of  the  most 
important.  Soon  after  Guttmann's  paper  appeared,  confirmatory  state- 
ments were  published  by  Lax,  and  directly  contradictory  by  Lashke- 
witz.  The  latter  lost  all  his  cases  treated  with  pilocarpine.  Pitschen 
and  Dilewsky,  on  the  other  hand,  succeeded  in  curing  many  which 
would  otherwise,  they  think,  have  died.  Archambault  treated  twenty- 
one  cases  according  to  Guttmann's  plan,  and  of  these  twelve  died,  a 
result  which  he  considers  bad.  In  this  country  Jacobi  was  one  of  the 
first  to  make  a  trial  of  the  new  remedy,  and  he  pronounced  against  its 
utility.  Payraudeau,  who  has  made  an  exhaustive  study  of  the  sub- 
ject, offers  some  conclusions  which  seem  to  the  author  eminently  sound. 
The  false  membrane  in  inaccessible  situations  is  softened  and  detached 
by  the  action  of  pilocarpine  ;  it  does  not  effect  the  elimination  of  the 
diphtheritic  poison  by  the  sweat  which  it  induces  ;  it  is  apt  to  cause 
nausea,  vomiting,  and  diarrhoea,  and  may  in  this  way  greatly  increase 
the  danger  of  the  case  ;  it  is  positively  contraindicated  when  the  car- 
diac muscle  is  weakened  in  any  way.  Although  these  positions  are 
perfectly  tenable,  there  are  facts  more  favorable  to  the  utility  of  pilo- 
carpine. They  are  well  stated  by  Courtois  :  The  results  of  the  treat- 
ment of  diphtheria  by  pilocarpine,  without  being  so  good  as  were  at 
first  supposed,  are  nevertheless  worthy  of  careful  consideration.  Chil- 
dren of  less  than  five  years  offer  such  slight  resistance  to  the  action 
of  the  morbific  germs  of  diphtheria,  that  they  are  rarely  cured.  Those 
above  this  age,  in  which  the  mixed  form  of  the  disease  is  most  fre- 
quent, are  especially  favorable  subjects  for  this  treatment.  The  false 
membrane  is  more  thoroughly  detached,  and  has  less  tendency  to  be 
reproduced,  than  by  any  other  treatment.  An  experienced  German 
physician  of  Philadelphia,  Dr.  Loling,  assures  me  that  he  finds  it 
highly  useful  when  the  condition  of  the  heart  does  not  contra-indi- 
cate.  Having  observed  cases  in  the  course  of  the  treatment,  I  am  able 
to  confirm  Dr.  Loling's  statements.  All  are  now  agreed  that  efficient 
support  must  be  given  the  patient  by  food  and  alcohol  during  the  pilo- 
carpine treatment ;  that  cases  characterized  by  extreme  depression  of 
the  vital  powers,  and  by  weakness  of  the  heart,  are  unsuited  for  this 
remedy. 

Guttmann  exhibited  pilocarpine  with  hydrochloric  acid  and  pepsin 
by  the  stomach,  giving  from  -fa  gr.  to  £  gr. 

This  subject  must  not  be  closed  without  some  observations  on  the 


G86  MOTOR   DEPRESSANTS. 

remarkable  aid  afforded  by  pilocarpus  in  the  removal  of  exudations, 
under  treatment  by  the  remedies  most  effective  for  this  purpose — 
iodides  and  mercurials.  Above,  attention  has  been  called  to  the  use 
of  pilocarpus  in  causing  absorption  of  effusions  in  the  pleural,  perito- 
neal, and  other  serous  cavities  ;  but  in  this  application  it  is  used  con- 
jointly with  iodine  and  mercury,  chiefly  to  increase  the  rate  at  which 

J  «/  *    7 

the  exudates  liquefied  by  these  sorbifacients  are  taken  up  and  excreted. 
In  cases  of  gummata,  for  example,  the  specific  action  of  mercury  or 
iodine  is  rendered  effective  by  the  timely  and  conjoint  use  of  pilocar- 
pus, exhibited  once  or  twice  a  day.  When  the  inflammatory  deposits 
in  chronic  pneumonia,  or  chronic  pleuritis,  or  in  other  organs  are 
sought  to  be  removed,  the  persistent  administration  of  mercury  and 
iodine  will  accomplish  far  more  if,  during  their  administration,  pilo- 
carpine  is  given  after  certain  periods  have  elapsed — for  example,  after 
one  week,  and  for  three  or  four  days  in  each  succeeding  week.  The 
size  of  the  dose,  and  the  amount  given  each  day,  will  be  determined  by 
the  degree  of  the  action.  The  author  has  found  that  a  dose  large 
enough  to  cause  but  little  sweating  and  salivation  suffices. 
Authorities  referred  to  : 

ANDERSON,  PROF.  McCALL.     Glasgow  Journal,  1880. 

ARCHAMBAULT,  DR.     Revue  de  Therapeutique  for  1881. 

BERKHAKT,  DR.     British  Medical  Journal,  June,  1880. 

CASTAING,  P.     Revue  de  Pharm.,  1881. 

DCJARDIN-BEAUMETZ,  DR.     Bulletin  General  de  Therapeutique  for  1881. 

GUTTMANN,  DR.     Berliner  kliniscJie  Wochenschrift,  1881. 

HARNACK  UND  MAYER.  Archiv fur  experimentelle  Pathologie  und  Pharmacologie,  vol. 
xii,  p.  366. 

HUCHARD,  DR.  Journal  de  Therapeutique  and  Bulletin  General  de  Therapeutique  for 
1880,  1881,  and  1882. 

ISHAM,  DR.     Medical  News  and  American  Journal  of  the  Medical  Sciences,  1881. 

LABBE,  DR.  Bulletin  de  la  Societe  de  Therapeutique,  November  30,  1881.  Ab- 
stract. 

MORAT,  DR.  M      Journal  de  Therapeutique  and  Lancet,  1881. 

MURREL,  DR. 

PROCHOWNICK,  DR.  (de  Hambourg).     De  TArt  Medical  for  1881.     Quoted. 

RINGER  AND  GOULD,  DRS.     Pamphlets. 

VULPIAN,  PROF.  DR.  Journal  de  Therapeutique  and  Bulletin  General  de  Therapeutique 
for  1881. 

Phy  so  stigma. — Calabar  bean.  The  seed  of  Physostigma  veneno- 
sum  Balfour  (Nat.  Ord.  Leguminosce,  Papilionacece).  Feve  de  Cala- 
bar, Fr.  ;  JZalabarbohne,  Ger. 

Extractum  Physostigmatis. — Extract  of  physostigma.  Dose,  gr.  \ 
_gr.  88— gr.  j. 

Tinctura  Physostigmatis. — Tincture  of  physostigma.  Dose,  m  v 
— ni  xx. 


PHYSOSTIGMA.  687 

COMPOSITION. — Calabar  bean  contains  two  alkaloids,  physostigmine, 
or  eserine  and  caiabarine.  These  have  been  supposed  to  be  the  same, 
but  they  differ  in  physiological  action  ;  physostigmine  paralyzes, 
whereas  calabarine  has  a  tetanizing  action.  "Eserine"  has  been  more 
used  than  "  physostigmine  "  to  designate  the  alkaloid. 

PhysostigmincB  Sulphas. — Physostigmine  sulphate.  A  white  or 
yellowish-white  microcrystalline  powder.  Very  soluble  in  water  and 
in  alcohol.  Dose,  gr.  y^-g-  to  gr.  -fa. 

Physostigmince  Salicylas. — Physostigmine  salicylate.  In  color- 
less, shining,  acicular,  or  short  columnar  crystals,  turning  reddish 
on  long  exposure  to  light  and  air,  odorless,  having  a  bitter  taste  and 
a  neutral  reaction.  Soluble  in  130  parts  of  water,  and  in  12  parts  of 
alcohol  at  59°  Fahr.  Dose,  gr.  -^ — gr.  -fa. 

ANTAGONISTS  AND  INCOMPATIBLES.  —  The  vegetable  astringents, 
tannic  acid,  and  the  caustic  alkalies,  are  chemically  incompatible.  As 
respects  physiological  actions,  physostigma  is  antagonized  in  a  limited 
part,  but  not  in  the  whole  of  its  actions,  by  atropine,  and  still  more  by 
chloral.  Therapeutically,  the  tetanizing  agents  may  be  regarded  as 
opposed  to  physostigma. 

SYNEKGISTS. — The  paralyzers,  or  depressors  of  the  motor  nervous 
system,  conium,  gelsemium,  nitrate  of  amyl,  etc.,  act  in  harmony  with 
physostigma,  increasing  its  effects  in  the  whole  range  of  its  physiologi- 
cal influence. 

PHYSIOLOGICAL  ACTIONS. — The  preparations  of  physostigma  are  apt 
to  excite  nausea.  Increased  secretion  of  the  gastro-intestinal  nmcous 
membrane,  and  increased  peristalsis,  follow  their  administration.  The 
active  principles  quickly  diffuse  into  the  blood.  Physostigma  does  not 
impair  the  respiratory  function  of  the  blood,  but,  after  death,  loose 
coagula  are  found,  the  globules  have  undergone  changes  of  shape,  and 
rectangular  plates  of  haemato-crystallin  occur  (Leven  and  Laborde). 
The  action  of  the  heart  is  affected  by  considerable  toxic  doses  ;  it  is 
paralyzed  in  the  diastole,  and  is  flabby,  but  it  contracts  lazily  on  elec- 
tric stimulation.  In  less  than  lethal  doses  the  action  of  the  heart  is 
slowed,  and  the  arterial  tension  is,  for  a  brief  period,  lowered,  but  soon 
rises  considerably  above  the  normal.  As  these  effects  are  not  due  to 
an  action  on  the  inhibitory  apparatus,  and  follow  when  the  heart  is 
separated  from  the  vaso-motor  center  by  division  of  the  spinal  cord,  it 
is  probable  that  the  action  consists  in  a  stimulation  of  the  cardiac  gan- 
glia, and  a  subsequent  paralyzing  action  on  the  cardiac  muscles.  The 
same  result  may  be  due  to  a  paralyzing  action  on  the  accelerator  nerves 
of  the  heart  (Kohler).  The  respiration  is  more  powerfully  affected 
than  the  circulation.  When  a  lethal  dose  is  administered  the  respira- 
tion becomes  slower  and  shallower,  and  death  ensues  from  arrest  of 
the  respiratory  movements  (asphyxia),  the  heart  continuing  in  action 
for  some  time  afterward. 
46 


688  MOTOR   DEPRESSANTS. 

Physostigma  does  not  affect  the  centers  of  conscious  impressions, 
and  consciousness  is  preserved  until  the  oxygenation  of  the  blood  is 
so  far  interfered  with  that  carbonic-acid  narcosis  supervenes.  Giddi- 
ness, vertigo,  and  a  sense  of  muscular  weakness  and  fatigue,  are  pro- 
duced by  considerable  doses  (Gubler).  When  a  lethal  dose  is  ad- 
ministered to  an  animal,  its  muscular  system  soon  grows  weak,  and 
complete  paralysis  soon  after  ensues.  The  voluntary  muscular  sys- 
tem, however,  before  complete  resolution  occurs,  is  agitated  by  a 
succession  of  tremors — temporary  tetanic  contractions  followed  by 
entire  relaxation.  These  muscular  tremblings  occur,  but  more  feebly, 
after  complete  paralysis,  and  persist  in  a  slight  degree  after  death. 
The  muscular  contractility  is  not  destroyed,  not  even  impaired,  by 
physostigma. 

The  irritability  of  the  motor  nerves  is  affected,  if  at  all,  to  a  very 
slight  extent,  and  the  sensibility  of  the  sensory  nerves  is  rather  height- 
ened. It  follows  from  these  facts  that  the  paralyzing  effect  of  phy- 
sostigma is  due  to  a  direct  action  on  the  spinal  cord. 

As  respects  its  effects  on  the  eye,  we  find  that  it  is  eminently  char- 
acteristic, and  whether  introduced  directly  into  the  eye,  or  taken 
into  the  stomach,  or  thrown  under  the  skin,  it  contracts  the  pupil. 
This  is  a  local  and  peripheral  action,  exactly  corresponding,  as  to 
its  seat,  to  the  action  of  atropine.  The  end-organs  of  the  sympa- 
thetic, or  of  the  motor  oculi,  and  it  may  be  of  both,  are  acted  upon. 
By  some  it  is  held  that  the  contraction  of  the  pupil  is  due  to  a 
tetanic  state  of  the  circular  fibers  (Grtinhagen,  Rogow);  by  others, 
to  a  paralysis  of  the  dilator  system  (Fraser,  Hirschmann).  It  werfe 
probably  safer  to  accept  the  conclusion  that  the  nerves  innervat- 
ing both  sets  of  fibers  are  acted  on — the  motor  oculi  stimulated 
(see  case  by  T.  Wharton  Jones,  "Practitioner,"  vol.  iii),  the  sym- 
pathetic depressed — for  we  find  that  tetanic  contraction  of  the  mus- 
cular fiber  of  the  intestine,  followed  by  dilatation  and  a  paretic 
state,  can  be  experimentally  produced  by  physostigma.  The  ap- 
paratus of  accommodation  is  also  affected  ;  myosis  begins  in  ten  to 
fifteen  minutes  after  eserine  is  inserted.  Direct  galvanization  of 
the  iris,  contracted  by  physostigma,  causes  it  to  dilate  (Engelhardt, 
Hermann). 

THEKAPT. — The  applications  of  physostigma  to  the  treatment  of 
disease  are  by  no  means  so  important  as  the  elaborate  study  given 
to  its  physiological  action,  by  various  observers,  would  seem  to 
indicate. 

In  torpor  of  the  muscular  layer  of  the  intestine,  combined  with 
deficient  secretion  of  the  mucous  membrane,  this  agent  is  often  very 
serviceable.  In  some  subjects  fifteen  minims  of  the  tincture  or  a 
half-grain  of  the  extract,  taken  at  bedtime,  will  procure  a  morning 
evacuation,  but  it  frequently  fails.  When  the  state  to  be  relieved 


PHYSOSTIGMA.  689 

is  such  as  is  indicated  above,  a  combination  of  physostigma,  bella- 
donna, and  nux-vomica,  is  sometimes  very  effective  :  $  Tinct.  phy- 
sostigraatis,  tinct.  nucis  vomicae,  tinct.  belladonnas,  aa  3  ij-  M. 
Sig.  Thirty  drops  in  water,  morning  and  evening.  $  Extract, 
physostigmatis,  ext.  belladonnas,  ext.  nucis  vomicae.  aa  gr.  v.  M. 
Ft.  pil.  no.  x.  Sig.  :  One  pill  at  bed-hour.  Physostigma  (gr.  £  — 
gr.  ss  of  the  extract)  is  a  useful  addition  to  a  cathartic  pill.  ]J  Ext. 
physostigmatis,  resinae  podophylli,  aa  grs.  iij.  M.  Ft.  pil.  no.  vj. 
Sig.:  One  pill  at  bed-hour. 

To  the  troublesome  flatulence  of  women  at  the  climacteric  pe- 
riod, usually  associated  with  a  paretic  state  of  the  muscular  layer 
of  the  bowel,  very  great  relief  is  often  afforded  by  the  use  of  phy- 
sostigma. With  the  relief  to  the  flatulence  there  usually  follows 
relief  to  the  morbid  fancies,  the  headache  and  vertigo  connected 
with  it. 

The  action  of  physostigma  on  the  spinal  cord,  as  a  paralyzer,  natu- 
rally suggested  its  use  in  tetanus.  The  evidence  of  its  utility  is  dis- 
crepant. Moreover,  tetanus,  in  many  instances,  manifests  a  tendency 
to  spontaneous  cure.  It  is  difficult,  therefore,  to  estimate  the  precise 
value  of  physostigma,  but  about  one  half  of  the  cases  treated  with  this 
agent  recover — according  to  Watson,  ten  in  eighteen  ;  according  to 
Roemer,  twenty  in  forty-seven  cases.  A  larger  measure  of  success 
might  have  been  achieved,  had  sufficient  attention  been  paid  to  the 
quality  of  the  extract  used  and  to  the  mode  of  administration.  The 
following  remarks  by  Dr.  Fraser,  in  regard  to  the  treatment  of  tetanus 
by  Calabar  bean,  are  of  great  importance  : 

"  I  should  myself  feel  inclined  always  to  commence  the  treatment 
by  subcutaneous  injection,  and  to  repeat  such  injection  until  the  sys- 
tem is  decidedly  affected,  and  then  to  administer  the  remedy  by  the 
mouth  in  a  dose  three  times  as  large  as  is  found  necessary  by  subcu- 
taneous injection.  Such  a  plan  might  be  quite  safely  followed  in  a 
child  of  even  nine  years.  If  the  remedial  effects  continue  to  be  pro- 
duced by  administration  by  the  mouth,  it  should  be  persevered  with, 
for  such  administration  has  obvious  advantages  as  far  as  the  conven- 
ience of  the  practitioner  is  concerned.  In  the  more  severe  cases,  how- 
ever, I  believe  subcutaneous  injection  should  be  alone  employed. 
The  distress  and  increase  of  spasm  caused  by  swallowing,  or  the  im- 
possibility of  introducing  substances  by  the  mouth,  will  render  this 
necessary.  I  can  not,  also,  too  strongly  urge  that  subcutaneous  injec- 
tion should  always  be  used  when  severe  and  continued  spasms  occur, 
when  a  fatal  result  is  imminent  from  the  exhaustion  caused  by  pro- 
longed and  frequent  convulsions,  and  when  apncea  threatens  at  once 
to  close  the  tragic  scene.  By  it  we  obtain  the  quickest  and  most  pow- 
erful effect. 

"From  the  preceding  remarks  it  can  not  be  expected  that  any 


690  MOTOR   DEPRESSANTS. 

arbitrary  rules  of  dosage  can  be  laid  down.  For  an  adult  one  grain 
of  the  extract  by  the  stomach,  or  one  third  of  a  grain  by  subcutane- 
ous injection,  will  generally  be  sufficient  to  commence  with.  This 
should  be  repeated  in  two  hours,  when  its  effects  will  usually  have 
passed  off,  and  the  succeeding  doses  may  be  modified  according  to  the 
experience  that  will  be  thus  gained.  .  .  .  The  great  object  is  to  pro- 
duce as  quickly  as  possible,  and  then  to  maintain,  the  physiological 
effect  of  physostigma  in  diminishing  reflex  excitability.  The  doses 
must,  therefore,  be  continued  in  increasing  quantities  until  this  physi- 
ological effect  is  produced,  or  until  the  sedative  action  of  the  drug  on 
the  circulation  is  carried  to  a  dangerous  extreme,  or  until  constant 
nausea  and  vomiting  compel  us  to  desist." 

Influenced  by  theoretical  considerations,  physostigma  has  been 
prescribed  in  chorea  and  epilepsy,  but  the  results  have  not  been  en- 
couraging. It  is  true,  successful  cases  of  chorea  have  been  reported, 
but  the  influence  of  favorable  hygienic  surroundings  and  time  is  so 
great  in  uncomplicated  chorea,  that  we  may  well  doubt  whether  phy- 
sostigma has  any  real  influence.  Of  twelve  cases  of  epilepsy  treated 
by  this  agent,  six  were  improved,  and  in  the  other  six  a  notable  in- 
crease in  the  number  of  the  epileptic  paroxysms  took  place  (Williams). 

In  progressive  paralysis  of  the  insane,  remarkable  improvement 
has  occurred  under  the  use  of  physostigma  in  a  few  cases  (Browne), 
but  in  others  the  results  have  been  entirely  negative  (Williams).  As 
in  this  melancholy  disorder  no  remedies  have  hitherto  been  of  any 
avail,  it  is  a  gratifying  fact  that  in  some  cases  Calabar  bean  has 
seemed  to  stay  its  progress. 

Since  it  has  been  shown  that  physostigma  lessens  the  activity  of 
the  respiratory  function,  lowers  the  action  of  the  heart,  and  depresses 
the  temperature,  it  has  been  used  in  bronchitis,  congestion  of  the  lungs, 
and  pneumonia,  with  a  degree  of  success  which  warrants  more  ex- 
tended and  systematic  use. 

Besides  the  various  applications  in  ophthalmic  practice  growing 
out  of  the  myosis  produced  by  physostigma,  it  has  been  used  with 
success  in  certain  paralytic  and  convulsive  states  of  the  ocular  muscles. 
In  a  case  of  paralysis  of  the  third  nerve,  with  ptosis,  double  vision, 
and  immobile  pupil,  Wharton  Jones  effected  a  cure  by  the  instillation 
of  physostigma  into  the  eye,  whence  he  concludes  that  the  myosis 
caused  by  this  agent  is  due  to  the  stimulation  of  the  third  nerve. 
Galezowski  recommends  the  instillation  of  physostigma  into  the  eye 
in  cases  of  suppuration  of  the  cornea  and  in  amblyopia.  Eserine  disks 
(of  gelatin)  have  been  successfully  employed  in  tic. 

The  experiments — thirty  in  number — of  the  British  Medical  Asso- 
ciation Committee,  with  regard  to  the  antagonism  between  physo- 
stigma and  strychnine,  have  led  them  to  the  following  conclusion  : 

"  Although  the  symptoms  produced  by  either  substance  were  mod- 


PHYSOSTIGMA.  691 

ified  considerably  by  the  action  of  the  other,  there  was  no  instance 
of  recovery  from  a  fatal  dose." 

The  antagonism  between  atropine  and  physostigma,  at  least  to  a 
considerable  extent,  has  been  well  established,  especially  by  the  labors 
of  Fraser.  In  1864  Kleinwachter,  influenced  probably  by  the  marked 
antagonism  of  the  two  agents  on  the  pupij,  employed  physostigma 
with  success  in  a  case  of  poisoning  by  atropine.  The  British  Asso- 
ciation Committee,  however,  conclude  as  the  result  of  their  investiga- 
tions that — "  1.  Sulphate  of  atropine  antagonizes  to  a  slight  extent 
the  fatal  action  of  extract  of  Calabar  bean  ;  2.  The  area  of  antago- 
nism is  more  limited  than  even  Dr.  Fraser  has  indicated  in  his  paper 
on  the  subject. 

"Thirty-one  experiments,  performed  by  the  committee  with  hy- 
drate of  chloral  and  Calabar  bean,  have  shown  that — 

"  1.  Hydrate  of  chloral  modifies  to  a  great  extent  the  action  of  a 
fatal  dose  of  extract  of  Calabar  bean,  mitigating  symptoms  and  pro- 
longing life. 

"  2.  Hydrate  of  chloral,  in  some  cases,  saves  life  from  a  fatal  dose 
of  Calabar  bean. 

"  3.  If  hydrate  of  chloral  be  given  before  extract  of  Calabar  bean, 
so  that  the  animal  is  deeply  under  the  influence  of  hydrate  of  chloral 
before  it  receives  the  extract  of  Calabar  bean,  the  symptoms  pro- 
duced by  the  latter  are  much  modified,  and  life  is  saved  from  the  ef- 
fects of  what  would  otherwise  be  a  fatal  dose. 

"4.  Chloral  hydrate  is  of  little  service  as  an  antagonist  to  extract 
of  Calabar  bean,  if  given  some  time  after  the  latter.  If  the  symptoms 
of  the  action  of  Calabar  bean  be  in  full  operation,  it  will  not  save  life, 
however  it  may  modify  symptoms." 

Uses  of  Eserine. — This  alkaloid  represents  the  powers  of  the  plant, 
and  is  the  most  eligible  form  for  internal  administration,  and  for  local 
use  in  ophthalmic  therapeutics.  Merck,  however,  maintains  that  the 
salicylate  of  physostigmine  is  the  best  preparation  of  the  alkaloids, 
and  it  has  been  made  official.  The  dose  for  internal  and  hypodermatic 
use  ranges  from  -fa  to  -fa  of  a  grain.  Gelatin  disks  of  eserine  are  now 
most  frequently  employed  for  instillation  into  the  eye,  but  a  neu- 
tral solution  of  any  of  its  salts  is  convenient  for  this  purpose.  It  is 
now  largely  used  to  counteract  the  effects  of  atropine  on  the  pupil ;  in 
iritis,  to  break  away  or  prevent  the  formation  of  adhesions  ;  in  ulcer- 
ation  and  suppuration  of  the  cornea  ;  after  extraction  of  cataract,  to 
prevent  suppuration  (Wecker) ;  in  the  operation  of  iridectomy.  The 
curative  influence  of  eserine  in  these  cases  is  due  to  its  action  in  low- 
ering the  intra-ocular  tension,  in  diminishing  the  conjunctival  secre- 
tions by  contracting  the  blood-vessels,  and  in  checking  the  migration 
of  the  white  blood-corpuscles  (Wecker).  Eserine  may  be  substituted 
for  physostigma  for  all  purposes,  by  the  stomach  or  hypodermatically 


692  MOTOR   DEPRESSANTS. 

Authorities  referred  to  : 

ARNSTEIN  UNO  SUSTCHINSKT.  Schmidfs  Jahrbiicker  der  gesammten  Medicin,  Band 
exlii,  p.  286. 

BENNETT,  DR.  J.  HUGHES.  Report  of  the  Committee  of  the  British  Medical  Association 
to  investigate  the  Antagonism  of  Medicines.  British.  Medical  Journal,  January  23,  1876. 

BROWNE,  DR.  J.  CRICHTON.     British  Medical  Journal,  p.  60,  January  10,  1874. 

FRASER,  DR.  THOMAS  II.  An  Experimental  Research  on  tlie  Antagonism  between  tht 
Actions  of  Physostigma  and  Atropia,  Edinburgh,  1872.  (I  am  indebted  to  the  courtesy  of 
Dr.  Fraser  for  a  copy  of  this  important  memoir.) 

GALEZOWSKI,  DR.  XAVIKR.      Gazette  des  Hopitaux,  124,  1869. 

GRUNHAGEN,  DR.      Virchow'1*  Archiv,  Band  xxx,  p.  621. 

HERMANN,  PROF.  DR.  L.     Lehrbuch  der  experimentellen  Toxifologie,  Berlin,  1874,  p.  337. 

JONES,  T,  WHARTON.     The  Practitioner,  vol.  iii,  and  vol.  vii,  p.  345. 

KOHLER,  DR.  H.  Experimentelle  Beitrage  zur  Kenntniss  der  Herzwirkung  des  Calabar% 
etc.  Archiv  fur  experimentelle  Pathologic  und  Pharmacologie,  1873,  p.  276. 

LASCHKEWICH,  DR.     Virchow's  Archiv,  vol.  xxxv,  p.  294. 

LABORDE  ET  LEVEN,  MM.     Gazette  de  Paris,  3,  6,  1870. 

PAPI,  CLEMENTI.     (Gaz.  Lomb.)  SchmidCs  Jahrbiicher,  voL  cxlii,  p.  286. 

ROEMER,  DR.  B.     St.  Louis  Medical  Journal,  1873,  p.  367. 

SUBBOTIN,  DR.  VICTOR.  Ext.  sem.  Physostigmatis  venen.  bei  atonischem  Zustande  del 
Darmkanals.  Archiv  fur  Jclin.  Medicin,\\,  2,  3,  p.  285,  1869. 

WATSON,  DR.  EBEN.  The  Practitioner,  vol.  iii,  p.  146,  and  Edinburgh  Medical  Jour- 
nal, May,  1867,  p.  999. 

Tabacum. — Tobacco.  Tabac,  Fr.  ;  TabaTcblatter,  Ger.  The  com- 
mercial dried  leaves  of  Nicotiana  tabacum  Linne  (Nat.  Ord.  Solana- 
cece). 

Infusum  Tabaci. — Infusion  of  tobacco  (  3  j — Oj).  Dose,  as  an 
enema,  |  ss —  f  iv.  (Not  official.) 

Oleum  Tabaci. — Oil  of  tobacco.     (Not  official.) 

Unguentum  Tabaci. — Tobacco-ointment  (  f  ss —  f  viij).  (Not  offi- 
cial.) 

Vinum  Tabaci. — Wine  of  tobacco  (  f  j — Oj).  Dose,  TH,  v —  3  ss. 
(Not  official.) 

COMPOSITION. — Tobacco  contains  a  powerful  alkaloid — nicotine — • 
in  combination  with  malic  acid.  It  is  an  oily,  colorless  liquid,  strongly 
alkaline  in  reaction.  Its  taste  is  hot  and  acrid,  and  its  odor  disagree- 
able and  peculiar.  It  is  contained  in  the  dried  leaves,  in  the  propor- 
tion of  about  five  per  cent. 

Tobacco  also  contains  a  peculiar  camphor — nicotianine. 

Tobacco-leaves  are  rich  in  mineral  constituents — potash,  lime,  ni- 
trates, and  phosphates.  The  vapor  of  tobacco  "contains  numerous 
basic  substances  of  the  picolinic  series,  and  cedes  to  caustic  potash, 
hydrocyanic  acid,  sulphureted  hydrogen,  several  volatile  fatty  acids, 
phenol,  and  creosote  "  (Fliickiger  and  Hanbury,  Husemann).  It  does 
not  contain  nicotine.  The  oil  of  tobacco  is  an  empyreumatic  product, 
obtained  by  distillation. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies,  tannin, 


TOBACCO.  693 

and  the  iodides,  are  chemically  incompatible.  Strychnine  is,  accord- 
ing to  Haughton,  a  true  physiological  antagonist.  Ergot,  digitalis, 
belladonna,  ammonia,  and  alcoholic  stimulants,  antagonize  the  effects 
of  tobacco  on  the  heart  and  arterial  system. 

In  cases  of  poisoning,  the  stomach  should  be  evacuated  by  emetics 
or  the  stomach-pump,  and  tannin  and  the  iodides  should  be  adminis- 
tered. Ammonia  and  brandy  are  indicated  to  relieve  the  failing  cir- 
culation. Subcutaneous  injection  of  strychnine  should  also  be  resorted 
to,  and,  if  necessary,  artificial  respiration. 

SYNEKGISTS. — All  of  the  motor  depressants  increase  the  effects  of 
tobacco. 

PHYSIOLOGICAL  EFFECTS. — Tobacco  is  a  severe  and  very  depress- 
ing nauseant  and  emetic.  It  is  locally  an  irritant  to  the  mucous  mem- 
brane, and  produces  burning  pain  at  the  epigastrium.  It  is  also  laxa- 
tive even  when  smoked,  and  in  considerable  quantity  by  the  stomach 
causes  hypercatharsis.  The  emetic  effect  of  tobacco  is,  doubtless,  the 
product  of  three  factors  :  its  cerebral  action,  its  local  irritation  of  the 
gastric  mucous  membrane,  and  its  specific  emetic  property.  The  secre- 
tions of  the  intestinal  mucous  membrane  are  increased,  and  the  mus- 
cular layer  is  thrown  into  tetanic  contraction,  whence  the  catharsis 
which  follows  its  administration.  Applied  to  a  wounded  surface, 
tobacco  produces  the  same  effects. 

Its  active  principle,  nicotine — the  salts  of  which  are  crystalline — 
diffuses  into  the  blood  with  great  rapidity.  It  corresponds,  in  the 
mode  and  intensity  of  its  action,  to  prussic  acid.  In  a  case  narrated 
by  Taylor,  a  fatal  result  ensued  in  three  minutes  after  a  toxic  dose. 
In  another  case  death  occurred  in  five  minutes  (M.  Fougnies,  poisoned 
by  Count  Bocarme).  When  a  lethal  dose  is  administered  to  an  ani- 
mal, the  action  of  the  heart  continues  after  respiration  has  ceased. 
Its  cavities  are  usually  found  empty,  or  containing  black  fluid  blood. 
Tobacco  is  not,  therefore,  a  cardiac  poison,  and  the  depression  of  the 
circulation  noted  when  full  medicinal  doses  are  administered  is,  doubt- 
less, due  to  the  interference  with  the  pulmonary  functions.  Applied 
directly  to  the  muscular  tissue  of  the  heart,  nicotine  does  not  impair 
its  contractile  power  (Benham).  The  blood  throughout  the  body  is 
black  and  fluid  ;  but,  as  agitation  with  oxygen  restores  its  color,  and 
as  the  blood-globules  are  unaffected,  the  condition  of  the  blood  is 
doubtless  due  to  the  arrest  of  oxygenation  (asphyxia). 

Trembling  and  clonic  spasms  are  produced  by  lethal  doses  of  to- 
bacco. Its  ultimate  effect  is  paralyzing,  but  preceding  the  muscular 
relaxation  and  paresis  there  is  in  animals,  and  occasionally  in  man,  a 
definite  tetanic  stage.  Death  ensues  through  its  paralyzing  action  on 
the  muscles  of  respiration.  The  end-organs  of  the  motor  nerves  lose 
their  excitability,  next  the  trunks  of  the  nerves,  and  then  the  spinal 
cord,  but  the  muscular  irritability  is  unaffected.  The  brain  is  not 


694  MOTOR    DEPRESSANTS. 

directly  affected.  Giddiness  and  delirium  have  been  noted  in  cases  of 
poisoning  by  tobacco,  but  these  symptoms,  as  well  as  the  insensibility 
which  immediately  precedes  death,  are  no  doubt  due  to  the  accumu- 
lation of  carbonic  acid  in  the  blood.  The  pupils  are  contracted  by 
tobacco,  and,  in  fatal  cases,  are  insensible  to  light. 

There  is  considerable  sweating,  and  the  skin  is  cold  and  clammy  in 
fatal  cases.  The  temperature  of  the  body  is  decidedly  reduced  (Tsches- 
chichin).  The  elimination  of  nicotine  probably  takes  place  by  the  kid- 
neys. Very  free  urinary  discharge,  at  all  events,  is  produced  by  to- 
bacco, and,  reasoning  by  analogy,  it  may  be  supposed  that  this  effect 
is  due  to  the  direct  action  of  the  nicotine  on  the  Malpighian  tufts  and 
on  the  tubules  of  the  kidneys. 

When  a  lethal  dose  of  nicotine  has  been  taken,  and  the  effects  fol- 
low immediately,  there  may  be  none  of  the  symptoms  described  above. 
In  the  case  narrated  by  Taylor,  the  "  deceased  stared  wildly ;  there 
were  no  convulsions,  and  he  died  quietly  [in  three  minutes],  heaving  a 
deep  sigh  in  expiring." 

THERAPY. — In  habitual  constipation,  due  to  a  relaxed  state  of  the 
muscular  layer  of  the  bowel,  five  minims  of  the  wine  of  tobacco,  ad- 
ministered at  bedtime,  will  not  unfrequently  afford  relief. 

Jmpaction  of  the  ccecum,  colica  pictonum,  sometimes  intussuscep* 
tion,  and  strangulated  hernia,  may  be  overcome  by  a  tobacco-enema 
It  must  be  borne  in  mind,  however,  that  this  is  an  expedient  not  free 
from  danger.  Numerous  deaths  have  been  caused  by  it,  and  Dr.  Cope- 
land  reports  one  instance  in  which  thirty  grains  by  enema  proved  fatal. 
Of  the  official  infusion  (  3  j — Oj)  it  is  not  safe  to  use  more  than  four* 
ounces,  or  fifteen  grains  ;  and  this  quantity  may  be  expected  to  pro- 
duce most  depressing  nausea.  It  must  be  urged  in  favor  of  this  remedy 
that  it  has,  in  very  unfavorable  cases,  proved  exceedingly  effective. 
It  is  especially  adapted  to  cases  in  which  obstruction  has  occurred 
from  paresis  of  the  muscular  layer  of  the  bowel  (impacted  caecum, 
typhlitis,  painter's  colic). 

Tobacco  is  one  of  the  antispasmodic  remedies  used  in  the  treatment 
of  spasmodic  asthma,  and  the  paroxysms  of  difficult  breathing  in  em- 
physema. It  enters  as  a  constituent  in  various  pastilles  and  cigarettes 
employed  in  these  maladies.  Asthmatics,  unaccustomed  to  the  use  of 
tobacco,  are  sometimes  relieved  by  smoking  a  cigar  or  pipe,  but  the 
effect  is  lost  by  habitual  use.  Laryngismus  stridulus  may  be  quickly 
arrested  by  a  snuff -plaster  to  the  neck — an  effective  but  dangerous 
domestic  remedy.  Obstinate  hiccough,  or  singultus,  may  be  cured  by 
five-minim  doses  of  wine  of  tobacco,  but  we  possess  other  useful  reme- 
dies, less  dangerous  and  less  unpleasant  in  action. 

We  possess  no  remedy  more  effective  in  the  treatment  of  tetanus 
than  tobacco.  It  may  be  used  in  the  form  of  an  enema,  commencing 
with  four  ounces  of  the  infusion,  and  regulating  the  quantity  to  be 


TOBACCO.  695 

administered  and  the  time  of  administration  by  the  effect  produced. 
Minim-doses  of  the  alkaloid  may  be  given  every  two  hours  by  the 
stomach,  or  two  minims  by  the  rectum  (Haughton).  When  it  acts 
favorably,  it  relaxes  the  trismus  so  that  nutriment  may  be  taken,  and 
suspends  the  tonic  convulsions.  Care  must  be  used  not  to  introduce 
a  lethal  quantity,  and  produce  death  by  asphyxia.  The  author  has 
known  the  wine  of  tobacco  to  be  used  successfully  in  a  severe  case  of 
tetanus,  the  quantity  administered  being  regulated  by  the  effect  of  the 
remedy  on  the  convulsions. 

The  experiments  of  Haughton  having  demonstrated  an  antagonism 
between  nicotine  and  strychnine,  he  proposed  the  use  of  nicotine  in 
strychnine-poisoning ',  and  cases  have  occurred  in  which  it  proved  en- 
tirely successful.  As  the  effects  of  nicotine  are  so  nearly  instantane- 
ous, the  stomach  administration — if  the  spasms  do  not  prevent — will 
suffice,  but  rectal  and  even  hypodermatic  injections  may  be  resorted 
to  if  necessary.  The  following  formula  of  Erlenmeyer  may  be  used 
for  the  subcutaneous  injection  in  strychnine-poisoning  and  in  tetanus  : 
5  Nicotinse,  gr.  ss  ;  aquae  destil.,  3  ij.  M.  Sig. :  Ten  minims  contain 
-fa  of  a  grain.  The  cases  of  strychnine-poisoning  in  which  tobacco 
was  used  successfully  were  treated  by  the  infusion. 

Tobacco  was  formerly  employed  in  the  treatment  of  dropsy.  It  is 
adapted  to  those  cases  in  which  digitalis  is  now  used.  It  promotes  free 
diuresis,  and  is  at  the  same  time  laxative — effects  especially  serviceable 
in  cardiac  dropsy.  It  is,  however,  so  disagreeable  in  action  that  few 
practitioners  have  the  temerity  to  prescribe  it,  and  few  patients  are 
willing  to  swallow  it. 

There  is  no  doubt  that  excessive  use  of  tobacco  lessens  the  venereal 
appetite.  Slightly  nauseating  doses  of  the  wine  of  tobacco  will  check 
chordee  and  priapism.  Satyriasis  is  effectively  quenched  in  tobacco- 
nausea.  Nocturnal  pollutions,  due  to  repletion  and  to  continence,  are 
also  usually  suspended  by  the  use  of  this  remedy  ;  but  it  is,  unfor- 
tunately, so  horribly  depressing  that  the  remedy  may  be  justly  con- 
sidered the  greater  evil. 

LOCAL  USES  OF  TOBACCO. — So  many  unfortunate  accidents  have  re- 
sulted from  the  external  application  of  tobacco,  that  its  use  in  this 
way  is  rarely  justifiable.  The  infusion  and  an  ointment  have  been 
employed  with  success  in  tinea,  scabies,  prurigo,  pityriasis,  etc.  An 
injection  of  tobacco  will  destroy  ascarides,  but  it  is  unsafe.  Other 
and  more  manageable  remedies  have  entirely  taken  the  place  of  tobacco 
in  the  local  diseases  above  named. 

Authorities  referred  to  : 

BENHAM,  DR.  W.  T.  On  the  Action  of  Nicotine.  West  Riding  Lunatic  Asylum  Re- 
ports, vol.  iy,  p.  307. 

BLATIN,  M.  LE  DK.  Recherches  Phys.  et  Clin.  sur  la  Nicotine  et  la  Tabac.  Gaz.  des 
Hdpitaux,  1870,  p.  221. 


696  MOTOR   DEPRESSANTS. 

COPLAND,  DR.     Dictionary  of  Practical  Medicine,  article  Colic,  yol.  i,  p.  443. 

CURLING,  MR.  T.  B.     A  Treatise  on  Tetanus,  London,  1836. 

ERLENMEYER,  DR.  A,    Die  subcutanen  Injectionen  der  Arzneimittel,  3.  Auflage,  p.  85. 

FLUCKIGER  AND  HANBCRY.     Pharmacographia,  English  edition,  p.  418. 

HAUGHTON,  REV.  PROF.  Dublin  Hospital  Gazette,  December,  1856,  and  Dublin  Quar- 
terly Journal,  August,  1862,  p.  172. 

HERMANN,  DR.  L.     Handbuch  derexper.  Toxicologie,  p.  318. 

HUSEMANN,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band, 
p.  1142. 

HIRSCHMANN,  DR.     Abstract  in  Bull.  Gen.  de  Therap.,  Ixv,  p.  561. 

HIRT,  DR.  LUDWIG.     Die  Krankheiten  der  Arbeiter,  erster  Theil,  p.  156,  ef  seq. 

NASSE,  DR.  0.      Centralblatt  fur  die  med.  Wi&sensch.,  1865,  p.  785. 

TARDLEU,  A.     Diet.  <T Hygtine,  deuxieme  edition,  1862,  article  Tabac,  p.  229,  et  seq. 

TAYLOR,  DR.  A.  S.     On  Poisons,  third  English  edition,  p.  803. 

TSCHESCHICHIN.     Arch,  fur  Anatomic  und  Physiologic,  1866,  p.  151. 

TRAUBE,  DR.  L.     As  quoted  by  Hermann. 

USPENSKY,  P.     Arch,  fur  Anat.  und  Physiologic,  1868,  p.  522. 

VAN  PRAAG,  DR.  L.     Arch  fur  Anat.  und  Physiologic,  viii,  p.  56. 

VON  BASCH  UND  OSER.      Wiener  medicinische  Jahrbucher,  1872,  p.  387. 

Lobelia. — Lobelia.  The  leaves  and  tops  of  Lobelia  inflata  Linne" 
(Nat.  Ord.  Lobeliacece),  collected  after  a  portion  of  the  capsules 
have  become  inflated.  Indian  tobacco.  Lobelie  enflee,  Fr. ;  Lobelia- 
kraut,  Ger. 

Acetum  Lobelice. — Vinegar  of  lobelia.  (Lobelia,  10  parts  ;  diluted 
acetic  acid  to  make  100  parts.)  Dose,  TII  v — 3  j.  (Not  official.) 

Tinctura  Lobelice. — Tincture  of  lobelia.  (Lobelia,  200  grin.  ;  di- 
luted alcohol  sufficient  to  make  1,000  c.  c.)  Dose,  in,  v —  3  j. 

JExtractum  Lobelice  Fluidum. — Fluid  extract  of  lobelia.  Dose, 
m  j—  3  ss. 

COMPOSITION. — The  effects  of  lobelia  are  due  to  the  presence  in  it 
of  a  peculiar  alkaloid — lobeline.  This  principle  is  oily  in  consistence, 
has  a  pungent,  rather  acrid  taste,  a  tobacco-like  odor,  and  is  strongly 
alkaline  in  reaction.  It  is  slightly  soluble  in  water,  but  more  freely 
soluble  in  alcohol  and  ether.  It  combines  with  acids  to  form  crystal- 
lizable  salts,  which  are  soluble  in  water  and  in  alcohol.  The  active 
principle — lobeline — is  combined  in  the  plant  with  lobelic  acid. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies  decom- 
pose lobeline  ;  hence  these  are  incompatible.  The  depressing  effects 
of  lobelia  on  the  circulation  are  counteracted  by  digitalis,  belladonna, 
ergot,  and  other  vaso-motor  excitants,  by  alcohol,  ether,  ammonia, 
etc.  ;  on  the  nervous  system  of  animal  life,  by  strychnine,  picrotoxin, 
thebaine,  etc. 

SYNEBGISTS. — All  of  the  motor  depressants  increase  the  effects  of 
lobelia. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  lobelia  is  pungent  and  acrid, 
and  it  persists  for  a  long  time  in  the  fauces.  The  leaves  chewed  excite 
a  very  abundant  flow  of  saliva,  and  soon  cause  a  feeling  of  epigastric 


LOBELIA.  697 

depression  and  nausea,  with  giddiness  and  headache.  The  preparations 
of  lobelia  administered  by  the  stomach  produce,  in  considerable  doses, 
a  degree  of  nausea  and  depression  which  amounts  to  anguish.  An 
abundant  outpouring  of  gastric  mucus  takes  place,  and  vomiting  en- 
sues, with  great  straining  and  distress.  The  action  of  the  heart  is 
enfeebled  ;  headache  and  vertigo  are  experienced  ;  a  profuse  sweat 
breaks  out  on  the  surface  of  the  body  ;  the  intestinal  canal  is  relaxed, 
and  the  discharge  of  urine  is  increased.  When  a  lethal  dose  is  taken, 
especially  if  vomiting  do  not  occur,  the  effects  are  chiefly  expended  on 
the  nervous  system  of  animal  life.  Muscular  weakness  and  trembling, 
shallow  respiration,  coldness  of  the  surface,  feeble  circulation,  insensi- 
bility, and  sometimes  convulsions,  have  occurred.  Death  ensues  from 
paralysis  of  the  muscles  of  respiration — the  action  of  the  heart  contin- 
uing after  respiration  has  ceased.  The  insensibility  is  doubtless  pro- 
duced in  the  same  way  as  by  tobacco,  and  the  cerebral  effects  are  not 
the  result  of  a  direct  action  of  the  poison. 

According  to  the  investigations  of  Ott,  lobeline,  in  moderate  doses, 
first  "  increases  the  blood-pressure  by  acting  as  an  excitant  on  the 
peripheral  vaso-motor  nervous  system."  This  primary  effect  is  not  of 
long  duration,  a  fall  in  the  blood-pressure  soon  occurs,  the  peripheral 
circulation  is  so  embarrassed  from  weakened  power  of  the  heart,  and 
obstructed  pulmonary  circulation,  that  oxygenation  of  the  tissues  is 
rapidly  impaired,  and  a  marked  reduction  of  temperature  takes  place, 
Lobeline  affects  chiefly  the  motor  nervous  system,  and  especially  the 
medulla  oblongata  and  its  respiratory  center  (nucleus  of  pneumo- 
gastric). 

THEKAPY. — Lobelia  is  much  employed  by  the  self-styled  pnysio- 
medical  practitioners  as  a  "  sanative  agent."  The  great  quantity  of 
mucus  discharged  from  the  stomach  under  its  emetic  action  is  consid- 
ered by  them  a  proof  of  its  power  as  an  eliminating  agent.  As  an 
emetic,  lobelia  is  entirely  too  harsh  and  depressant  to  justify  its  use 
for  this  purpose.  In  habitual  constipation,  dependent  on  atony  of  the 
muscular  layer  of  the  bowel  and  deficient  secretion  of  the  mucous 
membrane,  good  results  are  sometimes  obtained  by  small  doses  of  the 
tincture — ten  minims — administered  at  bedtime.  Impaction  of  the 
caecum,  when  inflammation  has  not  occurred,  may  be  removed,  and 
the  bowels  induced  to  act,  by  small  doses,  frequently  repeated,  of  the 
tincture  of  lobelia  (two  drops  every  hour).  This  remedy  can  be  used 
when  purgatives  would  produce  serious  mischief.  An  infusion  of  lobe- 
lia as  an  enema  has  succeeded  in  relieving  strangulated  hernia,  intus~ 
susception,  and  fecal  impactions.  This  use  of  the  agent  is  the  same  as 
for  the  corresponding  administration  of  tobacco  ;  it  is  much  safer  than 
tobacco,  and  can  be  made  to  produce  as  decided  therapeutic  effects. 

Unquestionably  the  most  important  application  of  lobelia  is  to  the 
treatment  of  the  asthmatic  paroxysm.  It  gives  relief  in  a  few  minutes 


698  MOTOR  DEPRESSANTS. 

to  violent  attacks  of  spasmodic  asthma,  and  it  sometimes  happens  that 
the  relief  is  permanent.  Frequent  repetition  of  this  remedy  in  the 
same  individual,  however,  lessens  its  effects,  and  it  may  finally  cease  to 
afford  any  relief.  To  be  effective  in  asthma,  a  teaspoonf ul  dose  of  the 
acetum  or  tincture  must  be  administered  every  fifteen  minutes  until 
nausea  is  induced.  Free  expectoration  and  abundant  gaseous  eructa- 
tions take  place,  and  the  breathing  soon  becomes  easy  and  calm.  The 
efficiency  of  lobelia  is  increased  by  the  addition  of  iodide  and  bromide 
of  ammonium.  §  Tinct.  lobeliae,  f  j  ;  ammonii  iodidi,  3  ij  ;  ammonii 
bromidi,  3  iij  ;  syrup,  tolutan.,  §  ij.  M.  Sig.  :  A  teaspoonful  every 
one,  tioo,  three,  or  four  hours.  The  hydrobromate  of  lobeline  is  the 
most  efficient  preparation  for  treating  the  respiratory  neuroses,  and 
certain  cardiac  affections,  such  as  pseudo-angina  pectoris. 

Whooping-cough,  especially  after  the  cessation  of  the  catarrhal 
stage,  has  been  treated  successfully  by  lobelia,  but  we  now  possess 
other  agents  more  effective  and  less  disagreeable  in  action.  Lobelia  is, 
however,  an  excellent  expectorant.  It  is  adapted  to  cases  in  which  the 
cough  is  dry,  resonant,  and  spasmodic.  It  succeeds  best  in  those  who 
have  attacks  of  cough  with  spasmodic  difficulty  of  breathing,  and 
who  get  up  a  little  tough  mucus  after  long  and  painful  paroxysms  of 
coughing.  A  lobelia-emetic  will  cut  short  an  attack  of  spasmodic 
croup,  but  it  is  too  harsh  and  dangerous  a  remedy  to  be  employed  for 
this  purpose  ;  but  it  is  less  dangerous  than  is  generally  supposed. 
In  consequence  of  the  fear  which  invests  it,  the  doses  given  are  often 
insufficient  to  effect  the  good  results  it  may  induce  ;  and  this  is  true 
of  the  various  catarrhal  conditions  of  the  respiratory  mucous  mem- 
brane especially. 

Authorities  referred  to  : 

OTT,  DR.  J.  Note  on  the  Action  of  Lobelina  on  the  Circulation.  (Reprinted  from  the 
Boston  Medical  and  Surgical  Journal.) 

PORCHER,  DR.  FRANCIS  PBTRK.     Resources  of  the  Southern  Fields  and  Forests,  p.  438. 

Acidum  Hydrocyanicum. — Hydrocyanic  or  Prussic  Acid.  Acide 
hydrocyanique,  Fr.  ;  Blausaure,  Ger. 

Acidum  Hydrocyanicum  Dilutum. — Diluted  hydrocyanic  acid.  A 
colorless  liquid,  having  a  peculiar  odor,  and  wholly  volatilized  by  heat. 
It  imparts  a  faint,  evanescent  red  color  to  litmus,  and  is  not  discol- 
ored by  hydrosulphuric  acid.  With  solution  of  nitrate  of  silver,  added 
in  slight  excess,  one  hundred  grains  of  it  produce  a  white  precipitate, 
which,  when  washed  with  water  until  the  washings  are  tasteless,  and 
dried  at  a  temperature  not  exceeding  212°,  weighs  ten  grains,  and  is 
wholly  soluble  in  boiling  nitric  acid. 

The  official  diluted  acid  contains  two  per  cent  of  anhydrous  acid 
and  ninety-eight  per  cent  of  alcohol  and  water.  Dose,  m  j — Tl  v. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  metallic  salts  are  gener- 


HYDROCYANIC  ACID.  699 

ally,  incompatible  ;  also  the  red  oxide  of  mercury  and  the  sulphides. 
Freshly-precipitated  oxide  of  iron  (hydrated  sesquioxide)  has  been 
proposed  as  a  chemical  antidote,  but  its  action  is  too  slow.  In  cases 
of  poisoning,  the  remedies  of  the  greatest  utility  are  cold  affusion 
to  the  spine,  the  inhalation  of  ammonia,  the  stomach  administration, 
as  also  the  intra-venous  injection  of  this  substance,  and  the  subcutane- 
ous injection  of  ether.  Atropine  has  been  proposed  as  a  physiological 
antagonist  by  Preyer  ;  but  the  rate  at  which  atropine  is  diffused,  as 
compared  with  the  diffusion  of  prussic  acid,  obviously  will  render 
such  antagonism  powerless,  how  much  soever  it  may  be  approved  on 
theoretical  grounds.  The  results  of  experiments,  as  the  author  and 
others  have  shown,  are,  however,  opposed  to  the  existence  of  this 
antagonism.  In  addition  to  these  measures,  artificial  respiration 
should  be  practiced. 

PHYSIOLOGICAL  EFFECTS. — Applied  to  the  unbroken  skin,  it  is 
doubtful  whether  hydrocyanic  acid  is  absorbed,  but  in  contact  with  a 
wound  or  an  abrasion,  and  with  the  mucous  membrane,  it  diffuses  into 
the  blood  with  great  rapidity. 

The  vapor  has  a  rather  fragrant  odor,  similar  to  that  of  bitter  al- 
monds. Inhaled,  it  has  speedily  caused  death.  When  the  effects  of 
the  vapor  are  short  of  lethal,  giddiness,  faintness,  embarrassed  breath- 
ing, a  weak,  small  pulse,  and  great  muscular  weakness,  are  produced  ; 
and  there  may  be  even  coma  and  profound  insensibility,  and  yet  re- 
covery ensue  (Taylor). 

In  small  medicinal  doses,  beyond  a  fugitive  and  very  slight  calma- 
tive effect,  no  symptoms  are  produced  by  it.  When  the  dose  some- 
what exceeds  the  medicinal  standard,  there  may  occur  transient  gid- 
diness, nausea,  faintness,  a  feeble  pulse,  and  general  muscular  weak- 
ness. The  effects  follow  very  speedily.  When  a  very  large  toxic 
dose  is  taken,  a  few  seconds  only  intervene  from  the  act  of  swallowing 
until  its  effects  are  manifest,  and  death  may  ensue  in  two  minutes  or 
be  postponed  to  five.  Under  these  circumstances,  the  following  phe- 
nomena have  been  observed  :  sudden  insensibility  ;  eyes  protruding 
and  glistening  ;  pupils  dilated  and  unaffected  by  light ;  extremities 
cold,  relaxed  ;  the  skin  covered  with  a  clammy  sweat  ;  breathing  con- 
vulsive, slow  ;  the  pulse  extremely  feeble  or  imperceptible  ;  evacua- 
tions involuntary  (Taylor).  When  the  effects  are  slower,  in  conse- 
quence of  the  ingestion  of  a  merely  lethal  dose,  there  are  occasionally 
tetanic  convulsions,  opisthotonos,  trismus,  etc. 

Although  the  effects  of  prussic  acid  are  exceedingly  rapid,  a  fatal 
result  is  not  instantaneous.  Various  acts  of  volition  may  be  gone 
through,  provided  but  a  few  seconds  are  required  for  their  perform- 
ance. Several  instructive  instances  of  this  kind  are  narrated  by  Tay- 
lor. The  effects  of  hydrocyanic  acid  are  not  more  rapid  than  can  be 
accounted  for  by  its  distribution  through  the  blood. 


700  MOTOR  DEPRESSANTS. 

Most  contradictory  opinions  have  been  expressed  as  to  the  action 
of  prussic  acid  on  the  blood  :  that  it  at  first  arterializes  and  afterward 
arrests  decarbonization  of  the  blood  ;  that  it  destroys  the  ozonizing 
power,  and  does  not  impair  the  capacity  of  the  red  blood-globules  to 
carry  and  to  yield  up  oxygen  ;  that  cyanohaemoglobin  is  formed  by 
the  combination  of  the  acid  with  haemoglobin,  and  that  this  combina- 
tion can  not  take  place,  owing  to  the  rapidity  of  the  action  of  the 
poison.  From  this  chaotic  state  of  scientific  opinion  the  following 
may  be  evolved  :  the  blood  is  dark,  owing  to  deficient  decarbonization, 
but  this  is  probably  due  to  a  spasm  of  the  pulmonary  arterioles  and 
paresis  of  the  muscles  of  respiration,  whence  it  follows  that  rapid  as- 
phyxia ensues.  The  primary  action  of  prussic  acid  on  the  terminal 
filaments  of  the  pneumogastric,  as  shown  by  Preyer,  is  confirmatory 
of  this  view. 

Although  the  action  of  the  heart  ceases  after  respiration,  prussic 
acid  undoubtedly  exerts  a  direct  paralyzing  action  on  the  cardiac 
ganglia. 

The  cerebral  effects  of  this  poison  are,  probably,  indirect,  the  re- 
sult of  rapid  carbonic-acid  poisoning,  and  the  sudden  withdrawal  of 
oxygen  from  the  cerebral  tissues.  Direct  application  of  prussic  acid 
to  the  medulla  oblongata  causes  (in  the  alligator)  a  sudden  and  com- 
plete expiration,  and  collapse  of  the  lung  (Jones).  The  tetanic  con- 
vulsions which  have  been  observed  in  many  cases  of  poisoning,  in  ani- 
mals and  in  man,  indicate  a  direct  action  of  this  agent  on  the  spasm- 
center  ;  but  the  disappearance  of  the  excitability  of  the  motor  nerves, 
and  of  the  contractility  of  muscles  which  it  causes,  shows  that  it* 
quickly  exhausts  the  irritability  of  the  spinal  cord.  These  effects  on 
the  cord,  on  the  nerve-trunks,  and  on  the  muscles,  are  also,  probably, 
in  part  due  to  the  circulation  through  them  of  blood  deprived  of  oxy- 
gen and  charged  with  carbonic  acid.  The  fact  that  instances  of  re- 
covery from  a  condition  of  profound  insensibility  are  numerous,  is  con- 
firmatory of  the  view  just  expressed.  Moreover,  artificial  respiration 
exerts  an  undeniable  influence  over  the  lethal  effects  of  the  acid  in  ani- 
mals (Preyer),  whence  it  may  be  concluded  that  to  supply  oxygen  to 
the  blood  is  sufficient  to  arrest  all  of  the  symptoms  produced  by  the 
want  of  oxygen  and  by  the  excess  of  carbonic  acid. 

Post-mortem  rigidity  sets  in  early  after  death  from  prussic  acid, 
and  is  very  pronounced.  The  fingers  are  tightly  closed,  the  toes 
strongly  flexed,  the  jaws  rigid,  the  eyes  prominent  and  staring.  The 
blood  is  dark-colored,  fluid,  and  the  venous  trunks  and  the  cerebral 
sinuses  are  gorged. 

The  quantity  of  medicinal,  diluted  hydrocyanic  acid  necessary  to 
produce  death  will  vary  with  the  age,  size,  and  bodily  vigor.  Habit, 
also,  influences  to  a  remarkable  degree  the  susceptibility  to  its  toxic 
influence.  A  quantity  equivalent  to  forty  minims  of  the  diluted  hy« 


HYDROCYANIC    ACID.  701 

drocyanic  acid  (United  States  Pharmacopoeia)  has  proved  fatal.  As 
the  effects  of  a  medicinal  dose  are  expended  in  a  half  hour  to  one  hour, 
the  repetition  of  the  doses  hourly  will  not  be  unsafe.  Hydrocyanic 
acid  is  not  a  cumulative  poison. 

THERAPY. — Hydrocyanic  acid  is  a  remedy  of  very  considerable  util- 
ity in  certain  affections  involving  the  functions  of  the  pneumogastric 
nerve.  It  is  often  highly  serviceable  in  various  kinds  of  nervous  vom- 
iting ;  for  example,  the  vomiting  of  pregnancy,  the  vomiting  which 
accompanies  some  cerebral  disorders,  and  the  reflex  vomiting  of  phthi- 
sis. The  good  effects  are  quickly,  if  at  all,  produced  ;  hence,  if  no 
result  is  attained  after  some  days'  administration,  no  advantage  can 
be  expected  from  its  continued  administration.  ^  Acid,  hydrocyan. 
dil.,  3  j  ;  aquae  laur.-cerasi,  3  ij.  M.  Sig.  :  A  teaspoonful  every  two 
to  four  hours. 

Gastralgia,  when  it  is  a  truly  neuralgic  affection  of  the  gastric 
nerves,  is  occasionally  very  quickly  cured  by  this  agent.  Sometimes 
cases,  apparently  in  every  way  suitable  for  its  use,  are  not  improved 
by  it.  If  a  few  doses  do  not  effect  any  amelioration,  it  will  be  useless 
to  continue  it.  Cases  of  indigestion  accompanied  by  pain  in  the 
nucha,  and  attacks  of  giddiness  (stomachal  vertigo),  are  sometimes  re- 
markably relieved  by  prussic  acid.  Irritative  dyspepsia,  manifested 
by  these  symptoms,  a  red-glazed  tongue,  pain,  epigastric  tenderness, 
and  a  feeling  of  weight  and  oppression,  may  be,  not  unfrequently, 
much  benefited,  and,  indeed,  cured  ;  but  while  the  results  are  often 
brilliant,  failures  are  also  frequent.  Enteralgia,  a  malady  often  ex- 
tremely rebellious  to  remedies,  not  unfrequently  yields  promptly  to 
prussic  acid. 

Considerable  medicinal  doses  of  this  agent  are  very  fatal  to  round 
worms  (lumbricoides). 

Hydrocyanic  acid  is  a  successful  remedy  in  whooping-cough,  after 
the  subsidence  of  the  catarrhal  symptoms.  It  acts  by  allaying  irrita- 
bility of  the  pneumogastric,  and  is  successful  just  in  proportion  to  the 
preponderance  of  the  nervous  symptoms.  The  cases  in  which  the  au- 
thor has  witnessed  the  best  results  were  cases  of  cough  by  habit,  after 
the  cessation  of  the  whooping-cough  proper.  The  nervous  cough  of 
mothers,  which  exists  during  the  presence  of  whooping-cough  in  the 
household,  may  be  allayed  by  this  agent.  3  Acid,  hydrocyan.  dil., 
3  j  ;  tinct.  sanguinariae,  3  iv  ;  syrp.  senegas,  f  ss  ;  syrp.  tolutan.,  §  ij  ; 
aquae  lauro-cerasi,  3  vij.  M.  Sig.  :  One  or  two  teaspoonfuls,  accord- 
ing to  age,  every  three  or  four  hours.  For  irritable  cough.  It  some- 
times happens  that  this  agent  will  greatly  relieve  the  cough  of  phthisis, 
but  only  when  it  is  chiefly  nervous. 

To  allay  cerebral  irritation  and  excitement,  prussic  acid  has  been 
employed  with  benefit  (McLeod).  In  forty  cases  of  mental  disorder  ob- 
served by  McLeod,  there  was  "slight  or  temporary  amelioration  "  in 


702  MOTOR   DEPRESSANTS. 

ten  ;  a  "  more  decided  and  permanent  effect,"  the  disease  being  still  sta- 
tionary or  progressive,  in  nineteen  ;  and  in  eight  cases,  six  of  acute 
mania,  and  two  of  acute  melancholia,  "  the  drug  has  been  a  factor,  and 
a  very  main  one,  in  rapid  restoration  to  reason."  In  the  treatment  of 
these  cases,  McLeod  used  from  two  to  five  minims  of  Scheele's  dilute 
acid,  which  contains  five  per  cent  of  anhydrous  acid.  His  method  of 
administration  consisted  in  giving  it  at  first  at  short  intervals  (every 
quarter  of  an  hour),  and,  when  effects  were  produced,  every  hour  or 
two.  He  also  employed  it  subcutaneously,  in  five-minim  doses. 

EXTERNAL  USES. — In  various  cutaneous  diseases  characterized  by 
itching,  the  local  application  of  prussic  acid  affords  relief.  The  follow- 
ing formulae,  from  Fox,  represent  serviceable  combinations  :  $  Bi- 
chloride of  mercury,  gr.  j  ;  dilute  hydrocyanic  acid,  3  j  ;  emulsion  of 
almonds,  3"  vj.  M.  Use  in  itching,  in  lichen,  in  the  syphilodermata. 
^  Dilute  hydrocyanic  acid,  3  ss  to  3  j  ;  infusion  of  marsh-mallow,  §  v 
to  3"  viij.  M.  Use  in  pruritus.  IJ  Acetate  of  ammonia,  3  j  ;  dilute 
prussic  acid,  3  jss  ;  infusion  of  tobacco,  3  viij.  M.  Sig.:  To  be  sponged 
on  the  part  twice  a  day  in  pruritus  ani  or  p.  vulvce.  $  Borax,  3  j  ; 
prussic  acid,  3  ij  ;  rose-water,  f  viij.  M.  In  thepruritus  of  old  people. 

Authorities  referred  to  : 

AMORT,  DR.  ROBERT.     The  Boston  Medical  and  Surgical  Journal,  vol.  ii,  1866,  p.  73. 
CASPER,  VON  DR.  CARL  LIMAN.     Gericht.  Medicin.,  zweiter  Band,  p.  521. 
HERMANN,  DR.  L.     Lehrbuch  der  experimentetten  Toxicoloffie.  Blausaure,  p.  288. 
HoFPE-SzYLER.     Archiv  fur  path.  Anat.,  Band  xxxviii,  p.  435. 
IBIDEM.     Tubinger  med.  chem.  Unter.,  p.  206. 
HUSEMANN,  DR.  THEOD.     Handbuch,  etc.,  zweiter  Band,  p.  1136. 
JONES,  DR.  JOSEPH.     The  Medical  Record,  New  York,  vol.  ii,  p.  459. 
KOLLIKER,  PROF.  DR.     Archiv  fur  path.  Anat.,  Band  x,  p.  272. 

LECORCHE  ET  MECRIOT,  MM.  Archives  Generates  de  Med.,  tome  xi,  6  ser.,  p.  530, 
6t  seq. 

MCLEOD,  DR.  KENNETH.     The  Medical  Times  and  Gazette,  vol.  i,  1863,  p.  262. 
PRETER,  DR.  W.     Die  Blausaure,  phys.  Untersucht,  Bonn,  1868-"70. 
TAYLOK,  DR.  A.  S.     On  Poisons,  third  London  edition,  p.  585,  et  seq. 

Potassii  Cyanidum. —  Cyanide  of  Potassium.  In  white,  opaque, 
amorphous  pieces,  having  a  sharp,  somewhat  alkaline  and  bitter-almond 
taste,  and  an  alkaline  reaction.  It  is  deliquescent  in  moist  air,  readily 
soluble  in  water  when  reduced  to  powder,  and  sparingly  soluble  in  alco- 
hol. Dose,  gr.  -fa — gr.  |. 

ANTAGONISTS  AND  INCOMPATIBLES. — Acids  decompose  it  and  set 
free  hydrocyanic  acid.  As  respects  its  physiological  properties,  its  an- 
tagonists are  the  same  as  those  of  hydrocyanic  acid. 

SYNERGISTS. — Same  as  for  hydrocyanic  acid. 

PHYSIOLOGICAL  ACTIONS. — The  effects  of  this  salt  have  been  already 
mentioned  in  sufficient  detail  in  the  preceding  article,  so  far  as  they 
correspond  to  hydrocyanic  acid.  It  has,  however,  some  special  physical 


CYANIDE  OF  POTASSIUM.  703 

properties  which  separate  it  slightly  from  the  powerful  agent  which  en- 
ters into  its  composition. 

Applied  to  the  unbroken  epidermis,  the  cyanide  of  potassium 
produces  at  first  a  sensation  of  coldness,  followed  by  tingling  and 
itching,  and  in  a  half-hour  the  skin  is  found  to  be  somewhat  red- 
dened. Prolonged  contact  produces  a  phlyctenular  or  eczematous 
eruption. 

Systemic  effects  are  produced  by  the  local  and  external  use  of  the 
cyanide  of  potassium,  viz.,  slowing  of  the  pulse  and  respiration,  mus- 
cular weakness,  drowsiness,  and  coldness.  Lethal  effects  may  follow 
prolonged  contact  with  the  skin,  even  when  the  epidermis  is  unbroken. 
Applied  to  a  wound  or  abraded  surface,  this  salt  causes  a  burning  pain, 
excites  a  high  degree  of  inflammation,  and  produces  prompt  lethal 
effects. 

THERAPY. — Cyanide  of  potassium  may  be  prescribed  as  a  substitute 
for  hydrocyanic  acid  in  all  of  the  maladies  for  which  the  latter  is  used. 
This  salt  has,  however,  some  special  applications  which  we  owe  to 
Trousseau.  This  eminent  observer  has  shown  that  a  solution  of  the 
cyanide  applied  to  the  seat  of  painful  sensations  gives  great  relief  in 
various  forms  of  reflex  headache,  gastric,  cardiac,  pulmonary,  and  men- 
strual. The  headache  which  accompanies  the  pyretic  state  is,  accord- 
ing to  the  same  authority,  cured  or  greatly  alleviated  by  the  cyanide 
solution,  while  at  the  same  time  a  favorable  influence  is  exerted  over 
the  temperature.  $  Potassii  cyanidi,  gr.  x — 3j  ;  aquae  lauro-cerasi, 
§  iv.  M.  Sig. :  A  compress,  moistened  with  the  solution,  to  be  applied 
to  the  seat  of  pain.  From  a  quarter  to  a  half  hour  of  contact  with  the 
skin  usually  suffices. 

A  solution  of  the  cyanide  of  potassium,  of  the  strength  given  above, 
will  remove  the  stains  of  nitrate  of  silver,  and  also  the  dissecting-room 
odor,  from  the  hands. 

Cyanide  of  potassium,  in  the  form  of  ointment  or  solution,  is  an  ex- 
cellent remedy  for  allaying  irritation  in  various  cutaneous  diseases.  In 
pruritus  and  urticaria,  the  following  formula  (McCall  Anderson)  gives 
relief  :  $  Potassii  cyanidi,  gr.  vj  ;  pulv.  cocci,  gr.  j  ;  ung.  aq.  rosae, 
§  j.  M.  Sig.:  Ointment.  In  eczema  with  pruritus,  the  same  authori- 
ty recommends  the  following  :  I£  Potassii  cyanidi,  gr.  v  ;  sulphuris, 
potassii  bicarb.,  aa  3  ss  ;  pulv.  cocci,  gr.  vj  ;  axungiae,  f  j.  M.  Sig. : 
Ointment.  A  solution  of  the  cyanide  of  potassium  is  one  of  the  most 
effective  applications  for  that  very  troublesome  disorder,  pruritus  pu- 
dendi.  ^  Potassii  cyanidi,  gr.  xv ;  aquae  lauro-cerasi,  f  viij.  M. 
Sig.  :  Lotion.  This  formula  is  also  serviceable  in  lichen  and  prurigo 
(Hardy). 

Entomologists  make  use  of  the  cyanide  to  destroy  insects  without 
injuring  their  structures.  One  part  of  the  cyanide,  two  parts  of  plas- 
ter of  Paris,  and  one  and  a  half  part  of  water,  made  into  a  paste  and 
47 


704  MOTOR   DEPRESSANTS. 

poured  into  a  wide-mouthed  bottle,  sets  into  a  solid  mass,  which  gives 
off  the  vapor  of  hydrocyanic  acid  (Squire). 

Authorities  referred  to  : 

TROUSSEAU  KT  PIDOCX.     Traite  de  Therapeutiqtie,  etc.,  vol.  ii,  p.  265,  et  seq. 
TROUSSEAU,  A.      Clinique  Medicale,  vol.  ii,  p.  332. 

Amyl  Nitris. — Amyl  nitrite.  Nitrite  d'amyle,  Fr.  ;  Amylnitrit, 
Ger. 

PROPERTIES. — A  yellowish  or  reddish-yellow  liquid,  rather  oily  in 
consistence,  very  volatile,  and  having  a  peculiar  and  very  diffusive 
ethereal  odor.  It  is  insoluble  in  water,  but  soluble  in  all  proportions 
in  alcohol,  ether,  chloroform,  benzol  and  benzin.  It  has  a  neutral  or 
a  slightly  acid  reaction.  It  may  contain,  as  impurities,  nitric  acid,  amyl- 
nitric  ether,  amylvalerianic  ether,  and  hydrocyanic  acid.  The  specific 
gravity  is  '877.  Dose,  ill  ij — m,  v,  by  inhalation  or  subcutaneously. 

ANTAGONISTS. — The  actions  of  the  nitrite  of  amyl  are  antagonized 
by  all  those  agents  which  increase  the  functional  activity  of  the  spinal 
cord  and  sympathetic  —  as  strychnine,  brucine,  picrotoxin,  digitalis, 
ergot,  belladonna,  and,  as  McCullough  has  shown,  it  is  an  efficient 
remedy  in  chloral  -  poisoning.  The  opposing  action  of  amyl  nitrite 
and  ergot  has  been  demonstrated  clinically  by  Dr.  Fancourt  Barnes^ 
in  cases  of  hour-glass  contraction  induced  by  ergot.  This  antago- 
nism may  not  be  available,  owing  to  the  difference  in  the  rate  at  which 
they  are  diffused,  to  affect  the  system. 

STNERGISTS. — All  of  the  motor  depressants  increase  the  effects  of* 
the  nitrite  of  amyl. 

PHYSIOLOGICAL,  ACTIONS. — The  following  are  the  symptoms  pro- 
duced by  nitrite  of  amyl  when  inhaled  :  acceleration  of  the  action  of 
the  heart  ;  sudden  flushing  of  the  face  ;  dilatation  of  the  arterioles  in 
consequence  of  paresis  of  the  muscular  layer  of  these  vessels  ;  a 
sense  of  extreme  fullness  of  the  brain,  with  vertigo  ;  fall  in  the  blood- 
pressure  ;  lowering  of  the  temperature  ;  complete  resolution  of  the 
muscular  system  of  animal  life.  The  vapor  of  nitrite  of  amyl  ap- 
plied directly  to  the  tissues — muscular  or  nervous — suspends  or  com- 
pletely arrests  functional  activity.  Circulating  in  the  blood,  it  un- 
doubtedly affects  most  the  vaso-motor  nervous  system  and  unstriped 
muscular  fiber. 

The  marked  acceleration  of  the  heart  (Pick)  is  in  part  consecutive, 
doubtless,  to  the  sudden  dilatation  of  the  arterioles,  permitting  such 
an  increased  quantity  of  the  blood  to  enter  these  vessels  as  to  require 
renewed  effort  on  the  part  of  the  heart  to  supply  it ;  in  part  also  to 
the  paretic  state  which  it  induces  in  the  inhibitory  apparatus.  The 
great  fall  in  the  blood-pressure  noted  by  Brunton,  Wood,  and  Amez- 
Droz,  is  also  due  to  dilatation  of  the  arterioles,  and  consequent  dimi- 


NITRITE   OF   AMYL.  705 

nution  of  tension  in  the  peripheral  vascular  system.  Dilatation  of 
the  retinal  vessels,  when  nitrite  of  amyl  is  inhaled,  has  been  ascer- 
tained by  ophthalmoscopic  examination  (Aldridge). 

On  the  nervous  system  of  animal  life  the  nitrite  of  amyl  acts  as  a 
depressant — impairing  motility  first,  and,  at  the  last,  sensibility.  It 
affects  both  the  spinal  cord  and  the  nerves,  lessening  the  sensibility 
to  all  forms  of  irritation,  and  diminishing  the  reflex  functions.  It  also 
impairs  the  contractility  of  muscle.  Death  ensues  from  failure  of  res- 
piration, and  the  cerebral  functions  are  unaffected  until  carbonic-acid 
poisoning  ensues. 

Decided  lowering  of  temperature  is  produced  by  the  nitrite  of 
amyl.  This  result  is  no  doubt  due  to  the  action  of  this  agent  on  the 
haemoglobin,  whereby  the  carrying  capacity  of  the  red  blood-glob- 
ules of  oxygen  is  lessened  (Gamgee),  metamorphosis  of  tissue  is  in- 
terfered with,  and  the  generation  of  animal  heat  is  diminished.  A 
peculiar  change  ensues  in  the  color  of  the  blood  as  a  result  of  the 
lessened  oxygenation  :  all  the  blood  of  the  body  assumes  a  modified 
venous  hue. 

A  curious  fact  has  been  noted  by  Hoffmann,  viz.  :  the  hypoder- 
matic injection  of  lethal  doses  of  nitrite  of  amyl  produces  in  rabbits  a 
temporary  glycosuria. 

THERAPY. — The  applications  of  the  nitrite  of  amyl  in  the  treat- 
ment of  disease  have  been  deduced  from  a  study  of  its  physiological 
actions.  It  is  especially  indicated  when  morbid  symptoms  result 
from  vaso-motor  spasm.  It  has  been  shown  that  epileptic  attacks 
may  be  warded  off  by  the  inhalation  of  nitrite  of  amyl  at  the  begin- 
ning of  the  movement  of  the  aura.  Patients  who  have  a  distinct 
warning  of  the  seizures  should  be  constantly  provided  with  a  small 
quantity  of  this  remedy  in  order  to  practice  the  inhalation  whenever 
an  attack  is  impending.  The  mechanism  of  the  action  is  very  simple  : 
the  vaso-motor  spasm  of  the  cerebral  vessels,  which  is  the  initial 
symptom  of  an  epileptic  convulsion,  is  relaxed,  and  the  vessels  dilated 
by  the  nitrite  of  amyl. 

By  the  timely  inhalation  of  the  nitrite,  the  cold  stage  of  an  ague 
may  be  aborted,  but  the  hot  stage  is  not  modified  in  any  way  (Price, 
Ziegler).  This  power  may  be  most  serviceable  in  cases  of  pernicious 
intermittent,  the  danger  of  which  consists  in  the  extreme  depression 
of  the  cold  stage.  The  cardiac  failure  caused  by  chloral,  chloroform, 
and  other  heart-poison,  and  the  condition  of  sudden  weakness  which 
may  ensue  from  various  causes,  in  cases  of  fatty  heart,  are  often  re- 
markably relieved  by  the  inhalation  or  hypodermatic  injection  of  amyl 
nitrite. 

An  attack  of  migraine,  of  that  form  characterized  by  vaso-motor 
spasm  (pallor  of  the  face),  may  be  quickly  relieved  and  sometimes 
aborted  by  the  inhalation  of  two  or  three  drops  of  amyl  nitrite. 


706  MOTOR    DEPRESSANTS. 

When  there  are  redness  of  the  face,  injection  of  the  conjunctive,  ana 
fullness  of  the  cerebral  vessels,  this  remedy  is  contraindicated. 
Cases  of  neuralgia  of  the  fifth  nerve,  second  division,  have  been 
cured  by  inhalation  of  amyl,  repeated  from  time  to  time  as  the  pain 
required  its  administration. 

Asthma,  when  purely  spasmodic,  is  usually  quickly  checked  by 
this  remedy.  The  paroxysms  of  difficult  breathing  which  accompany 
emphysema  and  cardiac  disease  are  not  relieved  in  this  way  ;  indeed, 
the  author  has  known  the  most  serious  distress  to  be  produced  by  the 
inhalation  under  these  circumstances. 

Exaltation  of  the  reflex  function  of  the  spinal  cord  and  muscular 
spasm  are  morbid  states  in  which  good  results  may  be  expected  from 
inhalation  of  the  nitrite  of  amyl.  It  has  been  used  with  success  in 
tetanus.  It  should  also  be  fairly  tried  in  strychnine-poisoning  and  in 
hydrophobia.  Michael  has  administered  it  in  tinnitus  aurium,  a  most 
obstinate  and  distressing  condition,  with  comparatively  good  effects  : 
of  a  group  of  thirty-three  cases,  nineteen  were  distinctly  benefited. 

Most  signal  relief  has  been  obtained  from  the  inhalation  of  amyl 
nitrite  in  angina  pectoris.  We  owe  this  important  suggestion  and 
practice  to  Brunton,  who  had  ascertained  that  when  the  paroxysm  of 
angina  pectoris  occurs,  a  great  rise  of  arterial  tension  takes  place. 
When  the  pain,  praecordial  distress,  and  anxiety  are  felt,  there  should 
be  no  delay  in  the  use  of  the  remedy.  Some  cautions  are,  however, 
needed.  It  may  be  unsafe  when  advanced  degeneration  of  the  cere- 
bral vessels  exists  (Anstie).  Fatty  degeneration  of  the  heart,  which, 
is  so  frequently  a  cause  or  an  accompaniment  of  angina  pectoris,  may 
also  render  the  use  of  so  powerful  a  paralyzer  of  doubtful  expediency. 

Dr.  Mary  Putnam  Jacobi  has  found  the  inhalation  of  nitrite  of 
amyl  very  serviceable  in  neuralgic  dysmenorrhoea.  As  an  antagonist 
to  ergot,  it  may  prove  in  a  high  degree  useful,  when  ill  effects  are 
caused  by  this  remedy.  Thus,  in  a  case  of  hour-glass  contraction  pro- 
duced by  ergot,  the  inhalation  of  amyl  nitrite  procured  immediate  re- 
lief. On  theoretical  grounds  this  agent  was  proposed  for  the  relief  of 
cholera  asphyxia  (Brunton,  Gamgee),  but  the  trials  thus  far  made 
with  it  have  demonstrated  its  inutility.  Owing  to  the  fact,  shown  by 
Gamgee,  that  nitrite  of  amyl  combines  with  haemoglobin,  Brunton  pro- 
poses that  this  remedy,  if  given  at  all  in  cholera,  must  be  administered 
by  the  stomach  or  by  subcutaneous  injection,  and  not  by  inhalation. 

Repetition  in  the  use  of  the  nitrite  of  amyl  diminishes  its  effects, 
and  hence  increasing  doses  are  necessary  when  it  is  often  employed  in 
the  same  case. 

Authorities  referred  to  : 

ALDRIDGE,  DR.  CHARLES.     The  West  Riding  Lunatic  Asylum  Mtdical  Reports,  vol.  L 
p.  97. 

AHEZ-DROZ,  DR.     Archives  de  Physiologie  Normale  et  Pathologique,  1873,  p.  467. 


NITRO-GLYCERIN.  707 

ANSTIE,  DK.  F.  E.     Transactions  of  Clinical  Society.     Lancet,  March  5,  1870. 
BKUNTON,  DR.  T.  L.     The  British  Medical  Journal,  July  13,  1872.     Ibid.     The  Lan- 
cet, July  27,  1867. 

GAMGEE,  DR.  ARTHUR.     Philosophical  Transactions,  1868,  p.  589. 

HADDON,  DR.  JOHN.     Edinburgh  Medical  Journal,  July,  1870,  p.  45. 

JACOBI,  DR.  MARY  PUTNAM.     The  Medical  Record,  New  York,  January  15,  1875. 

MITCHELL.  DR.  S.  WEIR.     The  Philadelphia  Medical  Times,  vol.  v,  p.  553. 

Nitro-Glycerinum. — Spiritus  Glonoini.  Spirit  of  nitre-glycerin. 
GLONOIN. 

PROPERTIES. — Nitro-glycerin  is  an  oily  liquid,  colorless,  or  pale  yel- 
low, and  has  the  specific  gravity  1*60  at  59°  Fahr.  It  burns  quietly  in 
the  open  air,  but  heated  in  a  close  vessel,  or  subjected  to  percussion, 
it  explodes  violently.  It  decomposes  if  long  kept.  It  is  very  slightly 
soluble  in  water,  but  dissolves  freely  in  alcohol  and  in  ether.  The 
best  preparation  for  administration  is  the  alcoholic  solution — one  part 
of  nitro-glycerin  to  one  hundred  parts  of  alcohol.  The  dose  of  this 
ranges  from  one  minim  to  many  minims.  As  the  susceptibility  to  this 
agent  varies  greatly,  the  initial  dose  should  be  the  smallest.  One 
minim  of  the  one-per-cent  solution  will  give  some  persons  violent 
headache,  while  others  may  take  a  minim  of  the  undiluted  drug  with- 
out any  decided  effect. 

So  much  apprehension  is  felt  by  patients  who  have  to  take  this 
remedy,  that  the  names  "glonoin"  and  "trinitrin"  have  been  pro- 
posed for  it,  and  have  now  come  into  general  use. 

Sodii  Nitris. — Sodium  nitrite. 

Potassii  Nitris. — Nitrate  of  potassium.  These  salts  have  been  pro- 
posed and  used  as  substitutes  for  amyl  nitrite  and  nitro-glycerin. 
Dose,  gr.  iij— gr.  viij. 

ANTAGONISTS. — All  those  agents  which  increase  the  reflex  activity 
of  the  spinal  cord  and  stimulate  the  vaso-motor  system,  as  strychnine, 
ergot,  digitalis,  belladonna,  etc.,  antagonize  nitro-glycerin. 

SYNERGISTS. — Amyl  nitrite  acts  very  similarly,  and  the  motor  de- 
pressants in  general  promote  the  actions  of  nitro-glycerin. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  nitro-glycerin  is  at  first 
sweetish,  but  this  impression  is  followed  by  aromatic  pungency.  In  a 
few  minutes — from  three  to  five — after  a  small  medicinal  dose,  there 
are  suddenly  experienced  a  feeling  of  giddiness,  tension  of  the  head, 
with  fullness,  languor,  nausea,  and  sometimes  stomach-pain.  Such 
effects  are  experienced  from  a  small  dose,  if  the  individual  taking  it 
is  susceptible.  It  follows,  then,  that  the  quantity  of  nitro-glycerin 
causing  such  symptoms  must  vary  in  different  patients.  Dr.  Harley 
experienced  these  effects  after  taking  fifteen  drops.  Dr.  Fuller  expe- 
rienced some  fullness  of  the  head,  perspiration,  intermittent  pulse,  and 
some  after-headache,  from  a  dose  equivalent  to  fifty  minims  of  a  one- 


708  MOTOR   DEPRESSANTS. 

per-cent  solution,  or  a  half-drop  of  the  nitro-glycerin  itself  (Murrell). 
In  some  persons  a  drop  or  two  of  the  one-per-cent  solution  will  cause 
dizziness,  faintness,  a  rapid  and  very  weak  pulse,  perspiration  of  a 
rather  clammy  character  ;  or,  indeed,  the  symptoms  may  proceed  to 
unconsciousness.  Dr.  Murrell  applied  the  moistened  cork  of  the  bottle 
containing  the  solution  to  his  lips,  and  in  a  few  minutes  experienced  a 
tremendous  action  of  the  heart  and  arterial  system  ;  his  pulse  rose  to 
100  and  higher,  and  he  had  "  a  splitting  headache  "  for  some  time. 
There  is  no  change  in  the  temperature.  Women  and  the  feeble  in 
constitution  suffer  more  decided  effects  than  the  robust.  Drowsiness 
comes  on,  with  a  feeling  of  languor,  in  those  on  whom  the  smallest 
dose  acts  kindly.  With  the  rapid  pulse  is  a  considerable  degree  of 
dicrotism.  The  change  in  the  character  of  the  pulse  begins  in  about 
six  minutes  after  the  dose  is  taken,  and  lasts  on  the  whole  about  one 
hour.  The  sphygmographic  tracings  appended  to  Dr.  Murrell's  paper 
are  remarkable  for  the  extent  of  the  excursions  of  the  lever,  the  ab- 
rupt ascent,  the  sharpness  of  the  summit,  and  the  dicrotic  rebound,  in- 
dicating an  extremely  low  state  of  the  arterial  tension.  When  the 
heart  of  a  frog  is  put  into  a  '75-per-cent  salt  solution,  and  two  drops 
of  a  ten-per-cent  solution  of  nitro-glycerin  are  added,  the  heart  acts 
more  and  more  slowly,  and  presently  stops.  An  alcoholic  solution 
has  no  effect  (Brunton).  When  injected  into  the  jugular  vein  of  a 
cat,  the  nitro-glycerin  solution  arrests  the  heart  speedily.  That  the 
vagus  is  paralyzed,  and  the  inhibition  thus  removed  from  the  heart,  is 
proved  by  the  fact  that  galvanic  excitation  of  the  vagus  has  no  effect 
in  restraining  the  cardiac  movements.  Changes  occur  in  the  blood' 
like  those  induced  by  amyl  nitrite  and  the  nitrites  of  soda  and  other 
nitrites  ;  that  is,  the  blood  assumes  a  chocolate-color,  and  probably 
loses  its  power  of  absorbing  and  conveying  oxygen  ;  but  its  so-called 
ozonizing  function  may  not  be  interfered  with,  since  nitro-glycerin 
does  not  prevent  the  guaiac  reaction,  in  which  respect  it  agrees  with 
the  other  nitrites.  The  change  in  the  color  of  the  blood  is  produced 
slowly  when  blood  is  shaken  up  with  some  nitro-glycerin  outside  of 
the  body  (Brunton). 

In  frogs  nitro-glycerin  causes  weakness,  tetanus,  ending  in  paral- 
ysis ;  but,  in  warm-blooded  animals,  there  are  convulsive  movements, 
as  twitching  of  the  muscles,  hiccough,  spasmodic  breathing,  etc.  The 
tetanus  in  frogs,  according  to  Brunton,  is  not  due  to  a  direct  action  of 
the  poison  on  the  spinal  cord,  thus  opposing  the  assumption  of  Minor, 
who  held  that  it  acts  on  the  medulla.  The  paralyzing  effect  of  nitro- 
glycerin  appears  to  be  due  to  an  action  on  the  muscles,  and  also  on 
the  motor  nerves.  When  it  is  applied  directly  to  the  muscles,  they 
quickly  lose  their  contractility.  The  reflex  function  of  the  cord  is 
extinguished  first  in  the  parts  external  to  the  cranium,  the  cerebral 
nerves  preserving  their  power  to  transmit  impressions  until  later.  Sen- 


NITRO-GLYCERIN.  709 

sation  is  destroyed  by  it  as  well  as  motility.  Death  is  due  to  asphyxia 
— to  paralysis  of  the  muscles  of  respiration.  Notwithstanding  the 
activity  of  nitro-glycerin,  the  most  serious  symptoms  are  recovered 
from  without  detriment.  Thus  Dr.  Murrell  narrates  several  cases  in 
which  unconsciousness  was  produced  without  any  ill  results,  except 
some  temporary  headache. 

THERAPY. — Nitro-glycerin  is  adapted  to  the  treatment  of  the  mala- 
dies in  which  its  congener,  amyl  nitrite,  has  proved  so  effective.  It 
has  the  advantages  over  the  latter  of  being  more  permanent,  more 
readily  administered,  and  more  sustained  in  action.  In  sea-sickness, 
reflex  vomiting,  gastralgia,  hepatic  colic,  and  other  painful  and  spas- 
modic affections  of  the  digestive  tube,  it  may  afford  very  prompt  re- 
lief. It  was  first  employed  in  the  treatment  of  angina  pectoris,  in 
which  it  gives  as  much  relief  as  does  amyl  nitrite,  but  the  latter  should 
be  preferred  when  the  utmost  promptitude  of  action  is  necessary.  The 
form  of  the  disease  requiring  this  medicine  is  that  characterized  by 
high  tension  of  the  peripheral  vessels,  which  is  doubtless  the  condition 
in  the  genuine  cases  of  angina  pectoris.  Very  prompt  relief  may  be 
given  to  attacks  of  hiccough  by  this  medicine.  Some  cases  of  spas- 
modic asthma  are  much  benefited  by  it.  The  less  there  is  of  struc- 
tural alterations,  the  more  certain  the  relief.  As  the  secretions  of  the 
mucous  membrane  of  the  respiratory  tract  are  increased  by  it,  the 
cases  with  deficient  secretion  are  those  most  certain  to  be  benefited. 
It  should  be  carefully  tried  in  whooping-cough  and  in  laryngismus 
stridulus.  There  is  much  to  be  expected  from  nitro-glycerin  in  dis- 
eases of  the  nervous  system  characterized  by  heightened  reflexes.  An 
attack  of  epilepsy  may  be  aborted  by  its  timely  administration,  and 
Hammond  finds  it  as  a  remedy  for  this  disease  second  only  to  the  bro- 
mides. By  preventing  the  spasm  of  the  vessels  and  consequent  sud- 
den anaemia  of  the  brain,  the  first  and  most  important  event  in  the 
series  can  not  occur.  It  should  be  fairly  tried  in  tetanus  and  hydro- 
phobia. In  neuralgia  of  the  fifth  nerve  it  has  given  immediate  relief 
in  numerous  instances.  It  is  the  most  appropriate  remedy  in  that  form 
of  migraine,  or  sick-headache,  in  which  the  vessels  are  in  a  condition 
of  spasm,  but  is  not  proper  in  those  cases  having  a  flushed  face  from 
dilated  vessels. 

The  cold  stage  of  an  intermittent  may  be  aborted  by  the  timely 
administration  of  nitro-glycerin.  It  promises  to  be  especially  useful 
in  the  pernicious  malarial  diseases  to  prevent  the  dangerous  depression 
of  the  cold  stage.  In  these  cases  its  administration  should  be  so  timed 
that  the  physiological  effect  of  the  remedy  occur  at  the  onset  of  the 
cold  stage  of  the  disease.  The  mechanism  of  its  curative  action  is 
obvious.  Remarkable  results  have  lately  been  obtained  from  this 
remedy  in  acute  and  chronic  Brighfs  disease  (Robson) — results  which 
the  author  is  able,  from  personal  observations,  to  confirm.  It  is  well 


710  MOTOR  DEPRESSANTS. 

known,  of  course,  that  high  arterial  tension  is  present  ;  but  whether 
as  causative  of  the  renal  changes,  or  a  consequence  of  them,  is  not 
known.  The  apparently  constant  association  of  degenerative  changes 
in  the  renal  ganglia  with  the  lesions  of  Bright's  disease,  discovered  by 
Da  Costa  and  Longstreth,  would  indicate  that  the  state  of  the  vessels 
is  a  factor  in  developing  the  structural  alterations.  The  manner  in 
which  mtro-glycerin  affords  relief,  and  possibly  effects  a  cure,  is  thus 
fully  explained.  Indeed,  all  of  the  curative  results  obtained  from 
nitro-glycerin  must  be  referred  to  its  action  on  the  vascular  apparatus. 
The  suggestions  as  to  its  therapeutical  employment  above  made 
have  been  abundantly  justified  by  the  experiences  gained  since  the 
publication  of  the  last  edition  of  this  work.  The  author  has  now  to 
submit  some  observations  on  the  utility  of  trinitrin  in  cardiac  affec- 
tions. Pseudo-angina pectoris,  fatty  heart,  and  weak  heart,  are  mor- 
bid states  that  appear  from  about  forty-five  onward.  Degenerative 
changes,  belonging  to  advanced  life,  underlie  the  attacks  of  pain  with 
disordered  function,  and  are  also  responsible,  to  some  extent,  for  the 
other  condition.  Weak  cardiac  contractions,  and  damaged  vessels, 
interfere  with  the  nutrition  of  the  body  in  general,  including  the  mus- 
cular substance  of  the  heart.  Feebleness  of  the  cardiac  contractions 
lessens  the  force  of  the  impulsion  with  which  the  blood  enters  the  arte- 
rioles,  and  they  contract  on  their  lumen  as  the  anaemia  increases.  Now, 
trinitrin  opposes  this  state  of  things.  Under  its  action,  the  heart  con- 
tracts more  frequently  and  energetically,  the  arterioles  dilate,  and 
thus  the  organs  of  circulation  are  helped  in  two  modes  :  in  facilitating 
the  distribution  of  the  blood  by  lessening  the  pressure  in  the  arterioles ' 
at  the  periphery  ;  and  in  improving  the  power  of  its  own  muscular  tis- 
sue, by  the  increased  amount  of  blood  passing  into  it  through  the 
coronary  artery.  If  we  add  to  these  good  effects  the  permanent  im- 
provement of  nutrition  by  a  suitable  diet  and  exercise,  we  have  a  sat- 
isfactory solution  of  some  of  the  most  difficult  problems  given  us  to 
solve.  It  should  be  understood,  also,  that  the  improvement  of  nutri- 
tion by  increased  alimentation  is  the  more  complete  because,  by  the 
action  of  trinitrin,  a  much  larger  quantity  of  blood  is  obtained  by  the 
tissues,  and  hence  more  of  the  nutritious  matters,  than  would  other- 
wise be  available.  The  author  has  availed  himself  of  these  facts,  and 
has  utilized  trinitrin  in  the  treatment  of  anaemia  in  its  ordinary  form, 
and  in  the  pernicious  variety.  One  of  the  most  common  of  the  thera- 
peutical fallacies  of  the  day  is  the  giving  of  iron  to  cure  anaemia,  for 
in  a  large  proportion  of  the  cases  the  iron  can  not  be  assimilated.  The 
organs  concerned  in  blood-making  may  be  in  a  pathological  condition, 
or  functionally  torpid.  Stomachal  and  intestinal  digestion  may  be  in 
such  a  state  that  the  ordinary  preparation  of  food-stuffs  is  too  imper- 
fectly performed  for  the  materials  to  be  utilized  in  blood-making.  To 
cure  anaemia,  something  more  is  requisite  than  to  give  iron.  The 


ACONITE.  711 

functional  or  pathological  states  that  interfere  must  be  removed. 
When  all  the  digestive  and  assimilative  functions  are  restored,  failure 
is  still  encountered  by  imperfect  distribution  of  the  blood.  The  heart 
may  be  feeble  and  act  imperfectly,  the  peripheral  arterioles  may  con- 
tract on  their  lumen,  and  thus  hinder  the  passage  of  the  blood.  Sucb 
is  the  condition  in  a  large  proportion  of  the  cases  of  anaemia.  To  bring 
about  a  proper  activity  of  the  nutrition,  it  is  necessary  to  restore  the 
organs  of  circulation,  and  admit  the  fullest  nutrient  supply  to  all  the 
tissues.  It  is  this  function  of  trinitrin  that  places  it  in  the  front  rank 
of  remedies  for  anaemia,  for  by  dilating  the  arterioles  and  energizing 
the  heart's  action  the  fullest  supply  of  blood  is  sent  to  all  the  tissues 
of  the  body. 

Authorities  referred  to  : 

BRUNTON,  T.  LAUDER.  St.  Bartholomew' 's  Hospital  Reports,  vol.  xii,  p.  140.  Prelimi- 
nary Notes  on  the  Physiological  Action  of  Nitroglycerin. 

MINOR,  DR.  A.  J.     Journal  of  Nervous  and  Mental  Diseases,  vol.  iii,  p.  355. 

MCBRELL,  DR.  WILLIAM.     The  Lancet,  1879,  pp.  80,  113,  225. 

ROBSON,  DR.  MAYO.     The  British  MedicalJournal,  November,  1880,  p.  803. 

Aconitum. — The  tuber  of  Aconitum  napellus  Linne  (Nat.  Ord. 
Ranunculacece).  (IT.  S.  P.)  Racine  cTaconit,  Fr.  ;  JEisenhutknollen, 
Ger. 

The  Indian  aconite-root,  or  bish,  is  supposed  to  be  more  powerful 
than  the  root  of  Aconitum  napellus,  and  is  preferred  for  the  manufac- 
ture of  aconitine  (Fluckiger  and  Hanbury). 

Extractum  Aconiti  Fluidum. — Fluid  extract  of  aconite.     Dose, 

m  j— mv. 

Extractum  Aconiti. — Extract  of  aconite.  Prepared  from  the  leaves. 
Dose,  gr.  \  to  gr.  ss. 

Tinctura  Aconiti. — Tincture  of  aconite-root.     Dose,  m,  j — TTI  v. 

COMPOSITION. — The  principal  alkaloid  is  aconitia  or  aconitinet 
which  exists  in  two  forms,  crystalline  and  amorphous,  and  forms  with 
acids  crystallizable  salts.  The  crystalline  form  of  aconitine  is  soluble 
in  chloroform,  ether,  and  alcohol.  Aconite  contains  also  another  alka- 
loid which  has  received  various  designations — -pseudo-aconitiney  na- 
pelline,  nepalline,  etc.,  which  is  closely  allied  to  aconitine,  and  is  found 
in  commerce  under  this  name.  It  is  but  slightly  soluble  in  chloro- 
form, ether,  and  alcohol,  and  it  exists  also  in  two  forms,  crystalline 
and  amorphous.  Besides  the  foregoing,  another  base  has  been  dis- 
covered, to  which  the  name  napdline  has  also  been  given  (Hubsch- 
mann).  This  is  an  amorphous  alkaloid,  having  strong  basic  proper- 
ties, soluble  in  water,  chloroform,  and  alcohol,  but  not  soluble  in  ether. 
These  basic  substances  are  united  with  a  peculiar  acid — aconitic  acid. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alcohol,  ether,  ammonia,  tur- 
pentine, digitalis,  heat,  etc.,  antagonize  the  actions  of  aconite.  In  cases 


712  MOTOR   DEPRESSANTS. 

of  poisoning,  the  stomach  should  be  evacuated,  stimulants  adminis- 
tered by  the  stomach  and  rectum,  and  external  warmth  applied.  Digi- 
talis has  been  used  with  considerable  advantage  (Fothergill).  The 
intra-venous  injection  of  ammonia  may  be  practiced,  and  artificial  res- 
piration resorted  to.  To  overcome  the  depression  of  the  heart's  ac- 
tion, which  is  the  capital  point,  the  hypodermatic  injection  of  atropine 
is  indicated.  As  the  chief  danger  consists  in  failure  of  the  heart's  ac- 
tion, the  recumbent  position  should  be  strictly  maintained. 

SYXEKGISTS. — All  the  agents  of  this  group  increase  the  effects  of 
aconite.  Cold,  fatigue,  and  all  depressing  emotions,  are  also  syner- 
gistic. 

PHYSIOLOGICAL  ACTIONS. — A  drop  of  tincture  of  aconite  placed  on 
the  tongue  excites  a  warm  and  pungent  sensation,  followed  by  persist- 
ent tingling  and  numbness.  Prolonged  contact  with  the  skin  causes 
similar  effects  upon  the  sensory  nerves.  During  the  medicinal  adminis- 
tration of  aconite  in  considerable  doses,  irritation  and  a  sense  of  constric- 
tion of  the  fauces  are  experienced.  Large  medicinal  doses  produce 
gastric  pain,  nausea,  and  even  vomiting.  When  the  gastro-intestinal 
mucous  membrane  is  in  an  irritable  state,  aconite  impairs  the  appetite, 
hinders  the  digestion,  and  causes  diarrhoea,  and  in  the  normal  state  of 
the  membrane,  increases  its  secretions  and  hastens  the  peristaltic  move- 
ments. 

The  systemic  effects  of  aconite  follow  within  a  half -hour  after  its 
administration.  The  number  and  force  of  the  heart-beats  are  reduced, 
and  the  arterial  tension  is  lowered.  The  action  of  the  skin  is  increased, 
and  a  more  abundant  urinary  discharge  takes  place.  If  the  quantity 
has  been  a  full  medicinal  dose,  some  muscular  weakness,  tingling  in 
the  tongue,  lips,  and  extremities,  are  also  experienced.  The  whole  du- 
ration of  the  effect  is  about  three  hours.  When  a  lethal  dose  is  swal- 
lowed, the  symptoms  begin  in  from  five  minutes  to  a  half -hour.  In  a 
medical  student,  who  swallowed  by  mistake  a  teaspoonful  of  the  tinc- 
ture of  the  root,  the  symptoms  began  after  he  had  reached  the  college, 
having  walked  from  his  quarters — the  time  being  about  twenty  min- 
utes. He  experienced  an  overpowering  sense  of  fatigue  in  the  lower 
extremities,  and  he  felt,  also,  great  muscular  weakness.  His  eyesight 
became  dim,  the  globes  rather  prominent,  the  pupils  dilated.  He  expe- 
rienced great  dyspnoea,  and  his  respirations  were  shallow  and  labored. 
The  pulse  was  at  first  slow  and  small,  and  at  last  became  imperceptible. 
The  surface  of  the  body,  the  tongue,  and  breath,  were  cold.  The 
skin  was  covered  with  a  profuse  sweat.  He  was  restless,  anxious,  and 
sighed  frequently  ;  but  he  had  no  stupor  or  convulsions.  There  were 
also  decided  numbness  and  tingling  in  the  extremities,  and  in  the 
tongue  and  lips.  Tactile  impressions  were  very  faint,  and  the  sense 
of  pain  was  greatly  reduced,  so  that  he  seemed  almost  unconscious  of 
irritants.  His  temperature  fell  2°  Fahr.  Under  the  use  of  heat,  bran- 


ACONITE.  713 

dy,  and  ammonia,  he  revived  in  the  course  of  six  hours,  and,  on  the 
following  day,  although  weak,  there  were  no  indications  of  the  effects 
of  the  poison. 

Aconite  affects  the  sensory  nerves  before  the  motor.  It  paralyzes 
first  the  end-organs,  next  the  nerve-trunks,  and  finally  the  centers  of 
sensation  in  the  cord.  Aconite  also  impairs  the  reflex  function  of  the 
spinal  cord ;  but  this  effect  is,  doubtless,  secondary  to  the  sensory 
paralysis.  The  power  of  voluntary  movement  continues  after  the  cessa- 
tion of  the  reflex  functions  ;  but  it  is  finally  lost.  The  arrest  of  motil- 
ity  is  due  to  the  action  of  the  poison  on  the  motor  centers  of  the  cord, 
and  subsequently  on  the  nerve-trunks. 

Aconite,  applied  directly  to  the  heart,  lessens  the  number  and  force 
of  its  beats,  and  finally  arrests  its  action  in  the  diastole.  The  cardiac 
muscle,  after  the  cessation  of  its  movements,  does  not  respond  to  gal- 
vanic excitation.  Aconite  lowers  the  arterial  pressure,  as  well  as  less- 
ens the  force  of  the  heart-beat.  From  these  facts  it  may  be  concluded 
that  it  is  a  direct  cardiac  poison,  affecting  its  ganglia  and  muscle,  and 
also  a  sedative  to  the  vasor-motor  nervous  system.  It  is  also  a  respira- 
tory poison,  in  virtue  of  its  paralyzing  action  on  the  muscles  of  respi- 
ration ;  but  the  action  of  the  heart  ceases  before  the  respiratory  move- 
ments. 

Aconite  increases  elimination  by  the  skin  and  kidneys.  With  in- 
creased discharge  of  water,  there  takes  place,  also,  increased  excretion 
of  solids. 

THERAPY.  — The  monopoly  by  homeopathic  practitioners  of  the  use 
of  aconite  has  aroused  a  prejudice  against  it,  which  has  discouraged  its 
employment.  Aconite  is,  however,  an  antagonist  to  the  fever-pro- 
cess ;  it  is  not  applicable  in  accordance  with  the  so-called  law  of  simi- 
lars. It  is  used  by  these  quacks  because  it  is  a  powerful  agent  which 
will  produce  manifest  effects  in  small  doses,  that  may  easily  be  dis- 
guised. 

The  author  can  quite  agree  with  Dr.  Ringer  in  the  statement  that 
aconite  is  a  very  valuable  medicine,  in  the  class  of  cases  to  which  it  is 
adapted.  It  lessens  the  pulse-rate,  lowers  arterial  tension,  diminishes 
abnormal  heat ;  it  therefore  antagonizes  that  condition  of  the  organism 
known  as  fever.  As  it  also  slows  the  respiratory  movements,  and  thus 
lessens  the  amount  of  work  done  by  the  breathing  apparatus,  it  is  espe- 
cially indicated  in  inflammatory  states  of  the  respiratory  organs.  As 
it  diminishes  the  sensibility  of  the  sensory  nerves,  it  is  useful  in  certain 
forms  of  neuralgice.  As  it  induces  muscular  weakness  and  lowers  the 
activity  of  the  reflex  functions,  it  is  indicated  in  morbid  states  charac- 
terized by  an  excess  of  motor  activity. 

Tonsillitis,  acute  pharyngitis,  ulcer  ation  of  tonsils,  when  accom- 
panied by  fever  and  elevated  arterial  tension,  are  greatly  relieved  by 
the  use  of  the  tincture  of  aconite.  From  a  half -drop  to  one  drop  every 


714  MOTOR   DEPRESSANTS. 

half-hour,  until  an  impression  is  made  on  the  fever-movement,  and  then 
every  hour  or  two,  is  the  best  mode  of  administration.  In  acute  catarrh 
(nasal  and  faucial),  acute  otitis,  and  in  acute  catarrhal  bronchitis,  the 
best  results  may  be  obtained  by  the  use  of  aconite,  as  above  described. 
The  author's  observations  entitle  him  to  speak  with  confidence  of  the 
good  effects  of  this  remedy  in  catarrhal  and  fibrinous  pneumonia.  It 
is  more  especially  serviceable  before  exudations  have  taken  place,  but 
is  not  without  utility  at  any  stage,  provided  the  inflammatory  process 
continues.  It  not  only  abates  the  symptoms,  but  it  favors  the  removal 
of  the  products  of  inflammation,  by  increasing  elimination  through  the 
skin  and  kidneys.  The  use  of  aconite  is  not  incompatible  with  the 
employment  of  other  measures  which  may  be  needed  ;  but,  generally, 
in  fibrinous  pneumonia,  aconite  is  sufficient  up  to  the  period  of  crisis. 
The  author  has  witnessed  excellent  results  from  the  use  of  aconite  in 
small  doses  frequently  repeated  (one  drop  every  hour)  in  lowering  the 
temperature  of  phthisis,  especially  when  new  districts  of  pulmonary 
tissue  are  invaded  by  pneumonitis.  For  the  treatment  of  acute  pleuri- 
tis,  previous  to  the  stage  of  effusion,  no  remedies  are  more  effective  than 
aconite  and  opium.  3  Tinct.  aconiti  rad.,  3  ij  ;  tinct.  opii  deodor., 
3  vj.  M.  Sig.  :  Eight  drops  in  water  every  hour  or  two.  If  the 
pain  is  severe,  a  larger  dose  of  opium  should  be  administered,  when 
the  effect  can  be  maintained  by  the  quantity  directed  in  the  above 
prescription. 

Overaction  of  the  heart,  with  hypertrophy  and  without  valvular 
lesion,  especially  if  there  be  present  a  condition  of  plethora,  is  bene- 
fited by  a  quantity  of  aconite  sufficiently  large  to  moderate  the  cardiac 
movements. 

Aconite  is  contraindicated  in  inflammatory  states  of  the  gastro-in- 
testinal  mucous  membrane.  It  is  very  serviceable  in  acute  congestion 
of  the  liver  and  hepatitis :  it  diminishes  the  fever,  and,  by  causing  free 
transpiration,  lessens  the  pungent  heat  of  the  skin.  Peritonitis  is  best 
treated  by  a  combination  of  aconite  and  opium,  as  described  above  for 
pleuritis.  Generally,  the  opium  needs  to  be  given  in  somewhat  larger 
quantity  in  peritonitis  than  in  pleuritis.  In  pelvic  peritonitis,  puer- 
peral metritis,  and  peritonitis,  aconite  is  indicated,  and  is  of  unques- 
tionable utility,  provided  there  be  present  a  condition  of  sthenic  reac- 
tion. A  condition  of  adynamia,  on  the  other  hand,  always  contraindi- 
cates  the  use  of  aconite. 

The  simple  fevers  of  childhood,  febricula,  ephemeral  fever,  arising 
from  various  causes,  as  cold,  fatigue,  excitement,  etc.,  are  best  treated 
by  small  and  repeated  doses  of  aconite.  The  remedy  induces  sweat- 
ing, and  then  the  fever-movement  subsides.  The  hot  stage  of  intermit- 
tents  and  remittent  fever,  if  any  febrifuge  is  required,  maybe  relieved 
of  its  intensity  by  frequently-repeated  doses  of  aconite.  The  continued 
fevers  are  not  benefited  by  this  remedy  unless  a  condition  of  hyperpy- 


ACONITE.  715 

rexia  is  threatened,  when  aconite  may  be  used  in  connection  with  other 
antipyretic  remedies. 

Aconite  possesses  the  highest  value  in  the  eruptive  fevers,  especially 
in  scarlet  fever.  There  are  two  conditions  of  this  disease  especially 
requiring  the  use  of  aconite — the  eruptive  stage,  and  the  period  of  des- 
quamation,  if,  as  is  usual,  a  marked  rise  of  temperature  takes  place  at 
this  period  of  the  disease.  Several  important  purposes  are  subserved 
by  the  use  of  this  remedy  :  it  lowers  the  fever-heat,  favors  the  action 
of  the  skin  and  kidneys,  and  checks  the  nasal,  faucial,  and  aural  in- 
flammations, which  constitute  such  troublesome  complications  and 
sequelae.  The  particular  utility  of  aconite  in  measles  consists  in  its 
power  to  arrest  the  catarrhal  pneumonia,  one  of  the  most  serious  com- 
plications of  this  disease.  We  have  no  remedy  more  useful  in  erysipe- 
las— idiopathic,  so  called,  and  not  arising  from  trauma  ;  but,  on  the 
other  band,  Ringer  describes  an  apparently  erysipelatous  inflammation 
following  vaccination,  which  is  quickly  cured  by  aconite.  According 
to  the  author's  observations,  it  is  facial  erysipelas  which  is  most  de- 
cidedly benefited,  and  cases  characterized  by  sthenic  reaction.  When 
there  is  a  state  of  adynamia  present,  the  eruption  being  dusky  and  the 
cutaneous  circulation  languid,  belladonna  is  preferable  to  aconite. 
When,  in  acute  rheumatism,  there  are  much  heat  and  a  dry  skin,  instead 
of  the  usual  sweating,  aconite  is  very  serviceable.  It  affords  very  con- 
siderable relief  in  muscular  rheumatism  when  there  is  much  fever. 

In  acute  inflammation  of  the  cerebral  and  spinal  meninges,  and  in 
cerebro-spinal  meningitis  before  effusion  has  taken  place,  aconite  is  as 
serviceable  as  in  other  acute  inflammations.  It  is  generally  advisable 
to  combine  opium  with  it,  especially  in  cerebro-spinal  meningitis.  In 
acute  maniacal  delirium,  and  in  mental  disorders  generally,  when  there 
is  much  motor  activity,  with  vascular  excitement  and  increased  ar- 
terial tension,  aconite  is  useful,  but  is  not  so  effective  as  gelsemium. 
Aconite  renders  important  service  in  the  active  form  of  acute  cerebral 
congestion. 

Neuralgia,  when  accompanied  by  arterial  excitement  and  muscular 
spasm,  is  relieved  by  aconite  ;  but  generally  the  neuralgias  are  much 
more  successfully  treated  by  hypodermatic  injections  and  galvanism. 

It  is  asserted  by  Ringer,  and  also  by  Phillips,  that  sudden  suppres- 
sion of  the  catamenialflow,  caused  by  cold,  can  be  relieved  by  aconite, 
in  drop-doses  of  the  tincture  every  half -hour  or  hour.  The  author  can 
assert  that  this  remedy  has  a  high  degree  of  utility  in  congestive  dys- 
menorrhoea,  occurring  in  plethoric  subjects.  These  are  cases,  also,  in 
which  gelsemium  is  so  undoubtedly  beneficial. 

Aconitine  in  Trigeminal Neuralgia. — Remarkable  results  have  late- 
ly been  obtained  by  the  use  of  Duquesnel's  aconitine  in  this  malady. 
The  following  formula  is  proposed  by  the  New  York  Therapeutical 
Society :  5  Aconitinae  (Duquesnel's),  gr.  -^  ;  glycerini,  alcohol.,  aa  3  j  ! 


716  MOTOR   DEPRESSANTS. 

aquam  menthse  pip.,  ad  f  ij.  M.  Dose,  a  teaspoonful.  The  dose  is 
sometimes  very  slowly  and  cautiously  increased  to  £.  Although  it 
does  not  succeed  in  all  cases  of  tic-douloureux  for  obvious  reasons,  it 
relieves  remarkably  in  others  (Seguin). 

Napelline. — Duquesnel  has  lately  rediscovered  (?)  a  principle  to 
which  he  has  applied  the  name  napelline.  Its  physiological  actions 
have  been  studied  by  Laborde.  He  finds  it  weaker  than  aconitine, 
and  was  able  to  administer  without  ill  results  from  a  half  (£)  grain  to 
three  fifths  (f )  of  a  grain.  It  possesses  valuable  hypnotic  properties, 
and  it  is  proposed  to  use  it  as  a  substitute  for  opium  and  chloral.  On 
trial  it  proved  to  be  an  effective  remedy  in  neuralgia,  and  as  a  sleep- 
producing  agent  in  cases  of  wakefulness,  mental  excitement,  and  allied 
conditions.  If  further  investigations  confirm  those  observations,  it 
will  be  a  valuable  addition  to  the  materia  medica. 

Authorities  referred  to  : 

ACHSCHARUMOW,  DR.     Archiv  fur  Anat.  und  Physioloffie,  1866,  p.  255. 

BOHM  UND  EWERS.  Ueber  diephys.  Wirk.,  etc.  Archiv  fur  experimentelle  Pathologit 
wid  Pharmakologie,  1873,  p.  385. 

FOTHERGILL,  DR.  J.  M.     The  British  Medical  Journal,  1870.     Ibid.,  January  17, 1874. 

HOTTOT,  M.     Journal  de  F 'Anatomic  el  de  la  Physiologic,  1864,  p.  113. 

HOTTOT  ET  LIEGEOIS.     Ibid.,  1861,  p.  520. 

HUSEMANN,  DRS.  THEO.  UND  AUG.   Pflanzenstoffe,  p.  210. 

HUSEMANN,  DR.  THEOD.     Handbuch  der  gesammten  Arzneimittettehre,  p.  1153. 

PHILLIPS,  DB.  C.  D.  F.  The  Practitioner.  Ibid.,  Materia  Medica  and  Therapeutics, 
1874,  p.  2. 

RINGER,  DR.  SYDNEY.     Handbook  of  Therapeutics,  article  Aconite. 

TAYLOR,  DR.  A.  S.     On  Poisons,  third  London  edition,  p.  74T. 

VAN  PRAAG,  DR.  L.     Archiv  fur  path.  Anat.,  vii,  p.  438. 

Veratntm  Viride. — American  hellebore.  The  rhizoma  and  roots  of 
Veratrum  viride  Solander  (Nat.  Ord.  Liliacece). 

Extractum  Veratri  Viridis  Fluidum. — Fluid  extract  of  veratrum 
viride.  Dose,  TTJ,  ij — mv. 

Tinctura  Veratri  Viridis. — Tincture  of  veratrum  viride.  Dose, 
HI  ij— TTIV. 

VERATKINA. — Veratrine.  An  alkaloid  or  mixture  of  alkaloids,  pre- 
pared from  the  seeds  of  Asagrcea  officinalis  Lindley  (Nat.  Ord.  Lilia- 
cece). Is  pulverulent,  grayish-white,  inodorous,  but  very  irritant  to 
the  nostrils.  It  has  an  acrid,  bitter  taste,  causing  a  sensation  of  ting- 
ling with  numbness  in  the  tongue.  It  is  very  slightly  soluble  in  water, 
but  readily  and  wholly  dissolved  by  alcohol.  It  has  an  alkaline  re- 
action. 

Oleatum  Veratrince. — Oleate  of  veratrine.  Veratrine,  2  grm.  ; 
oleic  acid,  98  grm.  (For  external  use.) 

Unguentum  Veratrince. — Veratrine  ointment.  Veratrine,  4  grm.  ; 
olive-oil,  6  grm.  ;  benzoinated  lard,  90  grm.  (For  external  use.) 


VERATRTJM   VIRIDE.  717 

COMPOSITION. — Veratrum  album,  veratrum  viride,  and  veratrum 
sabadillae,  correspond  closely  in  chemical  composition,  and  the  first  two 
in  botanical  characteristics.  Sabadilla  is  only  used  as  the  source  of 
the  alkaloid  veratrine.  The  alkaloids  of  veratrum  album  zrejervine 
and  veratralbine  (Mitchell).  Veratrum  viride  contains  two  alkaloids 
also — -jervine  and  veratroidine.  The  alkaloid  jervine  is  found  in  both 
plants,  is  the  same  in  chemical  action  and  in  physiological  effects,  and 
may,  therefore,  be  considered  identical.  There  are  very  close  affinities 
between  the  veratralbine  of  Mitchell  and  the  veratroidine  first  discov- 
ered by  Bullock,  but  they  are  not  the  same ;  they  differ  as  respects 
their  chemical  relations,  and  also  in  physiological  properties,  veratral- 
bine being  much  more  powerful  than  jervine  and  veratroidine.  Vera- 
trum album  and  veratrum  viride  contain  abundance  of  soft  resin, 
which,  when  pure,  is  nearly,  if  not  quite,  inert.  As  the  alkaloid  jer- 
vine is  with  difficulty  separated  from  the  resin,  it  is  probable  that  the 
physiological  activity,  ascribed  to  the  resin  by  some  observers,  is  really 
due  to  the  presence  of  the  alkaloid. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  effects  of  veratrum  viride 
on  the  heart  are  counterbalanced  by  alcoholic  stimulants,  opium,  and 
ammonia.  When  dangerous  symptoms  are  produced,  the  recumbent 
position  should  be  enforced,  alcoholic  stimulants  should  be  adminis- 
tered by  the  stomach  and  rectum,  and  dry  heat  should  be  applied  to 
the  body.  Ammonia  may  also  be  given  by  the  stomach  or  by  intra- 
venous injection,  and,  if  nausea  and  vomiting  persist,  morphine  may  be 
administered  subcutaneously.  The  tincture  of  opium,  in  stimulant 
doses,  may  be  prescribed  with  the  alcoholic  stimulants. 

SYNEEGISTS. — The  vaso-motor  depressants — tobacco,  lobelia,  aco- 
nite, etc. — are  synergistic.  Blood-letting,  haemorrhage,  purgatives, 
and  all  agencies  which  diminish  vital  power,  increase  the  effects  of 
veratrum. 

PHYSIOLOGICAL  EFFECTS. — In  the  remarks  which  follow,  veratrum 
viride  only  is  referred  to. 

Applied  to  the  skin,  veratrum  viride  excites  redness  and  heat,  and, 
to  the  Schneiderian  mucous  membrane,  it  causes  violent  sneezing.  It 
is  a  prompt  and  efficient  emetic,  but  its  operation  is  accompanied  with 
intense  nausea  and  depression,  and  the  vomiting  is  often  violent  and 
persistent.  The  contents  of  the  stomach  are  at  first  evacuated,  and 
afterward  of  the  gall-bladder,  so  that  it  has  been  supposed  to  possess 
the  power  to  increase  the  secretion  of  bile.  It  does  not  generally 
purge,  but  occasionally  profuse  watery  evacuations  have  been  produced 
by  it,  and  rarely  severe  hypercatharsis.  Its  alkaloids  enter  the  blood 
with  facility.  The  power  which  veratrum  viride  has  to  affect  the  car- 
diac movements  and  the  vascular  tonus  is  its  most  characteristic  prop- 
erty. It  lowers,  in  a  remarkable  manner,  the  number  and  force  of  the 
cardiac  pulsations.  The  pulse  may  be  reduced  to  fifty,  forty,  or  even 


718  MOTOR   DEPRESSANTS. 

thirty-five  per  minute,  and  its  force  correspondingly  diminished.  Ac- 
cording to  Linon,  the  arterial  tension  is  raised,  as  shown  by  the  sphyg- 
mograph.  By  very  careful  administration,  this  reduction  in  the  pulse- 
rate  may  sometimes  be  accomplished  without  inducing  nausea  and 
vomiting,  but  usually  vomiting  can  not  be  prevented  when  the  remedy 
is  pushed  to  this  extent.  When  the  pulse  is  reduced  very  decidedly, 
the  patient  being  in  the  recumbent  posture,  a  change  to  the  erect  posi- 
tion at  once  alters  its  character,  and  it  becomes  extremely  rapid, 
thready,  and  feeble. 

Very  great  depression  of  the  powers  of  life  is  produced  by  large 
doses.  The  action  of  the  heart  becomes  exceedingly  weak,  the  pulse 
almost  indistinguishable,  the  vomiting  and  retching  extreme,  the  sur- 
face of  the  body  cold  and  covered  with  a  cold  sweat,  the  temperature 
reduced.  There  are  also  produced  faintness,  dimness  of  sight,  dilata- 
tion of  the  pupils,  giddiness,  great  muscular  weakness,  shallow  and 
slow  respiration  ;  sometimes  somnolence,  coma,  and  insensibility,  with 
stertorous  breathing.  Notwithstanding  the  very  formidable  symp- 
toms produced  by  large  doses,  fatal  results  have  been  extremely  rare. 
An  ounce  of  the  tincture  has  been  swallowed  without  causing  death 
(Norwood).  The  prompt  emesis  which  it  produces  is  probably  the 
explanation  of  its  lethal  inactivity  ;  for,  in  the  act  of  vomiting,  the 
medicine  is  ejected  with  the  first  matter  from  the  stomach.  Suspen- 
sion of  the  medicine  and  free  stimulation  quickly  remove  the  most 
alarming  symptoms  of  depression. 

The  experimental  investigations  into  the  actions  of  jervine  and 
veratroidine,  made  by  Wood,  Peugnet,  and  others,  have  shown  that 
the  physiological  actions  of  veratrum  viride  are  the  sum  of  the  ac« 
tions  of  the  alkaloids.  The  nauseating  and  emetic  qualities  of  the 
drug  are  due,  chiefly,  to  veratroidine,  and  to  a  slight  extent  to  the 
resin.  Both  alkaloids  depress  the  functions  of  the  spinal  cord,  and 
destroy  its  reflex  activity  ;  but  they  do  not  impair  the  excitability  of 
the  nerves,  nor  the  contractility  of  muscles.  Veratroidine,  according 
to  Wood,  first  stimulates  the  inhibitory  cardiac  nerves  to  an  extraor- 
dinary extent,  and  afterward  paralyzes  them  ;  but  the  evidence  which 
he  adduces  in  favor  of  the  singular  statements  on  this  point  are  far 
from  satisfactory.  Both  alkaloids  lower  the  blood-pressure,  by  dimi- 
nution of  vaso-motor  tonus,  and  paralyze  the  cardiac  muscle,  and 
probably  also  its  contained  ganglia.  They  cause  death  by  asphyxia — 
by  paralysis  of  the  muscles  of  respiration.  The  cerebral  effects  which 
have  been  noted  in  man,  and  the  convulsions  in  animals,  are  doubtless 
due  to  the  accumulation  of  carbonic  acid  in  the  blood. 

THERAPY. — The  best  preparation  for  administration  is  the  tincture. 
As  the  therapeutic  properties  of  veratrum  viride  depend,  chiefly,  on 
the  jervine,  an  attempt  may  be  made  in  the  future  to  supply  this  alka- 
loid in  sufficient  quantity  for  administration  ;  but,  at  present,  the  pro- 


VERATRUM   VIRIDE.  719 

cesses  involved  in  its  preparation  are  too  intricate  and  expensive.  As 
the  effect  of  veratrum  viride  quickly  reaches  its  maximum,  if  it  be  de- 
sired to  maintain  the  pulse-rate  at  a  constant  level,  the  doses  must  not 
be  at  a  longer  interval  than  two  hours.  The  effect  must  be  main- 
tained by  increasing  doses,  if  necessary,  and  the  recumbent  posture 
must  be  rigidly  enforced. 

The  emetic  property  of  veratrum  viride  is  never  applied  in  prac- 
tice ;  too  much  depression  is  produced  by  it.  The  chief  use  of  this 
agent  is  to  depress  the  action  of  the  heart  and  to  lower  the  vaso-motor 
tonus.  In  simple  hypertrophy  of  the  heart,  without  valvular  lesion,  it 
diminishes  the  overaction  and  thus  gives  relief  to  the  most  distress- 
ing symptom.  The  irritable  heart,  so  frequently  found  associated 
with  and  dependent  on  the  excessive  use  of  tobacco,  on  mental  excite- 
ment and  irascibility  of  disposition,  and  on  overstrain,  is  relieved  by 
this  remedy,  provided  no  valvular  lesions  coexist.  The  hypertrophy 
of  the  cardiac,  muscle,  and  the  abnormal  arterial  tension,  which  ac- 
company the  chronic  form  of  albuminuria,  are  alleviated  by  veratrum 
viride.  Moderate  doses  of  the  tincture  (five  drops  ter  die)  usually 
suffice  in  these  cases.  When  there  are  valvular  lesions,  and  when 
the  cardiac  muscle  is  enfeebled  from  any  cause,  this  agent  is  inad- 
missible. 

Excellent  results  are  sometimes  obtained  in  aneurism  by  the  use  of 
veratrum  viride.  In  the  various  surgical  expedients  for  the  cure  of 
aneurism  (forced  flexion,  compression,  ligation),  this  remedy,  used  to 
depress  the  circulation,  renders  an  important  service,  by  lessening  the 
force  with  which  the  blood  is  propelled,  and  the  number  of  the  cardiac 
contractions.  In  this  way,  coagulation  of  the  blood  in  the  aneurismal 
sac  is  greatly  favored.  In  the  case  of  large  internal  aneurisms — of 
the  innominata,  aorta,  etc. — veratrum  viride  is  a  powerful  adjunct  to 
rest  and  other  means  of  treatment.  Some  precautions  are  necessary, 
however,  in  the  administration  of  this  remedy.  As  the  utmost  slow- 
ing of  the  circulation  consistent  with  safety  may  be  required,  a  suffi- 
cient quantity  of  the  tincture  must  be  administered  to  accomplish  this 
object,  and  the  effect  produced  is  the  only  measure  of  the  amount  to 
be  given.  The  result  must  be  accomplished,  if  possible,  without  caus- 
ing vomiting.  The  patient  should,  therefore,  remain  absolutely  in  the 
recumbent  posture,  and  a  little  opium  should  be  prescribed  with  the 
veratrum  viride.  Active  haemorrhage,  occurring  in  the  plethoric,  is 
sometimes  stopped  by  full  medicinal  doses  of  this  drug. 

There  can  be  no  doubt  that  veratrum  viride  renders  an  important 
service  in  acute  parenchymatous  congestion — of  the  brain,  lungs,  liver, 
and  other  organs.  Its  utility  ceases  when  exudations  have  taken 
place  :  its  action  is  confined  to  the  influence  which  it  has  in  diminish- 
ing the  blood-supply  to  the  affected  organs.  The  changes  produced 
by  inflammation  are  in  no  wise  affected  by  veratrum  viride.  Much 
48 


720  MOTOR   DEPRESSANTS. 

that  is  extravagant  has  been  written  in  regard  to  its  curative  influence 
in  pneumonia,  but  we  need  not  be  surprised  at  this,  when  we  reflect 
that  our  knowledge  of  the  natural  history  of  this  disease  is  only  of 
recent  origin.  Those  who  knew  nothing  of  the  period  of  crisis  of 
pneumonia  naturally  attributed  the  defervescence  of  temperature  to 
the  effect  of  the  remedy.  It  is  not  to  be  denied  that  in  the  very  in- 
cipiency  of  pneumonia,  before  fibrinous  exudation  has  taken  place, 
veratrum  viride,  by  lessening  the  amount  of  blood  circulating  in  the 
lungs,  may  render  an  important  service,  but  when  hepatization  occurs 
its  good  effects  cease.  The  same  observations  are  true  of  other  pa- 
renchymatous  inflammations,  and  equally  so  of  serous  inflammations. 

Veratrum  viride  has  been  much  extolled  as  a  remedy  for  reducing 
the  pulse-rate  and  the  temperature  in  typhoid  and  other  fevers  (Nor- 
wood). It  is  true,  these  effects  may  be  procured  by  it,  but  that  any 
influence  is  exerted  in  this  way,  over  the  course  and  duration  of  a 
fever,  seems  highly  improbable.  The  chief  dangers  in  fever  being  the 
occurrence  of  cerebral  or  cardiac  paralysis  due  to  the  persistent  eleva- 
tion of  the  temperature,  it  is  unwise  to  use  a  powerful  cardiac  depres- 
sant, although  it  has  the  power  to  lower  the  temperature  somewhat. 
There  is,  however,  a  condition  of  things  arising  in  the  course  of  fevers 
— viz.,  delirium  ferox — in  which,  when  dependent  on  arterial  excite- 
ment, much  good  may  be  accomplished  by  the  use  of  veratrum  viride. 

The  excitement  of  acute  mania,  of  maniacal  delirium,  and  other 
forms  of  mental  disorder  in  which  a  condition  of  cerebral  hypersemia 
may  be  supposed  to  exist,  is  successfully  combated  by  veratrum  viride. 
In  a  private  communication,  Dr.  Sullivan,  of  San  Francisco,  informs" 
me  that  this  agent  (  3  ss  of  the  fluid  extract  every  fifteen  minutes  until 
nausea  or  vomiting  ensues)  is  "invaluable  in  puerperal  convulsions." 
Barker,  in  his  "  Puerperal  Diseases,"  had  already  called  attention  to 
its  utility,  and  Boyd  confirms  the  previous  observations.  Increasing 
experience  adds  to  the  testimony  regarding  its  exceptional  value  in 
the  relief  of  this  formidable  malady. 

Veratrine  is  used  only  externally,  and  for  the  relief  of  neuralgia, 
headache,  myalgia,  etc.  The  official  unguentum  veratrice  is  the  form 
in  which  it  is  employed — a  small  quantity  being  rubbed  in  over  the 
seat  of  pain. 

Authorities  referred  to  : 

BOYD,  DR.     American  Practitioner,  January,  1878. 

BRIESEMANN,  C.  Mikroskopische  Untersuchunaen  uber  die  WirTcung  des  Diffitalin, 
Veratrinu.  Ergotin  auf  die  Circulation,  Rostock,  1869. 

LINON,  M.  Gazette  Medicate  de  Strasbourg.  Bulletin  General  de  Therapeutique,  vol. 
Ixxvi,  p.  94. 

MITCHELL,  CHARLKS  L.  Transactions  of  American  Pharmaceutical  Association,  vol. 
xxii,  p.  397.  The  Active  Principles  of  the  Officinal  Veratrums. 

NORWOOD,  DR.  W.  C.  The  Authorship  and  Therapeutical  Powers  of  Veratrum  Virid* 
more  fully  examined,  Albany,  1868,  p.  39. 


PULSATILLA.  721 

QULMONT,  M.     Bulletin  General  de  TJierapeutique,  vol.  Ixxiv,  p.  183. 
IBID.     Communication  of  paper  by  MM.  Zuber  and  Hirtz  to  Society  of  Therapeutics, 
Bulletin  General,  vol.  Ixxvi,  p.  468,  et  seq. 

PERCY  DR.  S.  R.     Transactions  of  American  Medical  Association,  1864. 

PEUGNET,  DR.  EUGENE.     The  Medical  Record,  May,  1872. 

SQUAREY,  DR.     The  Practitioner,  1870,  vol.  i,  p.  211. 

WOOD,  DR.  H.  C.     The  American  Journal  of  the  Medical  Sciences,  January,  1870. 

Pulsatilla. — Pasque-flower.  The  herb  of  Anemone  pulsatitta  and 
Anemone  pratensis  Linne"  (Nat.  Ord.  Ranunculacece),  collected  soon 
after  flowering.  (U.  S.  P.)  Pulsatille,  Fr.  ;  Ifiuchenschelle,  Ger. 

PREPARATIONS. — There  are  no  official  preparations.  The  tincture 
is  the  form  usually  employed  in  medical  practice,  the  dose  of  which 
varies  from  one  minim  to  twenty  minims.  A  fluid  extract,  made  in 
accordance  with  the  general  formula,  may  also  be  prepared. 

COMPOSITION. — The  peculiar  powers  of  the  plant  depend  on  the 
presence  in  it  of  an  alkaloid — anemonine,  a  camphor.  Anemonine 
crystallizes  in  prisms — the  regular  rhombic  system — and  is  hardly  at 
all  soluble  in  cold  water  and  in  alcohol  (Husemanu).  Pulsatilla  also 
contains  a  peculiar  acid — anemonic  acid. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  caustic  alkalies,  tannic 
acid,  and  the  metallic  salts  generally,  are  chemically  incompatible. 
From  the  physiological  standpoint,  pulsatilla  is  antagonized  by  alco- 
hol, by  opium,  digitalis,  etc. 

SYNERGISTS. — The  effects  of  pulsatilla  are  promoted  by  the  para- 
lyzers,  especially  by  the  other  members  of  the  same  family — notably, 
by  aconite,  veratrum  viride,  etc. 

PHYSIOLOGICAL  ACTIONS. — The  local  effects  of  pulsatilla  (the  fresh 
plant)  are  those  of  an  irritant ;  and,  after  prolonged  contact,  even 
caustic  effects  are  produced.  Applied  to  the  tongue,  it  gives  rise  to 
tingling,  burning,  followed  by  numbness — effects  very  similar  to  those 
caused  by  aconite.  On  the  intestinal  mucous  membrane  it  has  very 
pronounced  irritating  effects.  The  active  principles  diffuse  into  the 
blood  with  facility.  Depression  of  the  heart's  action,  lowering  of  the 
arterial  tension,  and  declination  of  temperature,  are  caused  by  pulsa- 
tilla. It  is  a  paralyzer  of  motility  and  sensibility,  but,  as  respects  the 
motor  functions,  it  is  not  known  whether  it  impairs  the  contractility 
of  muscle  or  the  irritability  of  nerve  ;  and,  as  respects  sensation,  it  has 
not  yet  been  determined  whether  the  lessened  sensibility  is  due  to  an 
influence  which  this  remedy  has  on  the  spinal  cord,  on  the  nerve- 
trunks,  or  on  the  peripheral  expansion — end-organs  of  the  sensory  sys- 
tem. Dilated  pupils,  hebetude  of  mind,  stupor,  coma,  and  convulsions, 
are  cerebral  symptoms  which  occur  after  a  lethal  dose  has  been  ad- 
ministered. These  cerebral  effects  may  be  due  to  a  primary  action  of 
pulsatilla  on  the  brain,  or  to  the  carbonic-acid  poisoning  and  the  anae- 
mia. When  the  action  of  the  heart  and  the  respiration  are  very  feeble 


722  MOTOR  DEPRESSANTS. 

carbonic  acid  accumulates  in  the  blood,  and  an  extreme  degree  of  cere- 
bral anaemia  ensues.  Coma,  convulsions,  and  insensibility,  are  natural 
effects  of  these  causes.  Nothing  is  positively  known  as  to  the  time 
and  mode  of  elimination  of  anemonine,  but  it  is  probable  that  excre- 
tion takes  place  by  the  kidneys. 

The  production  of  any  given  physiological  effect  will,  of  course, 
depend  on  the  genuineness  of  the  drug.  The  active  principles  are 
volatile,  and  often  disappear  in  the  process  of  desiccation. 

THERAPY. — Owing  to  the  irritating  action  of  pulsatilla,  it  is  not 
suited  to  the  treatment  of  gastro-intestinal  disorders,  especially  when 
a  state  of  inflammation  exists.  Notwithstanding  this  local  irritant 
effect,  homoeopathists  employ  it  for  the  relief  of  dyspepsia  and  the 
accompanying  mental  symptoms  ;  but,  in  coming  to  conclusions  as  to 
its  curative  value,  they  calmly  ignore  the  natural  history  of  these 
maladies. 

Pulsatilla  is  adapted  to  the  treatment  of  acute  inflammation  of  the 
nasal,  faucial,  laryngeal,  and  bronchial  mucous  membrane — acute 
catarrh.  It  is  not  proper  in  those  cases  when  accompanied  by  gastro- 
intestinal disturbance.  It  is  clearly  useful  in  acute  inflammation  of 
the  cerebral  and  spinal  meninges. 

It  is  used  by  the  homoeopathists  in  the  treatment  of  catarrhal  oph- 
thalmia, by  internal  and  local  applications  ;  and  they  hold  that  it  is 
very  efficacious  in  certain  diseases  of  the  uterus,  on  which  organ  they 
suppose  it  to  have  a  special  or  specific  action.  Sudden  arrest  of  the 
menstrual  flow,  whether  caused  by  moral  emotion  or  by  cold,  may  be 
relieved,  and  the  effects  prevented,  by  pulsatilla.  As  aconite  is  very 
useful  under  the  same  circumstances,  it  may  be  assumed  that  good 
results  may  be  had  by  the  administration  of  pulsatilla. 

Authorities  referred  to  : 

GUBLER,  PROF.  A.     Codex  Medicamentarius,  p.  1*7. 
HUSEMANN,  DRS.  AUG.  UND  THEOD.     Die  Pflanzenstoffe,  p.  YQS. 
PHILLIPS,  DR.  CHARLES  D.  F.     Materia  Medina  and  Therapeutics,  p.  17. 

Grindelia. — The  leaves  and  flowering  tops  of  Grindelia  robttsta 
Nuttall,  and  of  Grindelia  squarrosa  Duval  (Nat.  Ord.  Compositce). 

PREPARATIONS. — Extractum  Grindelice  Fluidum. — Fluid  extract 
of  grindelia.  Dose,  ill  x —  3  j. 

Extractum  Grindelice. — Extract  of  grindelia.  (Not  official.)  Dose, 
gr.  j— gr.  v. 

COMPOSITION. — An  alkaloid  with  basic  properties  has  been  isolated 
(Rademaker),  but  its  chemical  relations  have  not  been  fully  made  out. 
The  plant  contains  also  a  volatile  oil,  and  a  resin,  to  which  its  physio- 
logical activity  is  doubtless  in  part  due. 

ANTAGONISTS  AND  INCOMPATIBLES. — Water  precipitates  the  oleo- 
resin.  The  mineral  salts  and  caustic  alkalies  are  chemically  incom- 


GRINDELIA.  723 

patible.  Opium,  the  cerebral  stimulants,  alcohol,  strychnine,  picrotoxin, 
etc.,  are  opposed  as  respects  the  physiological  actions. 

SYNERGISTS. — All  motor  depressants  increase  the  actions  of  grin- 
delia. 

PHYSIOLOGICAL  ACTIONS. — The  taste  of  grindelia  is  rather  pungent, 
even  acrid,  and  in  the  stomach  it  excites  a  sensation  of  warmth.  The 
local  stimulant  effect  is  such  that  it  promotes  the  appetite  and  diges- 
tion ;  but,  if  too  long  continued,  or  in  too  great  quantity,  it  excites 
gastric  uneasiness.  Grindelia  slows,  somewhat,  the  heart  and  respira- 
tory movements.  When  administered  in  sufficient  quantity,  decided 
cerebral  effects  are  produced.  It  dilates  the  pupil  and  induces  sleep. 
During  this  condition  of  hypnotism,  the  general  cutaneous  sensibility 
is  much  reduced,  and  reflex  movements  become  sluggish.  Motility  is 
also  affected,  the  paresis  beginning  in  the  hind  extremities.  Its  toxic 
powers  are  by  no  means  great,  two  drachms  of  the  fluid  extract  be- 
ing required  to  induce  sleep  in  small  rabbits.  It  affects  other  warm- 
blooded animals,  and  also  frogs,  in  the  same  way.  When  death 
ensues,  it  is  from  paralysis  of  the  muscles  of  respiration.  Elimina- 
tion takes  place  by  the  pulmonary  mucous  membrane,  and  chiefly  by 
the  kidneys. 

THERAPY. — The  most  important  uses  of  grindelia,  thus  far  devel- 
oped, are  in  the  treatment  of  the  respiratory  neuroses.  Its  utility  in 
the  treatment  of  asthma,  especially  the  so-called  spasmodic  asthma,  is 
certainly  great ;  few  cases  fail  to  be  relieved  at  once.  Besides  the 
stomach  administration,  it  may  be  given  in  the  form  of  fumes,  accord- 
ing to  the  following  plan  :  The  plant  is  steeped  in  a  saturated  solu- 
tion of  nitre,  dried,  when  it  may  be  ignited  on  an  ordinary  tin  plate, 
the  patient  inhaling  the  fumes  as  they  arise,  or  the  fumes  in  the  air  of 
a  small,  closed  apartment.  This  preparation  may  also  be  rolled  into 
cigarettes,  and  smoked  with  or  without  the  addition  of  tobacco,  stra- 
monium, lobelia,  etc.  The  fluid  extract  of  grindelia  may  be  incorpo- 
rated with  other  asthmatic  remedies,  in  an  extemporaneous  prescrip- 
tion. For  example  :  IJ,  Ext.  grindeliae  fluid.,  §  ss  ;  ext.  lobeliae  fl., 
3  ij ;  ext.  belladonna  fl.,  3  j  ;  potassii  iodidi,  3  iij  ;  glycerini,  §  iij. 
M.  Sig.  :  A  teaspoonful,  as  necessary. 

Cough  by  imitation  and  habit,  whooping-cough,  and  the  spasmodic 
difficulty  of  breathing  which  accompanies  various  pulmonary  and  car- 
diac diseases,  hay-asthma,  etc.,  are  helped  by  grindelia.  It  is  also  an 
effective  remedy  for  bronchitis,  after  the  subsidence  of  acute  symp- 
toms ;  for  chronic  bronchitis  and  bronchorrhcea,  and  for  the  bronchitis 
of  emphysema. 

Besides  the  above  diseases  for  which  grindelia  has  been  used  with 
success,  it  will  prove  advantageous  in  chronic  pyelitis,  chronic  cystitis, 
etc.  In  these  diseases  local  application  of  the  oleo-resin  takes  place 
all  along  the  urinary  tract. 


724  MOTOR   DEPRESSANTS. 

Authorities  referred  to  : 

CROWE,  DR.  JOHN  E.     Louisville  Medical  News,  April,  1876. 
FISKE,  DR.  H.  M.     The  Pacific  Medical  and  Surgical  Journal. 
RADEUAKER,  DR.  C.  J.     Louisville  Medical  News. 

Phytolacca. — Phytolaccce  fructus. — The  fruit  of  Phytolacca  decan* 
dra  Linne  (Nat.  Ord.  Phytolaccacece).  (U.  S.  P.)  Poke-berries. 

PhytolacccB  radix. — The  root  of  Phytolacca  decandra — poke-root. 

PREPARATIONS. — Extractum  Phytolaccce  Fluidum. — Fluid  extract 
of  phytolacca.  Dose,  TTJ,  v —  3  j. 

Tinctura  Phytolaccce. — Tincture  of  phytolacca.  Dose,  T\[  x —  3  j. 
(Not  official.) 

COMPOSITION. — Claussen  has  obtained  a  neutral  principle,  which  he 
has  named  phytolactin,  but  this  should  not  be  confounded  with  an 
impure  resin  called  by  the  eclectics  "phytolaccin."  Claussen's  phyto- 
laccin  occurs  in  silky,  shining  crystals,  soluble  in  alcohol  and  ether, 
but  not  in  water.  A  peculiar  acid,  phytolaccic  acid,  has  also  been 
found  in  the  berries  by  Terail.  It  is  uncrystallizable,  but  soluble  in 
water  and  in  alcohol. 

ANTAGONISTS  AND  INCOMPATIBLES. — Alcohol,  ether,  opium,  digitalis, 
etc.,  oppose  the  action  of  phytolacca. 

STNERGISTS. — All  depressing  agents,  the  paralyzers,  and  emetics, 
contribute  to  the  effects  of  phytolacca. 

PHYSIOLOGICAL  ACTIONS. — Poke  is  nauseant  and  emetic,  and  these 
effects  occur,  whatever  may  be  the  mode  of  administration.  The  emesis 
does  not  occur  at  once  ;  there  is  a  slowly-accumulating  anguish  ;  vomit- 
ing does  not  result  for  an  hour,  and  the  vomiting  is  accompanied  with 
great  depression.  Rutherford  has  shown  that  the  eclectic  preparation 
phytolaccin  has  decided  cholagogue  property — ranking,  indeed,  among 
the  most  effective  of  the  agents  influencing  the  flow  of  bile. 

Phytolacca  lowers  the  rate  of  cardiac  movement  and  the  respiration, 
but  does  not  alter  the  rhythm.  It  is  a  paralyzer,  the  loss  of  power 
occurring  first  in  the  hind  extremities.  The  impairment  of  motility  is 
not  due  to  an  action  of  this  agent  on  the  motor  nerve  or  on  the  muscle 
— for  the  irritability  of  the  nerve  and  the  contractility  of  muscle  remain 
unaffected  when  a  lethal  dose  of  phytolacca  has  been  given.  The  action 
is  on  the  spinal  cord,  chiefly  on  the  medulla.  In  rabbits,  violent  trem- 
bling occurs,  and  convulsions,  partly  tonic,  partly  clonic,  are  produced. 
Death  ensues  from  paralysis  of  respiration  ;  for  in  frogs,  when  all  signs 
of  life  have  ceased,  the  heart  is  found  to  be  in  action,  on  opening  the 
chest.  In  cases  of  accidental  poisoning,  convulsions  of  a  tetanic  char- 
acter have  been  observed.  Elimination  takes  place  chiefly  by  the 
kidneys. 

THERAPY. — Poke  has  been  proposed  as  an  emetic,  but  the  slowness 
of  the  action,  and  the  great  depression  of  the  powers  of  life  which  it 


AILANTHUS.  .  725 

causes,  have  prevented,  and  will  ever  prevent,  its  employment  for  this 
purpose. 

Alterative  powers  have  been  ascribed  to  it,  and  cases  supposed  to 
be  malignant  have  been  cured  ;  but  these  results  were  probably  in- 
stances of  the  post  rather  than  the  propter  hoc.  Ulcers,  cutaneous  dis- 
eases, and  ophthalmia,  are  maladies  which  have  been  reported  cured. 
Fenner  reported  a  case  of  granular  conjunctivitis  cured  by  it,  and  in 
the  same  issue  of  the  journal  there  is  an  editorial  note,  affirming  the 
remarkable  powers  of  the  remedy  in  this  disease.  If  it  really  does 
cure  this  disease  when  given  by  the  stomach,  poke  is  a  remedy  of  ex- 
traordinary value.  The  evidence  is  strong  that  phytolacca  does  pos- 
sess considerable  power  to  promote  the  healing  of  varicose  and  other 
ulcers  of  the  leg  (Tidd).  A  soft  extract  is  spread  on  muslin,  and  kept 
applied  to  the  surface  of  the  ulcer.  Obstinate  eczema  has  been  cured 
in  the  same  way.  The  pain  and  inflammation  of  burns  may  be  as- 
suaged by  the  same  application,  and  the  healing  greatly  facilitated. 
How  far  the  effect  is  merely  mechanical  does  not  appear. 

It  has  long  been  known  that  phytolacca  is  a  serviceable  remedy  in 
chronic  rheumatism.  But  the  therapeutical  application  of  this  remedy 
most  deserving  of  consideration  is  the  treatment  of  inflamed  breasts. 
There  seems  to  be  no  reason  to  doubt  that  phytolacca  possesses  the 
remarkable  property  of  arresting  an  inflammation  of  the  mamma,  and 
preventing  suppuration.  For  this  purpose  the  fluid  extract  may  be 
given  internally,  and  the  solid  extract  spread  on  a  cloth  and  kept 
applied  to  the  breast  which  is  the  seat  of  the  inflammation.  The  pos- 
session of  this  property  to  prevent  suppuration  in  the  breast  implies 
the  existence  of  the  same  property  in  threatened  suppuration  in  other 
glandular  organs.  As  the  fact  is  entirely  empirical,  and  rests  on  no 
physiological  action  of  the  drug,  it  can  only  be  determined  by  further 
trials  whether  it  will  check  suppuration  elsewhere. 

Authorities  referred  to : 

BIGGKRS,  DR.  G.  W.     The  American  Journal  of  the  Medical  Sciences,  vol.  Lev,  p.  2Y5. 
DUTCHER,  DR.  A.  P.     The  Cincinnati  Lancet  and  Observer,  June,  1859. 
TIDD,  DR.  C.  H.     The  Clinic,  vol.  v,  p.  253. 

Ailanthus. — The  bark  of  A.  glandulosa,  a  well-known  and  abundant 
shade-tree.  (Unofficial.) 

PREPARATIONS. — Fluid  extract.     Dose,  m,  x  to  3  j.     Bark,  gr.  x — 

3j- 

COMPOSITION. — The  most  important  constituent  is  the  oleo-resin. 
It  contains,  also,  a  volatile  oil,  which  is  extremely  diffusible  and  pow- 
erful, and  a  bitter  principle. 

ACTIONS  AND  USES. — The  taste  is  bitter  and  somewhat  acrid.  It  is 
strongly  nauseant,  and  the  nausea  is  accompanied  with  weakness,  ver- 
tigo, and  cold  sweating.  It  possesses  decided  purgative  property,  the 


726  MOTOR   DEPRESSANTS 

stools  being  large  and  watery.  It  has  considerable  power  as  a  vermi- 
fuge, and  is  effective  when  employed  against  tsenia.  The  action  of  the 
heart  is  at  first  increased,  but  is  subsequently  slowed,  the  pulse  becom- 
ing small  and  weak.  Respiration  is  similarly  affected,  and  death  en- 
sues in  animals  by  paralysis  of  the  muscles  of  respiration. 

On  the  brain  and  nervous  system  ailanthus  acts  as  a  paralyzer,  the 
loss  of  power  beginning  in  the  hind  extremities.  The  paralyzing  ac- 
tion seems  to  depend  on  the  volatile  oil,  while  the  purgative  and  an- 
thelmintic  effects  are  possessed  by  the  oleo-resin. 

THERAPY. — The  most  important  application  of  ailanthus  is  in  the 
treatment  of  tape-worm,.  For  this  purpose  the  oleo-resin,  or,  better,  a 
decoction  of  the  fresh  bark  (  3  j —  §  iv),  may  be  used.  The  oleo-resin 
has  the  advantage  in  being  a  permanent  preparation,  whereas  the  bark 
loses  its  strength  in  the  process  of  drying. 

Agaricin  {Agaric  Acid). — Obtained  from  Agaricus  albus.  Crys- 
tallizes in  needles.  Dose,  gr.  -^  to  gr.  •£.  Given  in  pill  form.  It  is 
an  efficient  remedy  for  pathological  sweating,  but  rather  slow  in 
action,  beginning  to  have  an  effect  in  six  to  ten  hours.  It  may  cause 
nausea  and  diarrhoea,  when  it  should  be  combined  with  a  little 
opium. 

Muscarine. — The  alkaloid  of  Amanita  muscaria,  the  fly-fungus. 

PROPERTIES. — Muscarine  is  an  alkaloid  with  strong  basic  properties, 
and  combines  with  acids  to  form  salts.     It  has  the  consistence  of  sirup, 
is  without  odor,  free  from  taste,  and  is  readily  soluble  in  water  and  in ' 
alcohol,  but  is  insoluble  in  ether  and  in  chloroform. 

As  muscarine  is  but  slightly  irritating  to  the  tissues,  it  may  be 
used  subcutaneously.  The  dose  ranges  from  one  eighth  of  a  grain  to 
two  grains. 

ANTAGONISTS. — The  actions  of  muscarine  are  antagonized  by  atro- 
pine  (Schmiedeberg  and  Koppe),  by  digitaline  (Bohm),  and  by  eserine 
(Prevost).  By  atropine  it  is  antagonized  at  all  points.  When  the 
heart  is  arrested  by  muscarine,  it  possesses  the  capability  of  again  re- 
newing its  action  under  the  influence  of  a  large  number  of  agents,  but 
atropine  possesses  this  property  in  the  highest  degree  (Alison).  Mus- 
carine arrests  the  heart  in  diastole  by  stimulating  the  intracardiac  in- 
hibition apparatus — atropine  paralyzes  this  apparatus  (Prevost)  ;  mus- 
carine causes  intense  dyspnoea  by  inducing  strong  contraction  of  the 
pulmonary  arteries — atropine  relaxes  this  spasm,  unloads  the  right  cavi- 
ties of  the  heart,  and  respiration  is  resumed  ;  muscarine  lowers,  atro- 
pine raises  the  blood-pressure  ;  muscarine  tetanizes  the  muscular  layer 
of  the  intestine — atropine  induces  a  paresis  of  the  same  ;  muscarine  in- 
creases the  secretions  of  liver,  pancreas,  and  intestinal  mucous  mem- 
brane— atropine  arrests  these  secretions  ;  muscarine  stops  the  renal 


MTJSCARINE.  727 

secretion — atropine  restores  it ;  muscarine  causes  sweating,  salivation, 
and  lachrymation — atropine  dries  them  all ;  muscarine  contracts  the 
pupil — atropine  dilates  the  pupil.  For  the  quantity  producing  a  given 
physiological  effect,  the  power  of  the  two  agents  is  very  unequal, 
atropine  being  much  stronger.  An  atropinized  eye  dilated  to  a  cer- 
tain point  will  not  be  contracted  by  the  quantity  of  muscarine  suffi- 
cient when  unopposed  to  induce  a  marked  degree  of  myosis  ;  but  a 
much  larger  quantity  may  overcome  the  atropine.  The  same  fact  is 
true  throughout  the  whole  range  of  their  antagonistic  action. 

In  frogs  poisoned  by  digitaline,  the  cardiac  movements  recommence 
and  are  maintained  for  hours  by  the  application  of  a  solution  of  mus- 
carine. The  same  fact  is  true  of  tobacco  and  physostigma :  the  heart 
arrested  by  these  agents  recommences  movements  when  muscarine  is 
applied,  and  vice  versa. 

SYXERGISTS. — The  motor  depressants  synergize  some  of  the  actions 
of  muscarine.  A  close  correspondence  exists  between  pilocarpine  and 
muscarine.  They  both  cause  nausea,  diarrhoea  ;  muscarine  at  first 
quickens  then  slows,  and  pilocarpine  quickens  the  pulse  ;  they  both 
flush  the  face  and  produce  free  perspiration  and  salivation  ;  they  both 
cause  frontal  headache ;  both  contract  the  pupil ;  and  both  dimmish 
the  urinary  secretion.  They  differ  in  some  respects,  but  chiefly  in  the 
extent  of  their  action,  or  quantitatively.  Pilocarpine  causes  more 
perspiration  and  salivation  ;  muscarine  produces  decidedly  more  active 
intestinal  movements.  Pilocarpine  diminishes  the  urinary  secretion, 
but  muscarine  may  arrest  it  entirely.  Pilocarpine  slightly  contracts 
the  pupil ;  muscarine  contracts  the  pupil  more  decidedly,  but  when 
applied  to  the  eye  directly,  dilates  the  pupil.  Pilocarpine  always 
quickens  the  pulse,  muscarine  slows  the  pulse. 

PHYSIOLOGICAL  ACTIONS. — The  salivary  secretion  in  a  large  pro- 
portion of  subjects  is  much  increased.  A  feeling  of  constriction  of 
the  neck,  nausea,  and  vomiting,  and  more  or  less  abdominal  pain,  are 
produced  by  it,  whether  administered  by  the  stomach  or  subcutane- 
ously  (Brunton).  The  pancreatic  and  biliary  secretions  are  notably  in- 
creased after  the  injection  of  some  milligrammes  into  a  vein  (Prevost). 
This  increase  of  these  secretions  took  place  as  well  between  as  during 
digestion.  The  intestinal  mucus  is  also  greater  in  quantity  than  nor- 
mal, and  it  may  be  streaked  with  blood  (Schiff).  The  intestines  are 
thrown  into  active  contractions,  tetanized,  rather  than  merely  stimu- 
lated into  more  frequent  vermicular  movements.  Under  ordinary 
medicinal  doses  in  man,  the  bowels  are  relaxed  and  the  character  of 
the  evacuations  altered,  doubtless,  because  of  the  much  greater  quan- 
tity of  the  biliary  and  pancreatic  secretions  poured  out.  The  increased 
movement  of  the  intestines  is  accompanied  by  considerable  colic-like 
pain. 

Muscarine  enters  the  blood  promptly,  whether  introduced  through 


728  MOTOR   DEPRESSANTS. 

the  stomach  or  subcutaneously.  It  is  a  cardiac  poison.  A  very  mi- 
nute quantity — a  mere  trace — applied  to  the  frog's  heart,  arrests  its 
movements.  As  Schmiedeberg  and  Koppe  first  demonstrated,  it  ar- 
rests the  heart  in  the  diastole,  and  does  not  impair  the  irritability  of 
the  heart-muscle,  for,  on  irritation  of  the  heart  by  mechanical,  chemi- 
cal, or  electrical  means,  it  again  contracts.  If  the  dose  is  short  of 
lethal,  the  heart  is  merely  slowed,  the  number  of  pulsations  being 
reduced  ten,  twenty,  or  even  forty  beats  per  minute.  Section  of  the 
vagi  does  not  affect  this  result.  The  action  is  due  to  stimulation  of 
the  intracardiac  inhibitory  apparatus.  By  Alison  it  is  referred  to  over- 
excitation  of  the  cardiac  terminals  of  the  vagus,  and  coincident  dimi- 
nution in  the  activity  of  the  sympathetic  fibers.  When  the  effects  of 
muscarine  are  manifested  by  a  diminution  of  the  pulse-rate,  the  blood- 
pressure  begins  to  decline.  At  first  the  vessels  contract,  but  this  is 
soon  succeeded  by  dilatation  (Bogosslowsky).  With  the  slowing  of 
the  heart  and  dilatation  of  the  vessels,  the  blood  accumulates  in  the 
periphery,  and  the  blood-pressure  is  consequently  reduced  one  half. 

Disturbances  of  respiration  occur  with  the  other  defined  symptoms. 
The  breathing  grows  more  labored  with  the  increasing  effects  of  the 
agent,  and  presently  an  intense  dyspnoea  supervenes  (Schmiedeberg). 
The  mechanism  of  the  labored  respiration  is  obvious  enough.  Such  a 
strong  contraction  of  the  pulmonary  vessels  ensues  as  to  greatly  di- 
minish the  quantity  of  blood  circulating  in  the  lungs,  with  the  result 
of  over-distention  of  the  right  cavities  of  the  heart.  Hence  it  follows 
that  the  state  of  the  blood  is  impaired  by  the  lack  of  oxygen  and  the 
retention  of  carbonic  acid,  and  to  these  factors  must  be  attributed  in 
part  the  cyanosis  and  asphyxia.  These  modifications  of  the  respiration 
occur  after  preliminary  section  of  the  vagi.  The  almost  arrested  oxy- 
genation  of  the  blood,  the  languid  circulation,  and  the  profuse  perspi- 
ration, are  the  factors  which  cause  a  lowering  of  the  temperature.  By 
Schmiedeberg  and  Koppe  there  are  recognized  three  conditions  of  the 
body-heat :  1.  A  slight  elevation,  which  is  by  no  means  constant,  and 
very  transient,  coming  on  in  about  two  hours  after  the  dose — a  small 
one — has  been  taken ;  2.  A  depression  of  one  or  two  degrees,  suc- 
ceeded presently  by  the  normal  temperature,  produced  by  a  full  medi- 
cinal dose  ;  and,  3.  A  very  pronounced  lowering  of  the  temperature 
from  a  fatal  dose. 

By  the  internal  administration  of  muscarine  the  pupil  contracts,  and, 
singularly  enough,  by  direct  application,  dilates.  There  are  other  ex- 
amples of  this  paradox.  Vision  is  disturbed  by  alteration  of  the  ac- 
commodation apparatus  by  spasm.  The  myosis  depends  on  stimulation 
of  the  circular  fibers  of  the  iris  or  of  the  third  nerve,  and  not  on  paral- 
ysis of  the  radiating  fibers,  or  of  the  sympathetic  filaments. 

Muscarine  produces  abundant  perspiration,  and,  indeed,  stimulates 
this  function  only  less  powerfully  than  pilocarpine.  In  most  cases  the 


MUSCARTNE.  729 

saliva  is  correspondingly  increased.  The  two  functions  do  not  always 
act  together  with  the  maximum  energy,  and  one  may  be  powerfully 
affected,  while  the  other  is  quiescent.  Lachrymation  is  nearly  con- 
stant, and  the  nasal  mucus  is  more  abundant  than  in  the  normal  state. 
Thus,  while  all  other  secretions  and  excretions  are  increased  by  mus- 
carine,  it  is  remarkable  that  the  urine  should  be  decidedly  lessened  in 
amount,  even  suppressed.  In  eight  experiments  made  with  great  care, 
Prevost  found  that  the  injection  of  muscarine  into  a  vein  diminished 
the  urinary  secretion,  and,  indeed,  almost  stopped  it  when  the  dose 
was  large.  The  elimination  of  muscarine  takes  place  by  the  kidneys. 
The  best  evidence  that  it  is  excreted  unchanged  is  the  physiological 
action  of  the  urine.  The  urinary  secretion  of  an  animal  poisoned  by 
muscarine  will  poison  another  animal  to  whom  it  is  administered,  and 
its  powers  are  transmitted  with  little  diminution  through  several. 

THERAPY. — The  applications  of  muscarine  to  the  treatment  of  dis- 
ease are  yet  in  their  infancy.  The  physiological  effects  indicate  the 
direction  of  the  remedial  applications.  As  muscarine  stimulates  so 
powerfully  the  muscular  fiber  of  the  intestine,  and  the  secretions  of 
the  pancreas,  liver,  and  intestinal  mucous  membrane,  it  ought  to  be 
very  serviceable  in  cases  of  constipation  with  torpor  of  the  organs 
concerned  in  digestion.  When  constipation  is  due  to  paresis  of  the 
muscular  layer  of  the  bowel  and  to  deficient  secretion,  this  remedy 
will  probably  relieve  it.  In  the  treatment  of  intestinal  torpor  and  de- 
ficient secretion,  muscarine  may  be  combined  with  other  remedies,  as 
atropine  and  strychnine,  which  act  on  the  organs  concerned,  or  with 
cathartics  and  cholagogues  :  ^  Muscarinae,  gr.  iv  ;  ext.  belladonnas, 
ext.  nucis  vomicse,  aa  gr.  iij  ;  euonymin,  3  ss.  M.  Ft.  pil.  no.  xij. 
Sig.  :  One  pill  morning  and  evening.  When  the  digestion  of  the 
starches  and  fats  is  imperfect,  it  is  strongly  indicated.  In  catarrh  of 
the  duodenum,  and  in  catarrhal  jaundice,  it  ought  to  be  very  efficient. 
In  these  maladies,  the  remedy  should  be  administered  frequently  and 
in  small  doses  :  I£  Muscarinae,  gr.  j  ;  aquae,  §  j.  M.  Sig.  :  A  tea- 
spoonful  every  three  hours.  It  is  probable,  also,  that  it  will  prove 
useful  in  recent  haemorrhoids  due  to  congestion  of  the  portal  circulation. 
It  promises  well  as  a  remedy  for  the  removal  of  inflammatory  effusions 
and  exudations.  It  ought  to  afford  prompt  relief  at  the  onset  of  a 
common  cold,  an  acute  bronchitis,  hay-asthma,  etc.  As  muscarine  pro- 
duces strong  contraction  of  the  pulmonary  capillaries,  it  ought  to  be 
useful  in  pulmonary  haemorrhage,  in  incipient  congestion  of  the  lungs, 
etc.  Under  such  circumstances  the  combination  with  digitalis  ought 
to  be  especially  effective,  for,  while  digitalis  will  aid  the  curative  ac- 
tion on  the  pulmonary  vessels,  it  will,  at  the  same  time,  antagonize 
the  cardiac  depression  caused  by  muscarine.  It  is  contraindicated  in 
affections  of  the  air-passages  when  secretion  is  in  excess.  For  the 
night-sweats  of  phthisis  fly-fungus  has  long  been  used,  and  a  similar 


730  MOTOR   DEPRESSANTS. 

fungus  is  commended  by  Trousseau  ;  but  it  has  not  been  as  success- 
ful in  the  hands  of  Murrell  as  some  other  agents,  although  capable, 
sometimes,  of  very  good  results.  Muscarine  is  of  doubtful  propriety, 
if  not  positively  contraindicated,  in  renal  affections  characterized  by 
deficiency  in  the  excretion.  On  the  other  hand,  it  ought  to  be  of  sig- 
nal service  in  diabetes  insipidus  and  in  saccharine  diabetes.  It  has 
been  used  successfully  to  arrest  the  secretion  of  milk. 

Authorities  referred  to  : 

ALISON,  DR.  Bouchardafs  Annuaire  de  Therapeutique,  etc.,  for  1877,  p.  47  ;  also,  Gaz. 
Med.  de  Paris,  February  20,  1877.  The  Action  of  Atropine  and  Muscarine  on  the  Heart. 

BOGOSSLOWSKT,  DR.     Centralblatt  fur  die  med.  Wissenschaften,  No.  97,  1870. 

BRUXTON,  T.  LACDER.     Journal  of  Anatomy  and  Physiology,  1876,  p.  342. 

HARNACK,  DR.  ERICH.  Archiv  fur  experimentelle  Pathol.  und  Pharmakol.,  Band  iv, 
p.  168.  Untersuchungen  iiber  Pjlegenpilzalkaloide. 

PREYOST,  DR.  J.  L.  Bull.  Gen.  de  Therap.,  vol.  xciii,  p.  371.  Note  relative  d  FAn- 
tagonisme  mutucl  de  P  Atropine  et  de  la  Muscarine. 

RINGER  AND  MOSSHEAD.  Ringer's  Hand-Boole  of  Therapeutics,  eighth  edition,  article 
Muscarine. 

SCHIFF,  PROF.  Lo  Sperimentale,  abstracted  in  the  London  Medical  Record,  vol.  iv, 
1876,  p.  339. 

SCHMIEDEBERG  UND  KoppE.  Das  Muscarin,  das  giftige  Alkaloid  des  Fliegenpilzes.,  etc. 
Leipsic,  1869.  Vogel. 

Aspidospenna  (Quebracho). — The  bark  of  Aspidosperma  quebracho 
bianco  Schlechtendal  (Nat.  Ord.  Apocynacece). 

PREPARATIONS. — Tincture. — One  part  of  quebracho  to  five  parts  o£ 
alcohol.  Dose,  iq,  v —  3  j.  (Not  official.) 

Extractum  Aspidospermatis  Fluidum. — Fluid  extract  of  aspido- 
sperma.  Dose,  i\[  j  to  TTI  x  or  more. 

The  fluid  extract  is  a  more  eligible  preparation  than  the  alkaloid 
aspidospermine,  which  represents  in  part  only  the  powers  of  the  drug. 

COMPOSITION. — Quebracho  seems  peculiarly  rich  in  alkaloids,  but 
it  is  doubtful  whether  any  one  represents  in  its  entirety  the  physio- 
logical powers  of  the  bark  itself.  The  most  important  are  aspido- 
spermine, discovered  by  Fraude  in  1878,  and  quebrachine,  separated 
by  Hesse  in  the  following  year.  Hesse  describes  several  other  active 
constituents  or  alkaloids,  but  the  two  just  mentioned  are  the  most 
important. 

ADULTERATIONS.  —  Soon  after  the  first  specimens  were  sent  to 
Europe,  the  sudden  demand  which  sprang  up  induced  sophistication, 
and  quebracho-wood  and  quebracho  Colorado  were  substituted  for  the 
genuine.  This  substitution  proved  the  less  important,  since  these 
preparations  acted  in  a  similar  manner,  and  were  only  weaker  (Pen- 
zoldt).  The  early  physiological  investigations  must,  therefore,  be  in- 
terpreted by  the  light  of  this  difference  in  the  action  of  the  several 
substances  comprehended  in  the  term  quebracho. 


QUEBRACHO.  731 

PHYSIOLOGICAL  ACTIONS. — Quebracho  has  the  stomachal  effects  of 
the  bitters  in  general :  it  promotes  appetite  and  increases  the  diges- 
tive powers.  The  alkaloids  diffuse  promptly  into  the  blood.  The 
action  of  the  heart  is  lowered  ;  the  pulse  in  the  normal  state  is  less 
frequent ;  at  first,  the  tone  of  the  artery  is  higher  and  the  blood-press- 
ure is  raised,  but  as  the  action  is  continued,  especially  from  lethal 
doses  in  animals,  the  force  of  the  circulation  declines  and  the  pressure 
falls.  The  respiration  is  also  slowed,  and  the  sense  of  need  of  air  is 
less  imperative.  The  hurry  of  circulation  and  of  respiration,  and  the 
feeling  of  oppression  induced  by  active  exercise,  are  modified  by 
quebracho.  Picot-Berthold  studied  these  actions  on  his  own  person. 
Ascertaining  first  the  rate  of  increase  of  the  respiratory  movements  and 
of  the  circulation  induced  by  active  exercise  of  a  definite  amount,  he 
next  determined  the  influence  of  the  remedy  on  these  functions  when 
the  same  amount  of  exercise  had  been  taken.  While  without  quebra- 
cho his  pulse  and  respiration  rose  respectively  to  42  and  94,  under  the 
action  of  the  medicament  they  were  30  and  80.  Not  only  was  the 
rate  of  movement  lessened,  but  the  accompanying  distress  for  want 
of  air  was  decidedly  ameliorated. 

Guttmann,  who  has  made  an  elaborate  study  of  aspidospermine,  finds 
that  in  both  cold-  and  warm-blooded  animals  it  is  an  active  poison 
of  the  respiratory  and  circulatory  apparatus.  In  cold-blooded  animals 
the  respiratory  actions  are  most  pronounced,  and  death  is  produced 
by  the  effect  of  the  poison  on  the  respiratory  center.  Slowing  of  the 
heart's  action  proceeds  pari  passu  with  the  diminution  of  the  respira- 
tory energy,  and  the  cessation  of  the  heart's  movements  is  finally  due 
to  the  impression  of  the  poison  on  the  mtra-cardiac  motor  ganglia. 
In  warm-blooded  animals  (cats)  the  influence  of  the  poison  on  the 
heart  is  primary.  The  slowing  of  the  pulse  is  not  due  to  any  effect 
which  it  has  on  the  vagi,  but  to  the  paralyzing  action  which  it  exerts 
on  the  cardiac  motor  ganglia.  With  the  slowing  of  the  heart  the 
temperature  declines,  and,  with  the  diminution  of  respiration,  dyspnoea 
comes  on.  Then  the  accumulation  of  carbonic  acid  in  the  blood  in- 
duces stupor,  and  in  animals  convulsions.  The  reflex  function  is  low- 
ered in  cold-  but  not  in  warm-blooded  animals  ;  sensibility  is  unaf- 
fected in  the  latter,  but  motor  paralysis  finally  occurs  in  both  classes. 
Death  is  due  to  paralysis  of  the  heart. 

THEKAPY. — The  applications  of  quebracho  in  the  treatment  of  dis- 
ease were  originally  empirical,  but  they  are  clearly  deducible  from  its 
physiological  actions.  It  has  long  been  known  as  a  fever-medicine 
and  as  a  remedy  for  dyspnoea,  in  the  province  of  Santiago,  Chili, 
where  it  was  first  obtained  by  Dr.  Schickendanz.  It  has  been  used 
as  a  stomachic  tonic,  like  the  bitters  in  general,  but  more  especially 
like  cinchona,  to  increase  the  appetite  and  digestion  in  atonic  dys- 
pepsia. It  is,  however,  chiefly  important  as  a  remedy  for  dyspnoea. 


732  MOTOR   DEPRESSANTS. 

Picot,  Skoda,  Krauth,  Penzoldt,  and  many  others,  have  used  it  in  va- 
rious instances  of  difficult  breathing,  with  remarkable  palliation.  In 
emphysema,^  spasmodic  asthma,  urcemic  asthma,  in  spasmodic  cough, 
chronic  bronchitis,  with  asthmatic  breathing,  it  has  afforded  very  con- 
siderable relief.  It  has  appeared  to  be  much  less  useful,  if  not  injuri- 
ous, in  the  dyspnoea  from  valvular  disease  of  the  heart,  and  has  had  no 
effect  in  the  dyspnoea  of  old  subjects  due  to  atheroma  of  the  vessels. 
Krauth,  however,  has  used  it  with  advantage  in  the  dyspnoea  due  to 
hypertrophy  of  the  heart  and  in  the  difficulty  of  breathing  in  a  case  of 
albuminuria  consecutive  to  scarlatina.  The  relief  to  dyspnoea  in  all 
cases,  Penzoldt  thinks,  is  referable  to  the  increased  consumption  of 
oxygen  by  the  blood,  but  a  more  rational  explanation  would  seem  to 
be  the  action  on  the  respiratory  center,  and  the  diminution  in  the 
sense  of  need  of  air. 

Oxycamphor. — An  artificial  product  of  camphor-ortho-quinon,  in 
which  one  molecule  of  hydroxyl  (HO)  replaces  one  molecule  of  hydro- 
gen (H)  in  the  formula  for  camphor.  It  is  a  white  crystalline  pow- 
der, soluble  in  10  per  cent  of  cold  water.  It  has  a  somewhat  pungent 
and  bitter  taste.  It  precipitates  myosin  but  not  albumin  from  their 
solutions,  respectively.  It  is  inhibitory  of  the  lower  forms  of  organic 
life,  stops  fermentation,  and  converts  hemoglobin  into  tnethsemoglobin, 
by  preventing  the  absorption  of  oxygen.  It  paralyzes  the  nerve  end- 
ings in  the  muscular  layer  of  the  vessels.  Oxycamphor  acts  on  the 
heart  in  a  different  manner  from  camphor — for  while  camphor  stimu- 
lates the  cardiac  action  in  cold-blooded  animals,  oxycamphor  retards 
and  arrests.  The  differences  are  even  greater  in  warm-blooded  animals, 
camphor  causing  excitement  and  increased  rate  of  breathing.  Oxy- 
camphor acts  on  the  respiratory  center,  but  not  on  the  vaso-motor, 
except  secondarily.  In  the  treatment  of  dyspnoea  the  physiological 
actions  furnish  the  indications  for  its  administration.  It  should  be 
very  useful  in  cases  of  asthma,  in  the  asthmatic  paroxysms  of  emphy- 
sema. It  will  probably  give  relief  to  the  excited  breathing  of  phthisis 
and  to  the  harassing  cough. 

Yohimbin  or  Yumbehoa. — A  member  of  the  Apocynea,  growing  in 
equatorial  Africa. 

COMPOSITION. — An  alkaloid  has  been  obtained  from  the  bark,  by 
L.  Spiegel,  who  gave  it  the  name  yohimbin.  It  is  a  crystallizable 
principle  having  the  formula  Cj3,H49NsO4.  It  combines  with  acids  to 
form  salts,  of  which  the  most  eligible  is  the  hydrochlorate. 

The  dose  of  the  hydrochlorate  of  yohimbin  is  ^  to  -fa  gr.  This 
salt  may  be  dispensed  in  solution.  Of  a  one-per-cent  solution  the  dose 
should  be  from  one  to  ten  minims. 

PHYSIOLOGICAL  ACTIONS. — The  first  study  of  the  actions  of  yohim- 
bin were  made  by  Oberworth  on  both  cold-  and  warm-blooded  ani- 


YOHIMBIN.  733* 

raals.  It  is  a  paralyzer  of  both  classes  of  animals,  inhibiting  the  cen- 
tral nervous  system,  leaving  unimpaired  the  peripheral  nerves  and 
muscles.  Electrical,  chemical,  and  mechanical  irritation  of  a  motor 
nerve  is  followed  by  active  contraction  of  the  muscles  to  which  it  is 
distributed. 

Yohimbin  inhibits  the  heart's  action  finally  in  cold-blooded  ani- 
mals, stopping  it  in  the  diastole.  The  previous  administration  of  atro- 
pine  does  not  prevent  this  result.  It  is  also  a  paralyzer  of  respiration, 
which  becomes  irregular  in  time  and  volume  with  the  progress  of  the 
influence,  and  if  artificial  respiration  is  resorted  to,  death  ensues  by 
failure  of  the  heart. 

The  blood-pressure  falls  as  soon  as  the  remedy  is  administered. 
This  is  due  not  to  paresis  of  the  muscular  walls  of  the  vessels,  but  to 
failure  of  the  heart  itself.  The  heart-beats  are  not  increased  by  sec- 
tion of  the  vagi  nor  by  the  administration  of  atropine,  nor  does  irrita- 
tion of  the  vagus  center  or  the  peripheral  vagus  have  any  influence 
on  the  result.  The  actions  of  yohimbin  on  the  circulation  are  there- 
fore through  the  sympathetic  or  the  motor  ganglia  of  the  heart,  or 
both. 

The  most  important  effect  is  on  the  genito-urinary  apparatus,  caus- 
ing active  erections  of  the  penis,  emissions,  and  a  general  hyperaemia. 
No  structural  alterations  take  place  in  the  kidneys  and  genitalia,  not- 
withstanding the  considerable  hyperaemia  and  excitement  which  are 
produced  by  it  in  the  whole  apparatus. 

THERAPY. — The  applications  of  yohimbin  to  treatment  have  been 
thus  far  limited  to  a  few  maladies.  In  sexual  neurasthenia,  in  impo- 
tence due  to  functional  depression  of  the  sexual  apparatus,  its  use  is 
warranted  by  the  results  of  the  observations  on  animals.  As  it  has  a 
marked  and  distinctive  action  on  the  genito-urinary  apparatus,  it 
should  prove  useful  in  the  chronic  forms  of  albuminuria.  It  is  contra- 
indicated  in  acute  affections  of  the  kidneys,  but  .in  chronic  Bright's 
disease  and  in  such  cases  of  albuminuria  as  are  symptomatic  of  low- 
ered vital  action  or  depressed  function,  good  results  may  be  expected. 
This  opinion  is  based  on  personal  observation  of  appropriate  cases, 
especially  of  chronic  albuminuria,  in  which  it  has  seemed  to  lessen  the 
quantity  of  albumin  present  and  to  improve  the  general  state. 


EMETICS.  733 

REMEDIES    USED    TO   MODIFY  THE  FUNCTIONS 
OF  ORGANS  (CONTINUED). 

B.— OF  THE   GASTRO-INTESTINAL   CANAL. 
EMETICS. 

SOME  of  the  agents  in  this  group  produce  vomiting  by  virtue  of  a 
local  action  on  the  stomach,  and  do  not  affect  this  viscus  when  intro- 
duced elsewhere.  These  may  be  entitled  Emetics  by  Local  Action. 
There  are  others  which  cause  emesis  when  they  enter  the  blood  at  any 
point — Systemic  Emetics.  The  first  sub-group  of  emetics  make  an  im- 
pression on  the  gastric  nerves,  and  an  action  is  at  once  instituted  for 
their  expulsion.  The  process  consists  in  the  transmission  of  the  periph- 
eral irritation  to  the  spinal  center,  the  generation  of  a  motor  impulse, 
and  the  consequent  action  of  the  nervous  and  muscular  apparatus 
concerned  in  the  mechanism  of  vomiting.  The  systemic  emetics  pro- 
duce their  effects  through  the  intermediation  of  the  blood,  and  the  vom- 
iting is  only  one  of  the  results  of  the  disturbance  introduced  into  the 
functions  of  the  nervous  system. 

EMETICS  BY  LOCAL  ACTION. 

The  most  important  of  these  are  : 

Cupri  sulphas,  sulphate  of  copper. 

Zinci  sulphas,  sulphate  of  zinc. 

Hydrargyri  sulphas  flav a,  yellow  subsulphate  of  mercury. 

Alumen,  alum. 

Sinapis,  mustard. 

Scilla,  squill. 

All  of  the  members  of  this  group  have  been  discussed  in  other  parts 
of  this  work,  except  mustard  and  squill,  and  the  consideration  of  these 
will  be  more  appropriate  elsewhere.  It  is  necessary,  however,  in  this 
place  to  indicate  the  nature  of  the  action,  the  cases  to  which  they  are 
adapted,  and  the  mode  of  administration  of  the  more  important  of  the 
emetics  belonging  to  this  division. 

Cupri  Sulphas. — This  is  a  very  prompt  and  efficient  emetic.  The 
action  begins  in  a  few  minutes,  and  the  medicine  comes  up  with  the 
vomited  matters.  Very  little  depression  follows  the  emetic  action.  It 
is  more  especially  adapted  to  the  treatment  of  narcotic  poisoning,  be- 
cause, the  action  being  local,  the  obtunded  state  of  the  reflex  centers 
interferes  less  with  its  operation  than  is  the  case  with  the  systemic 
emetics  ;  and  to  phosphorus  poisoning,  because  of  its  antidotal  power. 
It  is  also  occasionally  used  in  croup,  to  effect  the  dislodgment  of  the 
false  membrane,  but  other  mechanical  emetics  are  preferable. 

ADMHSTISTRATION. — Dissolve  twenty  grains  of  the  sulphate  of  copper 
in  two  ounces  of  distilled  water,  and  give  a  tablespoonful  every  fifteen 


734  EVACUANTS. 

minutes  until  vomiting  occurs.  When  prompt  action  is  required,  as  in 
narcotic  poisoning,  ten  grains  of  the  sulphate  of  copper  may  be  given 
at  a  draught  in  an  ounce  or  two  of  water.  Its  action  should  be  assisted 
by  the  free  use  of  diluents. 

Zinci  Sulphas. — This  agent  acts  in  a  manner  similar  to  the  corre- 
sponding copper-salt,  but  is  less  powerful.  It  has  the  advantage  of  be- 
ing less  likely  to  induce  gastro-enteritis  than  sulphate  of  copper,  and 
is,  therefore,  usually  preferred  to  the  latter.  It  is  administered  in  cases 
of  narcotic  poisoning,  in  croup,  and  to  relieve  the  stomach  of  indi- 
gestible alimentary  substances. 

ADMINISTRATION. — In  narcotic  poisoning  a  scruple  of  the  sulphate 
of  zinc  may  be  administered  in  water,  and,  if  need  be,  repeated  once. 
In  croup,  or  for  other  purposes,  as  an  emetic,  it  may  be  given  as  fol- 
lows :  Dissolve  a  half -drachm  in  two  ounces  of  water,  and  administer  a 
tablespoonf ul  every  fifteen  minutes  until  emesis  is  produced.  The  free 
use  of  diluents  promotes  the  emetic  action. 

Hydrargyri  Sulphas  Flava. — This  is  one  of  the  most  efficient  mem- 
bers of  this  group.  It  is  an  active  poison,  but,  as  it  is  returned  with 
the  contents  of  the  stomach,  no  danger  attends  its  administration.  It 
does  not  act  so  speedily  as  copper  and  zinc.  It  produces  very  little 
nausea,  but,  when  the  action  begins,  the  effects  are  suddenly  experi- 
enced, and  are  powerful,  without  leaving  after-depression  and  sickness. 
It  is  not  so  well  adapted  to  the  treatment  of  narcotic  poisoning  as  the 
copper  and  zinc  sulphates,  but  it  is  the  most  desirable  emetic  in  the 
treatment  of  croup.  It  was  formerly  much  prescribed  in  this  disease 
as  an  emetic,  but  it  fell  out  of  fashion  until  revived  recently  by  Dr. 
Fordyce  Barker.  The  author's  experience  in  its  use  is,  in  the  main, 
in  accord  with  the  much  more  extended  experience  of  Dr.  Barker. 

ADMINISTRATION. — As  the  yellow  subsulphate  of  mercury  has  but 
little  taste,  it  is  easily  administered  to  children.  It  should  be  prescribed 
in  the  form  of  powder,  rubbed  up  with  sugar  of  milk.  The  dose  varies 
from  two  to  five  grains.  Dr.  Barker  makes  the  useful  suggestion  that 
powders  of  this  preparation,  labeled  "  croup-powders,"  should  be  kept 
in  every  household,  the  children  of  which  have  a  tendency  to  attacks 
of  croup.  It  should  be  given  when  the  first  symptoms  manifest  them- 
selves, and  its  repetition  will  be  governed  by  the  state  of  the  breathing. 

Alumen. — Powdered  alum  is  a  safe,  efficient,  but  slow  emetic, 
About  a  half -hour  usually  elapses  after  it  is  swallowed  before  the  eme- 
sis occurs.  It  acts  mechanically,  produces  no  considerable  nausea,  and 
leaves  behind  no  depression.  As  an  emetic,  its  only  use  is  in  croup  and 
diphtheria,  administered  with  the  view  to  cause  a  detachment  of  the 
false  membrane.  Some  effect  has  been  ascribed  to  the  local  action  of 


SYSTEMIC  EMETICS.  735 

the  alum  in  its  passage  along  the  throat,  but  this  opinion  is  scarcely 
tenable. 

ADMINISTRATION. — A  teaspoonful  of  powdered  alum  may  be  ad- 
ministered in  sirup,  honey,  or  mucilage.  It  can  be  repeated,  if  need 
be,  every  half-hour. 

Sinapis. — Mustard  is  a  stimulant,  local  emetic.  It  acts  promptly 
and  efficiently.  In  emergencies,  other  emetics  not  being  available,  it 
may  be  employed  in  narcotic  and  other  forms  of  poisoning.  As  an 
emetic  it  is  especially  adapted  to  depressed  conditions  of  the  system — 
for,  while  it  causes  vomiting,  it  stimulates  the  action  of  the  heart. 
When,  therefore,  an  emetic  is  indicated,  and  at  the  same  time  the  cir- 
culation is  feeble,  the  surface  cold,  and  the  functions  of  animal  life 
oppressed,  mustard  should  be  used. 

ADMINISTRATION. — A  tea-  to  a  dessert-spoonful  of  powdered  mus- 
tard should  be  stirred  up  in  a  tumblerful  of  tepid  water,  and  quickly 
swallowed.  The  irritant  action  of  the  mustard  may  be  limited,  and  its 
emetic  action  promoted,  by  the  free  use  of  diluents. 

SYSTEMIC  EMETICS. 

Apomorphine. — Apomorphince  Hydrochloras. — Apomorphine  hy- 
drochlorate.  The  hydrochlorate  of  an  artificial  alkaloid  obtained  by 
the  action  of  strong  acids  upon  morphine  contained  in  closed  tubes  and 
subjected  to  a  somewhat  elevated  temperature.  It  is  obtained  also  by 
the  action  of  chloride  of  zinc  in  solution  on  morphine.  It  is  a  whitish 
powder,  which  becomes  greenish  by  absorption  of  moisture.  It  is  solu- 
ble in  water,  and  it  may,  therefore,  be  administered  in  this  menstruum. 
Dose,  gr.  ^  to  gr.  \.  If  given  hypodermatically,  gr.  ^  is  sufficient  ; 
if  by  the  stomach,  gr.  £.  As  it  undergoes  important  changes  when  in 
contact  with  water,  the  solution  for  hypodermatic  use  should  be  made 
when  required,  or  at  least  should  be  frequently  renewed. 

Apocodeine, — Apocodeince  Hydrochloras. — Apocodeine  hydrochlo- 
rate. An  artificial  alkaloid  obtained  from  codeine,  as  apomorphine  is 
made  from  morphine.  It  has  similar  powers  and  properties  to  apo- 
morphine, but  it  is  somewhat  less  active  as  an  emetic,  while  it  is  more 
useful  as  an  expectorant.  Apocodeine  is  given  by  the  stomach  or  sub- 
cutaneously.  The  dose  is  gr.  -fa  to  gr.  £. 

PHYSIOLOGICAL  ACTIONS. — Whether  injected  under  the  skin  or 
taken  into  the  stomach,  apomorphine  causes  vomiting.  The  rate  at 
which  it  moves  to  affect  the  stomach  depends  somewhat  on  the  dose 
administered.  From  five  to  twenty  minutes  elapse  after  the  hypo- 
dermatic injection  before  vomiting  begins.  The  act  of  vomiting  is  pre- 
ceded by  very  little  nausea,  the  contents  of  the  stomach  are  usually 
thoroughly  evacuated,  and  the  vomiting  recurs  a  few  times  at  inter- 
vals of  a  quarter  to  a  half  hour.  In  voung  subjects  very  considerable 
49 


736  EVACUANTS. 

depression  has  been  observed  to  be  produced  by  it,  and  dangerous 
symptoms  of  cardiac  paralysis  have  followed  its  emetic  action  in  a  few 
instances.  These  clinical  facts  seem  to  contradict  the  experimental 
observations  of  Siebert  and  Moerz,  who  have  shown  that  apomorphine 
does  not  affect  the  blood-pressure,  and  that  the  pulse  rises  when  emesis 
comes  on,  reaches  its  maximum  during  vomiting,  and  declines  in  the 
interval.  The  cardiac  depression  which  has  been  observed,  clinically, 
may  have  been  the  result  of  idiosyncrasy,  yet  we  should  not  lose  sight 
of  the  fact  observed  by  Harnack,  that  in  cold-blooded  animals  it  may 
be  produced  experimentally. 

Apomorphine  causes  at  first  increased  rapidity  of  the  respiration, 
afterward  diminishes  the  force  and  depth  of  the  movements,  and 
finally  arrests  them.  As  this  result  occurs  when  the  vagi  are  divided, 
the  drug  must  necessarily  first  excite  and  afterward  exhaust  the  irrita- 
bility of  the  respiratory  center.  Apomorphine  has  no  appreciable  in- 
fluence on  the  temperature. 

As  respects  its  impression  on  the  nervous  system,  apomorphine  is 
at  first  strongly  excitant.  Afterward  it  causes  muscular  tremblings, 
followed  by  paralysis  and  convulsions.  The  muscular  irritability  is 
impaired  but  not  destroyed,  and  the  functions  of  motor  and  sensory 
nerves  remain  intact ;  hence  it  may  be  concluded  that  the  convulsant 
action  of  this  agent  is  due  to  a  direct  impression  on  the  spinal  cord 
(the  spasm-center). 

THERAPY. — Apomorphine  is  indicated  as  an  emetic  when  swallow- 
ing is  difficult  or  impossible,  and  when  very  prompt  action  is  neces- 
sary. As  it  produces  vomiting  by  its  spinal  action,  profound  narcosis* 
will  prevent  it,  and  hence,  in  narcotic  poisoning,  it  may  fail  of  effect 
unless  administered  before  narcosis  has  supervened.  It  is  a  suitable 
emetic  when  it  is  desired  to  empty  promptly  an  overloaded  stomach. 
It  is  to  be  preferred  to  all  emetics  which  must  be  introduced  into  the 
stomach,  when  this  viscus  is  in  a  state  of  inflammation,  for  it  is  best 
given  subcutaneously.  Apomorphine  has  been  administered  as  an 
emetic  in  suffocative  catarrh,  to  empty  mechanically  the  bronchial 
tubes,  but  it  produced  serious  depression — a  result  which  might  have 
been  a  priori  predicted,  since  this  drug  exerts  a  paralyzing  action  on 
the  respiratory  organs.  It  has  also  been  given  as  an  expectorant,  but 
on  insufficient  data,  for  it  does  not  seem  to  have  an  effect  upon  the 
vagi,  and,  as  above  stated,  at  first  it  excites  the  respiration  movements, 
and  afterward  paralyzes  them. 

As  compared  with  its  congeners,  morphine  and  codeine,  it  is  more 
excitant  than  morphine  and  codeine,  and  without  their  hypnotic  and 
anodyne  properties.  As  respects  its  convulsant  action  in  animals,  it 
has  close  physiological  relations  to  narcotine  and  thebaine.  Some  clini- 
cal experiences  have  shown  (Riegel  und  Bohm)  that  apomorphine 
causes  heaviness  in  the  head,  giddiness,  drowsiness,  yawning,  mental 


SYSTEMIC  EMETICS.  737 

hebetude,  etc.  The  trials  in  which  these  results  were  noted  were  made 
with  Merck's  preparation  of  apomorphine. 

Recent  experiences  have  demonstrated  that  apomorphine  has 
remarkable  calmative  and  hypnotic  effects  in  the  excitement  and 
wakefulness  of  alcoholism.  For  this  purpose  it  is  better  given  hypo- 
dermically,  although  good  effects  have  been  obtained  by  the  stomachal 
administration.  The  dose  by  the  former  method  is  from  fa  to  £  gr., 
and  by  the  latter,  £  to  \  gr. 

It  has  proved  most  successful  in  delirium  tremens,  inducing  quiet 
and  refreshing  sleep,  when  the  most  noisy  and  threatening  delirium 
had  occurred.  This  agent  is  probably  one  of  those  most  relied  on  to 
remove  the  desire  for  alcoholic  drinks,  and  to  quiet  the  restlessness 
and  excitement  which  the  absence  of  the  stimulant  sets  up  in  those 
undergoing  the  so-called  cure. 

Ipecacuanha. — Ipecacuanha.  The  root  of  Cephaelis  ipecacuanha 
A.  Richard  (Nat.  Ord.  Rubiacece).  (U.  S.  P.)  Racine  d?  ipecacuanha, 
Fr.  ;  Brechwurzel,  Ger. 

Extractum  Ipecacuanhce  Fluidum. — Fluid  extract  of  ipecacuanha. 
Dose,  TII  ij —  3  j. 

Syrupus  Ipecacuanhce. — Sirup  of  ipecacuanha  (fluid  extract,  70 
c.  c.  ;  sirup  to  1,000  c.  c.).  Dose,  3  j —  §  ss. 

Tinctura  IpecacuanhcB  et  Opii. — (Deodorized  tincture  of  opium 
and  fluid  extract  of  ipecac.)  Dose,  T^,  v — v\.  xv.  A  liquid  equivalent 
of  Dover's  powder. 

Trochisci  Ipecacuanhce. — Troches  of  ipecacuanha  (ipecac,  traga- 
canth,  arrow-root,  sugar,  and  sirup  of  orange-peel).  Dose,  one  or 
more.  Each  troche  contains  one  fourth  of  a  grain  of  ipecacuanha. 

Trochisci  Morphines  et  Ipecacuanhce, — Troches  of  morphine  and 
ipecacuanha  (each  troche  contains  one  fortieth  of  a  grain  of  morphine 
and  one  twelfth  of  a  grain  of  ipecac). 

Vinum  Ipecacuanhce. — Wine  of  ipecacuanha  (fluid  extract  of  ipe- 
cac, 100  c.  c.  ;  alcohol,  100  c.  c.  ;  white  wine  to  1,000  c.  c.).  Dose, 

m.j-3j. 

Pulvis  Ipecacuanhce  et  Opii. — Compound  powder  of  ipecacuan- 
ha. Dover's  powder.  Ten  grains  contain  one  grain  each  of  ipecac 
and  opium,  and  eight  grains  of  sugar  of  milk.  This  preparation  has 
already  been  discussed  in  the  article  on  opium. 

COMPOSITION. — Since  the  time  of  Magendie  emetine  combined  with 
ipecacuanhic  acid  has  been  held  to  be  the  active  principle.  The  di- 
verse opinions  entertained  regarding  the  physiological  properties  of 
this  alkaloid  have  been  explained  by  the  discovery  recently,  by  Paul 
and  Cownley,  that  emetine  is  composed  of  two  distinct  alkaloids, 
which  they  have  named  cephceline  and  emetine,  the  latter  being  the 
same  as  the  emetine  described  by  Glenard.  Ipecacuanhic  acid  is  a 
glucoside,  and  is  chemically  related  to  kinic  and  caffetannic  acids. 


738  EVACUANTS. 

ANTAGONISTS  AND  INCOMPATIBLES. — The  salts  of  lead  and  mer- 
cury, the  vegetable  acids,  and  astringent  infusions,  are  incompatible. 
The  tannate  of  emetine  is  extremely  insoluble.  Bismuth,  carbolic  acid, 
hydrocyanic  acid,  and  narcotics  generally,  hinder  its  emetic  action. 

SYNEEGISTS. — The  emetics — those  by  local  action  and  the  systemic 
— favor  the  vomitive  action  of  ipecac.  Its  effects  on  the  skin  and  bron- 
chial mucous  membrane  are  promoted  by  opium,  warm  diluents,  etc. 

PHYSIOLOGICAL  ACTIONS. — Inunctions  of  ipecacuanha  excite  very 
considerable  irritation  of  the  skin  :  at  first,  small,  isolated  pustules  ap- 
pear, and  these  are  followed  by  large  pustules  and  ulceration  (Duck- 
worth). When  applied  to  the  mucous  membrane  of  the  nares,  it  pro- 
duces a  sensation  of  heat,  and  causes  sneezing.  Some  persons  are  so 
susceptible  to  its  action  that  the  smallest  quantity  inhaled  will  induce 
an  asthmatic  paroxysm. 

Administered  by  the  stomach  in  small  doses  (from  one  eighth  to 
one  quarter  of  a  grain),  ipecacuanha  acts  as  a  stomachic  tonic,  and 
probably  increases  the  gastric  secretions.  In  larger  doses  (from  five 
grains  to  a  scruple),  it  is  nauseant  and  emetic  ;  but  the  sickness  which 
it  causes  is  not  severe,  and  the  vomiting  is  not  accompanied  nor  fol- 
lowed by  much  depression.  Its  action  as  an  emetic  is  rather  slow, 
from  twenty  minutes  to  a  half-hour  being  required,  and  is  not  per- 
sistent. Repetition  of  large  doses  will,  in  most  cases,  but  not  invari- 
ably, produce  a  condition  of  tolerance,  when  vomiting  does  not  occur, 
but  a  cathartic  action  is  induced,  the  stools  having  a  peculiar  bilious 
character,  appropriately  designated  "  ipecacuanha-stools."  Both  vomit- 
ing and  purging  are  sometimes  produced  by  an  emetic  of  ipecacuanha.* 

Like  other  nauseants  and  emetics,  ipecac  increases  the  secretions  of 
the  broncho-pulmonary  mucous  membrane,  and  is,  therefore,  held  to 
possess  expectorant  properties.  More  than  any  other  agent  of  the  class, 
it  relaxes  the  skin,  and  promotes  cutaneous  transpiration. 

Ipecacuanha  exerts  but  little  influence  over  the  circulation.  In  ani- 
mals, lethal  doses  of  emetine  cause  death  by  paralysis  of  the  muscles 
of  respiration,  the  heart  continuing  in  action  after  the  cessation  of  the 
respiratory  movements  (D'Ornellas).  The  temperature  of  the  surface 
falls,  but  the  internal  temperature  remains  the  same,  or  rises  somewhat, 
owing,  it  is  said  (D'Ornellas),  to  the  irritant  action  of  the  agent  on  the 
intestinal  mucous  membrane. 

In  the  post-mortem  examination  of  animals  killed  by  emetine,  very 
considerable  gastro-intestinal  irritation  is  found.  The  lungs  are  some- 
times seen  to  be  hyperaemic  and  presenting  patches  of  hepatization, 
and  sometimes  exsanguine,  but  the  former  condition  is  more  frequently 
observed.  As  the  most  common  state  of  the  lungs,  caused  by  lethal 
doses  of  ipecac,  is  similar  to  that  which  is  induced  by  section  of  the 
vagi,  it  is  a  reasonable  conjecture  that  it  has  a  special  action  on  these 
nerves — according  to  Chouppe,  on  the  terminal  filaments  of  the  vagi. 


SYSTEMIC  EMETICS.  739 

The  elimination  of  emetine  takes  place  in  large  part  by  the  gastro- 
intestinal mucous  membrane,  and  it  is  found  in  the  secretions. 

The  physiological  actions  of  the  alkaloids  of  ipecacuanha  have 
been  reported  on  by  Wild,  and  his  conclusions  are  represented  in  the 
following  summary  :  Both  cephaeline  and  emetine  possess  a  powerful 
emetic  action,  but  the  dose  required  to  produce  emesis  was  twice 
greater  for  emetine,  but  the  nausea  preceding  vomiting  was  twice 
greater  with  cephaeline.  Both  lower  the  arterial  tension,  but  more 
depression  was  caused  by  emetine.  Both  cause  contraction  of  the 
blood-vessels,  but  emetine  is  the  more  active.  Both  cause  slowing 
and  weakening  of  the  heart's  action  in  about  the  same  degree.  Both 
act  as  muscle  poisons,  but  cephaeline  has  the  greater  effect,  and  also 
acts  on  the  motor  nerve  endings,  causing  muscular  contraction.  Sali- 
vation was  caused  by  both,  and  a  flow  of  nasal  mucus  by  emetine. 
Both  apparently  increased  peristalsis,  and  gave  rise  to  loose  motions 
without  any  distinct  purgative  action.  No  effect  was  observed  on  the 
skin  or  kidneys  by  either  alkaloid. 

Wild  concludes  that  cephaeline  may  prove  useful  as  an  emetic, 
without  depressing  effects,  in  doses  of  from  one  twelfth  to  one  sixth 
of  a  grain.  It  is  too  slow  in  action,  however,  for  cases  of  poisoning. 
As  an  expectorant  in  catarrhal  and  febrile  conditions,  emetine  would 
seem  to  be  indicated  in  doses  of  from  one  sixth  to  one  third  of  a  grain. 
The  effect  it  has  in  causing  contraction  of  the  vessel  explains  the  util- 
ity of  ipecacuanha  in  haemorrhage,  and  indicates  the  special  value  of 
emetine  for  this  purpose. 

THERAPY. — As  both  the  alkaloids  of  ipecacuanha  have  a  decided 
emetic  property,  they  may  be  utilized  under  the  same  conditions  and 
with  the  same  limitations  as  the  powder  of  the  root.  As  they  can  be 
used  subcutaneously,  they  present  obvious  advantages  in  many  stom- 
achal and  other  diseases.  Although  emetine  is  slower  in  action,  it 
causes  less  nausea  and  systemic  disturbance  than  cephaeline.  As  these 
alkaloids  increase  secretion,  nasal  and  intestinal,  and  also  promote  peri- 
stalsis, they  can  be  prescribed  instead  of  ipecacuanha  in  torpor  of  the 
liver,  constipation  from  insufficient  secretion  of  the  intestinal  glands, 
etc.  Just  as  ipecacuanha  is  now  prescribed  as  an  expectorant  in  cases 
of  broncho-pulmonary  catarrh,  ordinary  coughs,  asthma,  and  similar 
affections,  emetine  may  now  be  substituted.  As  a  remedy  in  pul- 
monary haemorrhage,  in  menorrhagia,  purpura,  and  similar  morbid 
states,  emetine  will  no  doubt  prove  efficient.  It  is  probable  that  in 
uterine  hcemorrhage,  under  the  conditions  named  in  the  paragraph  on 
that  subject,  emetine  subcutaneously  may.  prove  an  efficient  substitute 
for  the  crude  drug.  Until,  however,  more  facts  are  accumulated  and 
the  true  powers  of  the  alkaloids  are  determined  by  clinical  trials,  it  is 
probable  that  the  crude  drug,  or  its  preparations,  will  continue  to  be 
preferred.  For  therapeutic  purposes,  the  most  efficient  preparation  is 


740  EVACUANTS. 

the  fluid  extract.  The  dose  of  this  is  so  small  and  its  efficiency  so 
decided,  that  on  the  score  of  convenience  as  well  as  power  it  has  many 
advantages  as  compared  with  the  powder. 

For  ordinary  purposes  no  emetic  is  more  safe  and  efficient  than  ipe- 
cacuanha. As  it  causes  but  little  depression,  and  is  free  from  irritant 
effects  in  ordinary  doses,  it  may  be  given  in  conditions  of  the  system 
in  which  tartar-emetic  and  the  other  mineral  emetics  are  inadmissible. 
When  the  stomach  is  to  be  relieved  of  undigested  aliment,  ipecacuanha 
is  the  most  suitable  emetic.  Attacks  of  acute  indigestion,  migraine, 
and  the  so-called  bilious  sick-fteadache,  may  not  unfrequently  be  cut 
short  by  an  ipecac-vomit.  The  good  effects  of  the  vomitive  treatment 
are  not  unfrequently  most  strikingly  exhibited  in  the  beginning  of 
continued  fevers,  the  eruptive  fevers,  erysipelas,  and  periodical  fevers. 
It  has  been  alleged  that  fevers  are  sometimes  "  aborted  "  in  this  way. 
In  denying  the  possibility  of  such  results,  it  must  be  admitted  that 
clinical  experience  has  shown  the  good  effects  of  the  practice  on  the 
subsequent  course  of  the  malady.  Formerly  an  ipecacuanha-emetic 
was  much  more  frequently  employed  at  the  outset  of  fevers  than  is  the 
fashion  at  present,  and  the  author  is  convinced  that  this  mode  of  treat- 
ment should  be  resorted  to  now  in  suitable  cases.  The  indications  for 
the  use  of  emetic  doses  of  ipecacuanha,  in  the  fevers  above  named,  are 
these  :  a  heavily  coated  tongue,  much  nausea  and  ineffectual  efforts  to 
vomit,  a  strong  sense  of  epigastric  oppression,  icterus  or  an  icterode 
hue  of  the  surface,  a  hot  and  dry  skin,  acid  and  turbid  urine.  When 
these  symptoms  are  present  in  cases  of  malarial  fever,  the  antiperiodic* 
remedies  will  be  much  more  effective  in  their  action  if  their  adminis- 
tration has  been  preceded  by  an  ipecacuanha- emetic. 

In  all  the  cases  in  which  emetics  are  employed  for  mechanical  effects, 
as  in  membranous  croup,  capillary  bronchitis,  foreign  bodies  lodged, 
etc.,  ipecacuanha  may  be  used.  In  croup  it  is  not  so  effective  as  the 
yellow  subsulphate  of  mercury  ;  in  capillary  bronchitis,  as  tartar-emetic; 
but,  as  respects  the  latter  disease,  ipecacuanha  is  to  be  preferred  in  the 
very  young  or  very  old,  and  in  those  debilitated  by  any  cause.  In  the 
domestic  treatment  of  laryngismus  stridulus  an  emetic  dose  of  the 
sirup  of  ipecac  is  the  most  usual  remedy. 

As  an  emetic,  twenty  grains  of  the  powder  of  ipecacuanha  may  be 
diffused  in  a  cup  of  warm  water,  and  a  tablespoonf ul  of  the  mixture 
exhibited  every  fifteen  minutes  until  emesis  occurs.  Two  grains  may 
cause  vomiting  ;  and  four  grains  will  usually  act  efficiently  ;  hence  a 
good  method  of  proceeding,  when  an  emetic  effect  is  desired,  is  to  ex- 
hibit a  powder  of  four  grains  in  a  tablespoonful  of  warm  water  every 
fifteen  minutes  until  vomiting  occurs.  The  action  will  be  facilitated 
by  drinking  freely  of  warm  water ;  but,  if  the  systemic  impression  of 
the  ipecacuanha  is  desired,  the  patient  should  retain  the  recumbent  post- 
ure, and  all  fluids  should  be  withheld.  If  the  cathartic  as  well  as  the 


SYSTEMIC  EMETICS.  741 

emetic  action  is  sought  for,  some  weak  animal  broth  should  be  given 
when  the  stomach  is  emptied  of  its  contents.  If  free  action  of  the 
skin  is  to  be  promoted,  as  soon  as  the  vomiting  has  ceased,  warm 
aromatic  infusions  should  be  administered,  and  the  patient  should  be 
covered  with  blankets. 

It  has  long  been  known  that  ipecacuanha,  in  small  doses,  has  the 
power  to  arrest  certain  kinds  of  vomiting.  Attention  has  recently  been 
recalled  to  this  curious  fact.  It  is  in  nervous  vomiting  more  especially 
that  this  remedy  is  useful :  for  example,  in  the  vomiting  of  'pregnancy ', 
vomiting  of  drunkards,  vomiting  of  migraine,  etc.  A  minim  of  the 
vinum  ipecacuanhae,  given  every  half-hour  or  hour  in  a  little  water,  will 
sometimes  relieve  these  cases  in  a  very  remarkable  manner.  It  fails 
much  more  often  than  it  succeeds,  and  the  author  has  never  yet  seen 
an  instance  of  its  successful  use  in  this  way.  The  belief  in  this 
action  is  largely  traditional — even  apocryphal. 

It  is  a  singular  fact,  showing  the  remarkable  phases  through  which 
professional  opinion  passes,  that  ipecacuanha,  which  was  introduced  at 
the  close  of  the  seventeenth  century  as  a  remedy  for  dysentery,  after  a 
time  ceased  to  be  employed  in  this  disease,  but  has  again  been  restored 
to  the  estimation  in  which  it  was  originally  held.  Epidemic  dysentery, 
especially  of  malarious  and  tropical  countries,  is  the  form  of  the  disease 
to  the  cure  of  which  ipecacuanha  seems  best  adapted.  The  author  has 
used  it  with  much  success  in  acute  dysentery,  as  it  occurs  in  the  interior 
valley  of  this  continent.  When  the  characteristic  ipecacuanha-stools 
are  produced,  the  tormina  and  tenesmus  cease,  and  the  dejections  soon 
become  fecal ;  the  skin,  previously  dry  and  hot,  becomes  moist  and 
cool,  and  a  refreshing  calm  is  experienced.  Large  doses  of  ipecacuanha 
are  required  in  the  treatment  of  acute  dysentery.  In  the  severe  attacks 
of  tropical  regions,  from  twenty  to  sixty  grains  are  given  for  the  initial 
dose,  and  the  quantity  subsequently  administered  depends  on  the  effect 
— usually  about  twenty  grains  every  four,  six,  or  eight  hours.  It  is 
important  to  establish  tolerance  of  the  remedy  as  speedily  as  possible. 
If  the  first  dose  be  rejected,  subsequent  ones  may  be  retained.  Various 
expedients  may  be  resorted  to  in  order  to  secure  the  retention  of  these 
large  doses.  The  ipecacuanha  may  be  combined  with  some  opium  and 
aromatic  powder  :  3  Ipecacuanha,  3  ss  ;  opium,  gr.  j  ;  pulv.  aromat., 
grs.  v.  M.,  ft.  pulv.  no.  j.  After  the  dose  of  ipecacuanha  is  adminis- 
tered, a  sinapism  may  be  applied  to  the  epigastrium,  and  an  enema  of 
laudanum  and  starch,  or  the  subcutaneous  injection  of  morphine,  may 
be  practiced.  Milk  is  an  excellent  vehicle  for  the  administration  of  ipe- 
cacuanha. In  the  cases  of  dysentery  treated  on  this  plan  by  the  author, 
he  has  found  that  doses  of  fifteen  grains,  given  in  milk,  were  generally 
pretty  well  borne.  It  not  unfrequently  happens,  however,  that  toler- 
ance can  not  be  established,  and  the  remedy  must  then  be  abandoned. 
Some  patients  so  object  to  the  nausea  produced  by  it  as  to  be  reluctant 


742  EVACUANTS. 

to  take  it,  and  others,  after  one  trial,  decline  to  continue  the  treatment 
!N  otwithstanding  these  drawbacks,  it  must  be  conceded  that  ipecacu- 
anha is  a  most  valuable  remedy  in  epidemic  and  sporadic  dysentery. 
It  has  been  shown  that  in  India,  before  the  introduction  of  this 
method  of  treatment,  the  mortality  from  dysentery  was  about  79*6 
per  one  thousand  of  cases  ;  but,  since  the  use  of  ipecacuanha  has 
been  generalized,  the  mortality  has  fallen  to  20*15  per  one  thousand 
of  cases. 

Ipecacuanha  has  also  been  used  with  success  in  chronic  dysentery, 
but,  in  the  author's  experience,  it  is  by  no  means  so  beneficial  as  in  the 
acute.  It  succeeds  best  in  those  cases  which  are  the  outgrowth  of  acute 
attacks,  and  in  which  the  intestinal  ulcerations  are  not  far  advanced. 
The  rules  for  its  administration  are  the  same  in  chronic  as  in  acute  dys- 
entery. In  the  summer  dysentery  and  diarrhoea  of  teething  children, 
ipecacuanha  is  often  extremely  serviceable.  The  special  indication  for 
its  use  is  the  occurrence  of  greenish  stools,  containing  mucus  and  some- 
times blood.  These  stools  are  usually  voided  with  much  pain  and 
straining.  At  the  same  time  the  skin  is  harsh  and  dry,  the  tongue 
rather  dry  and  pasty,  or  glazed,  and  there  is  great  thirst,  although  the 
fever  may  not  be  high.  Ipecacuanha  changes  the  character  of  the 
stools,  induces  perspiration,  and  allays  the  thirst  and  dryness  of  the 
mouth.  From  two  to  five  grains  every  two  hours  may  be  given  in  these 
cases,  or  it  may  be  administered  with  pepsin,  oxide  of  zinc,  bismuth, 
or  other  remedies.  $  Ipecacuanhas,  grs.  xij ;  bismuthi  subcarb.,  3  j  ; 
pepsinae  sacch.,  3  ss.  M.,  ft.,  pulv.  no.  xij.  Sig.  :  One  in  milk  every* 
two  hours. 

The  evidence  is  conclusive  that  ipecacuanha  possesses  very  valuable 
antihaemorrhagic  powers.  It  has  been  successful  in  hemoptysis,  epis- 
taxis,  menorrhagia,  post-partum  hcemorrhage,  etc.  As  Peter  has  ob- 
served, "  the  vomitive  medication "  (ipecacuanha)  "  arrests  not  only 
haemoptysis  but  all  kinds  of  haemorrhage,  and  is,  therefore,  a  general 
antihaemorrhagic  medication."  In  haemorrhages  the  ipecacuanha  should 
be  given  in  frequently-repeated  doses  until  vomiting  ensues  ;  usually, 
when  this  effect  is  produced  the  haemorrhage  ceases.  Other  antihsem- 
orrhagic  agents  may  be  combined  with  ipecacuanha.  IjL  Ext.  ipecac, 
fluidi,  3  ij  ;  ext.  ergotae  fluidi,  3  iv  ;  ext.  digitalis  fluidi,  3  ij.  M. 
Sig.  :  Thirty  minims  to  a  teaspoonful  at  a  dose,  as  required.  The 
author  has  witnessed  excellent  results  from  this  combination  in  hae- 
moptysis and  menorrhagia.  In  the  treatment  of  post-partum  haemor- 
rhage, the  most  suitable  combination  is  fluid  extract  of  ipecacuanha 
and  fluid  extract  of  ergot.  Trousseau  strongly  urges  the  employment 
of  ipecacuanha  in  post-partum  haemorrhage,  and,  indeed,  in  the  various 
accidents  which  occur  in  the  puerperal  state,  and,  above  all  others,  as 
respects  the  utility  of  the  treatment — puerperal  dysentery — in  which 
the  author  has  verified  Trousseau's  statements.  "  He  has  not  observed 


SYSTEMIC  EMETICS.  743 

the  least  ill-result  from  this  practice  ;  on  the  contrary,  in  the  most  of 
these  cases,  he  has  obtained  either  a  cure  or  a  notable  amendment." 

Certain  acute  affections  of  the  broncho-pulmonary  mucous  mem- 
brane are  much  benefited  by  non-emetic  doses  of  ipecacuanha  ;  for 
example,  acute  catarrh  of  the  nasal  and  bronchial  mucous  membrane, 
hay-asthma,  capillary  bronchitis.  An  emetic  dose  will  cut  short  an 
attack  of  laryngismus  stridulus.  An  occasional  emetic  gives  great 
relief  in  whooping-cough,  when  there  is  profuse  bronchial  secretion. 
Non-emetic  doses  of  the  fluid  extract  (TTJ,  j — TJI  iij)  diminish  the  violence 
of  the  spasms  in  this  disease.  Nauseating  and  emetic  doses  are  ser- 
viceable in  the  attacks  of  spasmodic  asthma,  but  the  good  effects  of  the 
remedy  are  lost  by  repetition.  Ordinary  colds,  especially  in  children, 
are  benefited  by  doses  sufficient  to  produce  slight  nausea  but  not  vomit- 
ing. A  troublesome  cough  at  night,  which  prevents  sleep,  may  not 
unfrequently  be  arrested  by  a  dose  at  bed-hour  of  some  one  of  the 
ipecacuanha  preparations.  For  these  various  purposes  the  wine  or  the 
fluid  extract  may  be  used,  but  the  latter  preparation  is  much  more 
trustworthy  and  effective  than  the  former,  if  genuine. 

Authorities  referred  to  : 

CHOUPPE,  M.     Archives  de  Physiologic,  No.  1,  1875,  p.  101. 

D'ORNELLAS,  DR.  ANTOMO-EVARISTO.  Du  Vomissement,  etc.  Bulletin  Gen.  de  Therap., 
vol.  Ixxxiv,  pp.  193,  244,  295,  348. 

DUCKWORTH,  DR.  DTCE.     St.  Bartholomew's  Hospital  Reports,  vol.  v,  p.  287,  1869. 

FLTJCKIGER  AND  HAXBURY.     Pharmacographia,  article  Ipecacuanha. 

FULLER,  C.  C.     London  Lancet,  December  4,  1869.     On  the  Action  of  Ipecacuanha, 

HUSEMANN,  DR.  THEODOR.  Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Bandf 
p.  608,  et  seq. 

PETER,  M.  MICHEL.  A  propos  des  Hemoptysies  et  de  leur  Traitement  par  la  Medication 
Vomitive.  Bulletin  Gen.  Therap.,  vol.  Ixxvii. 

PHILLIPS,  DR.  C.  D.  F.  On  the  Actions  and  Uses  of  Ipecacuanha.  The  Practitioner, 
vol.  iii,  p.  276,  et  seq. 

IBID.     Materia  Medica  and  Therapeutics,  article  Ipecacuanha. 

RINGER,  DR.  SYDNEY.     Handbook  of  Therapeutics. 

TROUSSEAU  ET  PIDOUX.  Traite  de  Therapeutique  et  Mat.  M'ed.,  huitifeme  edition,  vol. 
i,  p.  733,  et  seq. 

Antimonii  et  Potassii  Tartras. — Antimonium  and  Potassium  Tar- 
trate. — Tartar-emetic. 

This  is  a  powerfully  spoliative  and  depressing  emetic,  which  has 
already  been  discussed  under  the  head  of  "  Agents  promoting  Destruc- 
tive Metamorphosis."  It  was  formerly  much  employed  as  an  emetic 
in  croup,  capillary  bronchitis,  and  at  the  onset  of  fevers  and  inflamma- 
tions ;  but  the  local  irritation,  as  well  as  the  systemic  depression  which 
follows,  has  led  to  its  almost  entire  disuse  for  these  purposes  ;  but,  in 
the  author's  judgment,  not  wisely  in  toto. 

ADMINISTRATION. — Six  grains  may  be  dissolved  in  four  ounces  of 
water,  and  a  tablespoonf ul  be  given  every  fifteen  minutes  until  emesis 


744  EVACTJANTS. 

occurs.     Ipecacuanha  and  tartar-emetic  are  frequently  administered 
together — twenty  grains  of  the  former  and  two  grains  of  the  latter. 

CATHARTICS. 

Purgatives  are  divisible  into  several  groups,  according  to  the  nature 
of  their  action. 

Laxatives  are  medicines  which  stimulate  the  intestinal  movements, 
without  increasing  to  any  considerable  extent,  at  least,  the  intestinal 
secretions. 

Saline  Purgatives  excite  increased  secretion,  while  at  the  same 
time  they  hasten  the  peristaltic  action.  The  dejections  which  are 
produced  by  them  are  loose  and  watery. 

Mercurial  Purgatives,  chiefly  calomel  and  blue  mass,  exert  an  in- 
fluence peculiar  to  themselves.  Without  expressing  an  opinion  at 
present,  for  or  against  their  supposed  cholagogue  effects,  the  author 
believes  that  they  differ  so  much  in  their  action  from  other  purgatives 
as  to  be  appropriately  placed  in  a  separate  class. 

Tonic-astringent  and  Resin-bearing  Purgatives. — These  affect  the 
liver  and  the  glandular  appendages  of  the  mucous  membrane,  and  in- 
crease the  tonicity  of  the  muscular  layer  of  the  intestine.  They  in- 
crease the  proper  secretion  of  the  glands,  and  do  not  merely  cause  an 
outward  diffusion  from  the  vessels  into  the  canal. 

Hydragogue  Purgatives  act  with  great  energy,  and  not  only  in- 
crease the  glandular  secretions,  but  cause  a  very  abundant  outward 
diffusion,  so  that  the  dejections  which  they  produce  are  extremely* 
watery.     This  group  of  purgatives  also  excite  very  rapid  and  violent 
peristaltic  movements. 

Laxatives. — Manna. — Manna.  The  concrete,  saccharine  exudation, 
in  flakes,  of  Fraxinus  ornus  Linne  (Nat.  Ord.  Oleacece).  Dose,  3  j — 
|  ij,  according  to  age. 

COMPOSITION  AND  PROPERTIES. —  Manna  has  a  sweetish,  rather 
mawkish  taste  ;  is  soluble,  when  pure,  in  three  parts  of  cold  water,  and 
in  its  own  weight  of  boiling  water.  It  contains  a  sugar — manna- 
sugar  or  mannite,  which  constitutes  from  seventy  to  eighty  per  cent 
of  the  best  specimens  of  manna.  It  is  said  to  contain  dextrin,  or  a 
mucilage  having  similar  reactions,  and  ether  extracts  from  it  in  small 
quantity  a  slightly  acrid,  reddish-brown  resin,  on  which  the  laxative 
property  of  manna  probably  depends. 

ACTIONS  AND  USES. — Manna  is  a  very  mild  laxative,  but,  when 
administered  alone,  is  apt  to  cause  griping.  It  is  rather  slow  in  its 
operation,  but  is  free  from  irritating  qualities,  and  leaves  no  unpleas- 
ant after-effects.  It  is  most  frequently  combined  with  other  purga- 
tives— senna  chiefly — the  operation  of  which  it  aids,  and  at  the  same 
time  renders  less  drastic.  It  is  rarely  given  alone,  and  only  to  chil- 


CATHARTICS.  745 

dren   and  pregnant  women.     Formerly  it  was  used  as  a  laxative  in 
hsemorrhoidal  affections. 

Sulphur. — Sulphur  lotum  (washed  sulphur).  Sulphur  sublimatum 
(sublimed  sulphur).  Washed  sulphur  only  should  be  used  as  a  laxa- 
tive. Sublimed  sulphur  contains  a  trace  of  acid  which  imparts  to  it  a 
griping  quality.  Dose,  3  j —  3  iij. 

ACTIONS  AND  USES. — Sulphur  is  insoluble  in  water,  but  dissolves  in 
alkaline  solutions  and  in  the  volatile  and  fixed  oils.  In  the  small  in- 
testine, sulphur  is  placed  under  favorable  conditions  for  absorption. 
That  it  does  enter  the  blood  is  proved  by  the  fact  that  it  appears  in 
the  perspiration,  urine,  milk,  etc.  Silver  coins,  carried  in  the  pockets 
of  those  taking  sulphur,  are  discolored  by  the  formation  of  the  sul- 
phide of  silver.  Considerable  sulphureted-hydrogen  gas  is  produced 
as  a  result  of  the  chemical  changes  in  the  intestines,  and  a  quantity  of 
offensive  flatus  is  an  unpleasant  sequel  of  its  administration.  The  in- 
testinal secretions  are  somewhat  increased  by  it,  and  the  stools  are 
therefore  softer.  It  is  a  very  mild  laxative.  Combination  of  sulphur 
and  bitartrate  of  potassa  or  magnesia  is  occasionally  resorted  to,  es- 
pecially in  domestic  practice,  for  the  purpose  of  increasing  the  laxative 
action. 

Sufficient  attention  has  already  been  paid  to  the  sulphur  compounds, 
and  it  only  now  remains  to  speak  of  sulphur  as  a  laxative.  It  is  used 
chiefly  to  render  the  stools  softer  and  more  easily  voided  in  cases  of 
hemorrhoids,  fissures  of  the  anus,  and  after  surgical  operations  about 
the  pelvic  organs.  It  is  used  also  as  a  laxative  in  skin-diseases,  chronic 
rheumatism,  sciatica,  and  lead-cachexia,  conjoined  usually  with  sul- 
phur-baths, the  sulphurous  mineral  waters,  and  other  appropriate  med- 
ication. 

PULVIS  GLYCYRBHIZ^E  COMPOSITUS  is  an  efficient  laxative.  It  is 
made  as  follows  :  Senna-leaves,  eighteen  parts  ;  licorice-root,  sixteen 
parts  ;  fennel-seeds,  eight  parts  ;  washed  sulphur,  eight  parts  ;  re- 
fined sugar,  fifty  parts.  M.  Sig.  :  A  teaspoonful  at  a  dose. 

Magnesia. — Magnesia. — Light  magnesia.  A  white,  very  light  and 
very  fine  powder,  slowly  absorbing  carbonic  acid  from  the  air,  odorless, 
having  an  earthy  but  no  saline  taste,  and  a  faintly  alkaline  reaction 
when  moistened  with  water.  It  is  almost  insoluble  in  water,  or  in  alco- 
hol, etc.  Dose,  3  ss —  3  ij,  or  more. 

Magnesia  Ponderosa. — Heavy  magnesia.  A  white,  dense,  and 
very  fine  powder,  corresponding  in  all  other  properties  to  the  above. 
Dose,  3  ss —  3  ij. 

Magnesii  Carbonas. — Magnesium  carbonate.  Light,  white,  fria- 
ble masses,  or  a  light,  white  powder,  odorless  and  tasteless,  insoluble 
in  alcohol,  and  almost  insoluble  in  water.  Dose,  3  ss —  3  ij. 


746  EVACUANTS. 

Mistura  Magnesias  et  Asafoetidce. — Mixture  of  magnesia  and  asa- 
fcBtida.  (Carbonate  of  magnesium,  five  parts  ;  tincture  of  asafoetida, 
seven  parts  ;  tincture  of  opium,  one  part  ;  sugar,  ten  parts  ;  and  suffi- 
cient distilled  water  to  make  up  one  hundred  parts.  Dewees's  for- 
mula.) Dose,  one  fourth  to  one  teaspoonful. 

ACTIONS  AXD  USES. — A  mild  antacid  laxative.  In  the  stomach  it 
neutralizes  any  free  acid  it  meets  with,  and  the  resulting  salt  has  a 
laxative  action.  It  is  used  to  correct  acidity,  the  carbonate  being  pre- 
ferred when  there  is  an  irritable  state  of  the  stomach,  because  the 
carbonic  acid,  which  is  set  free  by  the  action  of  the  stomach  acid,  is  a 
local  sedative  and  anodyne.  If  magnesia  does  not  enter  into  combi- 
nation with  the  stomach  acid,  no  laxative  effect  is  produced.  Under 
these  circumstances  a  solution  of  citric  acid  or  lemonade,  taken  after 
the  magnesia,  will  cause  it  to  act.  Magnesia  is  a  useful  antacid  and 
laxative  in  sick-headache,  especially  when  accompanied  by  acidity  and 
constipation.  It  has  been  employed  also  in  gouty  affections,  and  in 
lithiasis  (uric  acid)  ;  but  it  is  much  inferior  to  the  potash  salts  in 
these  affections.  In  the  intestinal  indigestion  of  infants,  attended 
with  flatulence,  magnesia  is  much  prescribed  in  conjunction  with  car- 
minatives. Dewees's  formula  for  flatulent  colic  and  diarrhoea  in  in- 
fants has  been  made  official,  and  is  given  above  as  Mistura  Magnesice 
et  Asafcetidce.  The  carminative  of  Dalby  is  similar  in  composition  :  IJ 
Magnesii  carbonat,  3ij  ;  ol.  menth.  pip.,  gt.  j  ;  ol.  myrist.,  gtt.  ij  ;  ol. 
anisi,  gtt.  iij  ;  tinct.  castor.,  gtt.  xxx  ;  tinct.  asafcetid.,  gtt.  xv  ;  tinct. 
ol.  hedeomae,  gtt.  xv  ;  tinct.  cardam.  comp.,  gtt.  xxx  ;  aquae  menthsfr 
pip.,  |  ij.  M.  Sig.  :  A  teaspoonful,  as  necessary. 

Magnesia  is  frequently  combined  with  other  purgatives  because  of 
its  antacid  property.  The  following  is  Meigs's  formula,  gelsemium 
having  been  substituted  for  henbane  :  ]J  Magnesii  carb.,  3  ss  ;  mag- 
nesii  sulphat.,  3  iij  ;  spts.  ammonias  aromat.,  3  j  ;  tinct.  rhei,  §  ss  ;  tinct. 
gelsemii,  3  ss  ;  aquae  menthae  pip.,  §  iv.  M.  Sig.  :  A  tablespoonful 
two  or  three  times  a  day. 

It  is  unsafe  to  use  magnesia  in  large  quantity  for  lengthened 
periods,  owing  to  the  fact  that  it  may  form  intestinal  concretions 
—  a  hydrate  of  magnesia.  Instances  of  this  kind  have  been  re- 
ported. 

Freshly-precipitated  hydrate  of  magnesia  is  an  antidote  to  arseni- 
ous  acid  in  solution,  but  it  is  not  so  effective  as  the  hydrated  sesqui- 
oxide  of  iron. 

Fel  Bo  vis. —  Ox-gall. — The  fresh  bile  of  -Z?os  Taurus  Linne  (class 
Mammalia;  order,  Ruminantid). 

DESCRIPTION. — A  brownish-green  or  dark-green,  somewhat  viscid 
liquid,  having  a  peculiar  odor,  a  disagreeable,  bitter  taste,  and  a  neu- 
tral or  faintly  alkaline  reaction. 


CATHARTICS.  747 

Pig's-gall,  which  can  be  procured  in  any  desired  quantity,  should 
be  substituted  for  ox-gall,  as  it  conforms  more  nearly  to  the  charac- 
teristics of  human  bile. 

Fel  Bovis  Purificatum. — Purified  Ox-gall. — Fresh  ox-gall  precipi- 
tated by  alcohol  and  evaporated  to  the  proper  consistence  for  a  pill- 
mass.  Dose,  gr.  x —  3  j. 

ACTIONS  AND  USES. — The  above-mentioned  preparations  of  ox-gall 
have  a  liquefying  effect  on  the  bile  ;  they  increase  the  duodenal  secre- 
tions, emulsionize  fats,  and  quicken  the  peristalsis  of  the  intestines. 
Hence,  they  are  laxative.  Ox-gall  has  been  given  with  some  success 
in  those  disorders  of  the  intestinal  canal  characterized  by  the  absence 
of  some  secretions,  and  the  diminution  of  others,  by  foul  odor  of  the 
stools  due  to  decomposition,  and  in  jaundice,  when  the  bile  is  retained 
in  the  liver  because  of  inspissated  masses  that  block  the  common  duct, 
or  of  mucus  that  has  had  the  same  effect. 

Rhamnus  Purshiana. —  Cascara  Sagrada. — The  bark  of  Rhamnus 
Purshiana  De  Candolle  (Nat.  Ord.  Hhamnacece). 

Extractum  Ehamni  Purshiance  Fluidum. — Fluid  extract  of  rham- 
nus  Purshiana.  Dose,  ni  x —  3  ij. 

ACTION  AND  USES. — Under  the  name  cascara  sagrada  (sacred  bark) 
it  has  long  been  used  in  California  as  a  cathartic.  Besides  this  action, 
extraordinary  qualities  have  been  attributed  to  it.  The  taste  is  bitter, 
and  it  has  some  of  the  properties  of  substances  of  that  kind,  having 
the  effects  of  a  stomachic  tonic.  It  improves  appetite  and  digestion, 
and  increases  the  secretions  of  the  gastro-intestinal  canal,  in  consequence 
of  which  it  has  a  laxative  action.  In  this  combination  of  tonic  and 
cathartic  effects,  cascara  resembles  rhubarb  (Tcheltzaffon).  Although 
a  cholagague  action  is  ascribed  to  it,  there  is  no  reason  to  suppose  that 
it  possesses  this  property  in  any  higher  degree  than  rhubarb.  It  is  well 
adapted  for  the  relief  of  catarrhal  jaundice,  and  it  is  useful  in  cases  of 
dyspepsia  accompanied  by  constipation.  Habitual  constipation,  as  a 
merely  functional  state,  has  been  cured  by  it,  and  it  is  now  much  in  re- 
quest for  the  treatment  of  that  condition.  As  a  laxative,  for  the  relief 
of  haemorrhoids  and  affections  of  the  pelvic  organs,  it  is  quite  useful. 

Authorities  referred  to  : 

EYMERY,  DR.     These  de  Paris,  1884.     Quoted  by  Journal  de  Therapeutique,  1884. 
LIMOUSIN,  M.     Pharmacist.     Bulletin  General  de  Therapeutique  for  1884. 
TCHELTZAFFON,  DR.     Research  in  Professor  Botkin's  Laboratory.     Quoted  by  Virchow 
und  Hirscfts  Jahresbericht  for  1886. 

Oleum  Ricini. —  Castor-oil.  Huile  de  ricin,  Fr.  ;  Castordl,  Ger.  A 
fixed  oil  expressed  from  the  seed  of  Hicinus  communis  Linne  (Nat. 
Ord.  Euphorbiacece).  Dose,  3  j  —  §  j. 

PROPERTIES  AND  COMPOSITION. — Castor-oil  has  a  pale  amber-color, 
a  rather  nauseous  taste,  and  is  quite  viscid.  Cold  increases  the  viscid- 
ity. It  has  a  specific  gravity  of  about  0*96.  It  contains  several  fatty 


748  EVACUANTS. 

acids — palmitic  and  ricinoleic — the  latter  peculiar  to  castor-oil.  The 
seeds  appear  to  contain  a  drastic  constituent,  which  is  more  powerfully 
purgative  than  the  oil.  The  purer  the  oil,  the  less  active  its  purgative 
property. 

ACTIONS  AND  USES. — Castor-oil  is  a  mild  but  very  certain  and  effi- 
cient laxative.  It  operates  in  from  four  to  six  hours,  causing  but  little 
pain,  and  producing  copious  stools.  It  increases  but  slightly  the  in- 
testinal secretions — hence  the  stools  are  not  very  liquid.  Its  purgative 
principle  enters  the  blood,  and  the  milk  of  the  mother  may  in  this 
way  acquire  a  purgative  property.  It  does  not  appear  to  have  any 
effect  upon  the  hepatic  secretion.  Rohrig's  experiments,  which  dem- 
onstrated this  point,  have  been  confirmed  by  the  subsequent  investi- 
gations of  Rutherford  and  Vignal.  After  the  action  of  castor-oil  has 
been  completed,  it  may  not  unfrequently  be  seen  floating  on  the  stool ; 
yet  Buchheim  (Husemann)  has  been  unable,  after  careful  examination 
of  the  faeces,  to  discover  in  them  castor-oil  or  any  of  its  derivatives. 

Castor-oil  is  justly  held  in  great  esteem  as  a  laxative  for  children, 
for  pregnant  women,  for  the  puerperal  state.  When  hardened  faeces 
and  irritating  substances  are  to  be  removed  from  the  intestinal  canal, 
castor-oil  is  the  most  efficient  purgative  compatible  with  safety.  When 
inflamed  hcemorrhoids,  fissures  of  the  anus,  or  surgical  operations  on 
the  pelvic  viscera,  require  the  use  of  a  mild,  certain,  but  unirritating 
laxative,  castor-oil  should  be  selected.  Unfortunately,  its  taste  is  so 
repugnant  to  many  palates,  that  no  considerations  will  overcome  the 
disgust  which  it  excites.  No  remedy  is  more  useful  in  the  diarrhoea 
of  children,  induced  and  maintained  by  undigested  aliment  or  irritat* 
ing  secretions.  It  is  judicious  practice,  in  these  cases,  to  give  a  laxa- 
tive dose  of  castor-oil  to  empty  the  canal,  and  follow  it  with  an  opiate 
or  enema  of  laudanum.  The  dysentery  of  children,  and  sporadic  dys- 
entery of  adults,  especially  after  the  more  acute  febrile  symptoms  have 
subsided,  are  generally  very  successfully  managed  by  an  emulsion  of 
castor-oil :  3  Ol.  ricini,  §  j ;  mucil.  acaciae,  syrup,  simplicis,  aa  f  ss  ; 
aquae  cinnamomi,  f  ij.  M.  Sig. :  A  tablespoonful  every  four  to  six 
hours.  In  cases  of  dysentery,  when  there  are  much  pain,  tenesmus, 
and  frequent  passages,  ten  to  twenty  drops  of  laudanum  may  be  added 
to  each  dose  ;  when  there  are  much  depression,  a  low  state  of  the  ar- 
terial tension,  and  a  dry,  glazed  tongue,  five  drops  of  turpentine  may 
also  be  added. 

A  poultice  made  of  the  leaves  of  the  castor-oil  plant  applied  to  the 
breasts,  it  is  said,  has  the  power  to  promote  the  secretion  of  milk. 
Warm  applications  to  the  mammae  undoubtedly  stimulate  their  func- 
tional activity,  but  it  is  questionable  whether  castor-oil  leaves  have  a 
special  galactagogue  property.  It  is  said#  however,  that  the  inhabit- 
ants of  the  Cape  Verd  Islands  have  long  been  acquainted  with  this 
supposed  property.  The  internal  use  of  a  fluid  extract  of  the  leaves 


CATHARTICS.  749 

has  also,  it  is  supposed,  the  power  to  determine  an  increased  secretion 
of  milk.  Jaborandi  will  probably  prove  to  be  more  effective  in  this 
respect  than  the  ricinus  communis. 

Saline  Purgatives. — Many  of  these  have  been  discussed  elsewhere  ; 
some  of  them  are  no  longer  employed  in  medical  practice.  The  sul- 
phate and  the  citrate  of  magnesium  may  be  regarded  as  typical  repre- 
sentatives of  the  class,  and  hence,  in  a  statement  of  their  physiological 
actions  and  therapeutical  applications,  may  be  comprehended  all  that 
is  of  immediate  and  practical  value  on  the  subject. 

Magnesii  Sulphas. — Magnesium  sulphate.  Sulfate  de  magnate, 
Fr. ;  Bittersalz,  Ger.  In  colorless  crystals,  which  slowly  effloresce  on 
exposure  to  the  air,  and  are  very  soluble  in  water.  Dose,  3  j —  §  j. 

Magnesii  Citras  Effervescens. — A  white,  coarsely-granular  salt,  del- 
iquescent on  exposure  to  air,  odorless,  having  a  mildly  acidulous,  re- 
freshing taste,  and  an  acid  reaction.  Soluble  with  copious  efferves- 
cence in  two  parts  of  water  at  60°  Fahr.  ;  almost  insoluble  in  alcohol. 
Dose,  3  j —  3  iv. 

Liquor  Magnesii  Citratis. — Solution  of  citrate  of  magnesia.  Dose, 
|  iv —  |  viij.  A  tablespoonful  of  the  granular  salt  added  to  a  half- 
tumblerful  of  water,  and  drunk  during  effervescence,  is  the  quantity 
and  the  form  in  which  it  may  also  be  taken.  The  bottled  solution, 
which  is  also  highly  effervescent,  must  be  drunk  immediately  on  being 
poured  out.  It  is  a  pleasant  drink,  and,  when  properly  prepared,  an 
active  cathartic. 

PHYSIOLOGICAL  ACTIONS  OF  SALINE  PURGATIVES. — As  a  general 
rule,  saline  cathartics  are  easily  borne  by  the  stomach  ;  especially  is 
this  true  of  the  Epsom  salts.  The  purgative  action  is  due  chiefly  to 
increase  of  the  intestinal  secretions,  and  hence  the  stools  are  large  and 
watery.  Thiry  and  Radziejewski  had  apparently  demonstrated  that 
all  purgatives  acted  by  increasing  the  peristaltic  movements,  but  ex- 
actly opposite  results  have  been  obtained  by  Moreau,  whose  observa- 
tions have  been  confirmed  by  Vulpian  and  Brunton.  The  conclusion 
reached  by  the  last-named  observer  is  expressed  as  follows  :  "  Such 
positive  results  as  these  seem  to  prove  that  purgatives  do  cause  a  flow 
from  the  intestinal  wall,  quite  as  conclusively  as  experiments  with 
Thiry's  fistula  do  the  opposite  ;  and,  as  the  conditions  under  which  the 
purgatives  act  on  the  intestines  more  nearly  approach  the  normal  in 
Moreau's  than  in  Thiry's  experiments,  there  can  be  little  doubt  that 
purgatives  produce  a  decided  secretion  of  fluid  from  the  intestines,  as 
well  as  accelerate  peristaltic  movements."  Of  the  agents  employed 
by  Brunton  in  his  experiments — croton-oil,  elaterin,  gamboge,  jalapin, 
and  sulphate  of  magnesia — the  greatest  secretion  was  caused  by  the 
latter.  The  results  of  the  best  directed  experiments  are,  therefore,  in 


750  EVACUANTS. 

accord  with  clinical  observations,  and  it  may  hence  be  considered  as 
established  that  saline  cathartics  produce  an  outpouring  of  fluid  into 
the  intestinal  canal.  This  outward  osmosis  occurs  chiefly  from  the 
vessels,  and  is  not  truly  a  secretion  of  the  glandular  appendages  of  the 
mucous  membrane. 

THERAPY. — The  saline  purgatives  are  indicated  in  acute  inflamma- 
tory affections,  as  a  part  of  the  denutrition  treatment.  If  the  arterial 
tension  is  abnormally  high,  purgatives,  especially  the  salines,  lower  it, 
as  the  sphygmographic  tracings  show.  When  a  considerable  quantity 
of  serum  is  withdrawn  from  the  intestinal  vessels,  the  blood-pressure  is 
necessarily  diminished  elsewhere  (Brunton).  Free  transudation  from 
the  blood-vessels  of  the  intestinal  canal  lessens  the  amount  of  work 
which  the  kidneys  have  to  do,  and,  if  these  organs  are  hyperaemic,  re- 
moves the  congestion.  Saline  cathartics  are  therefore  very  important 
remedies  in  the  treatment  of  renal  and  cardiac  dropsy.  Free  purga- 
tion, also,  influences  the  condition  of  the  kidneys  by  reflex  action.  As 
a  result  of  the  lessened  hypersemia  of  the  kidneys,  the  diminution  of 
the  blood-pressure,  and  the  reflex  stimulation  of  these  organs,  the  ac- 
tion of  a  purgative  is  often  followed  by  greatly-increased  activity  of 
the  renal  function.  In  ascites  from  obstruction  of  the  portal  circula- 
tion, saline  cathartics  are  even  more  conspicuously  beneficial  than  in 
general  dropsy — for  in  this  case  they  affect  directly  the  organs  in- 
volved. Cholcemia,  uraemia)  oedema  of  the  brain,  increased  intra- 
cranial  blood-pressure  from  any  cause,  are  conditions  requiring  the  use 
of  active  saline  cathartics. 

The  most  important  applications  of  saline  cathartics  are  in  the  treat* 
ment  of  various  intestinal  disorders.  When  the  stomach  is  irritable, 
and  the  intestines  inflamed,  no  other  purgative  is  so  well  borne  as  Ep- 
som salts,  and  its  use  may  be  resorted  to  when  any  other  agent  of  the 
kind  would  be  inadmissible.  Impaction  of  the  caecum,  and  typhlitis 
resulting  from  this  cause,  may  be  removed  by  the  proper  administration 
of  this  remedy.  It  is  unsafe,  by  active  and  drastic  purgatives,  to  at- 
tempt to  unload  the  bowel — for  these  harsh  measures  will  only  aggra- 
vate the  existing  inflammation.  Epsom  salts  will  liquefy  the  fecal 
masses  and  deplete  the  vessels,  and  thus  remove  the  obstruction  with- 
out causing  any  irritation.  Small  doses  frequently  repeated  are  more 
suitable  than  a  large  purgative  dose.  Usually  about  a  teaspoonf  ul  in  a 
wineglassf  ul  of  water,  every  three  hours,  will  be  the  quantity  required. 
Perityphlitis  and  the  peritonitis  arising  from  inflammation  and  perfora- 
tion of  the  appendix  vermiformis  are  conditions  in  which  purgatives  of 
any  kind  are  inadmissible. 

The  constipation  which  accompanies  lead-colic  can  be  overcome  by 
Epsom  salts.  $  Magnesii  sulphatis,  f  j  ;  acidi  sulphuric,  dil.,  3  j ; 
aquse,  ^  iv.  M.  Sig. :  A  tablespoonful  every  three  hours.  As  Brunton 
has  pointed  out,  the  administration  of  Epsom  salts  is  a  very  important 


CATHARTICS.  751 

expedient  in  the  treatment  of  the  saturnine  cachexia.  Lead,  as  well 
as  other  minerals,  mercury  and  copper,  for  example,  is  eliminated  with 
the  bile,  and  is  discharged  into  the  intestine,  where  it  is  again  ab- 
sorbed. For  an  indefinite  period,  therefore,  the  absorption  and  dis- 
charge of  the  same  metal  may  be  going  on  ;  and  hence  the  utility  of 
giving  purgative  doses  of  Epsom  salts  during  the  treatment  of  lead- 
poisoning. 

The  most  efficient  treatment  of  acute  dysentery  is  by  the  adminis- 
tration of  sulphate  of  magnesia.  It  is  especially  adapted  to  the  acute 
stage  when  there  are  fever,  pain,  tenesmus,  and  stools  of  mucus  and 
blood.  It  lessens  the  hyperaemia  and  causes  fecal  evacuations,  with  the 
result  of  relieving  the  pain  and  the  distressing  straining.  It  is  admin- 
istered as  follows  :  Take  a  sufficient  quantity  of  sulphate  of  magnesia 
to  saturate  eight  ounces  of  water,  and  to  this  saturated  solution  add 
one  half  ounce  of  diluted  sulphuric  acid.  The  dose  of  this  is  a  table- 
spoonful  every  hour  or  two,  in  a  wineglassf ul  of  water,  until  it  oper- 
ates. Sulphate  of  morphine  may  be  combined  with  it,  or  starch  ene- 
mata  with  laudanum  may  be  employed. 

The  bleeding  from  haemorrhoids  may  sometimes  be  arrested  by  the 
above-described  solution  of  Epsom  salts  and  sulphuric  acid,  especially  if 
the  state  of  the  hsemorrhoidal  vessels  be  due  to  constipation.  Uterine 
haemorrhage  caused  by  the  presence  of  a  fibroid,  or  by  subinvolution, 
and  congestion  of  the  pelvic  viscera,  are  not  unfrequently  relieved  by 
the  same  agent  when  other  agents  apparently  more  powerful  fail. 
When  congestion  of  the  pelvic  organs,  constipation,  and  anaemia  coex- 
ist, the  following  is  an  efficient  remedy  :  ^  Magnesii  sulphat.,  §  j ;  ferri 
sulphat.,  manganesii  sulphat.,  aa  3j  ;  acid,  sulphur,  dil.,  3  ij  ;  aquae,  f  iv. 
M.  Sig.  :  A  tablespoonful  in  a  wineglassful  of  water  each  morning 
before  breakfast.  For  habitual  constipation  in  those  of  full  habit  and 
active  circulation,  a  daily  morning  dose  of  a  teaspoonf  ul  of  Epsom  salts 
is  often  a  permanently  effective  remedy. 

The  disagreeable  taste  of  Epsom  salts  is  perfectly  well  covered  by 
coffee.  Boil  for  two  minutes  in  an  earthen  vessel  one  ounce  of  sul- 
phate of  magnesia  and  two  and  a  half  drachms  of  roasted  coffee  in  a 
pint  of  water ;  then  remove  from  the  fire,  allow  it  to  "  draw "  for  a 
few  minutes,  and  strain. 

The  other  saline  purgatives  belonging  to  this  group  are  : 

Sodii  Sulphas,  sulphate  of  sodium,  Glauber's  salts, 

Potassii  Sulphas,  sulphate  of  potassium ;  but  both  of  these  have 
long  since  ceased  to  be  used. 

Sodii  Phosphas,  phosphate  of  soda, 

Potassii  et  Sodii  Tartras,  tartrate  of  potassium  and  sodium,  Ro- 
chelle  salts,  and 

Pulvis  Effervescens  Compositus,  effervescing  aperient  powders  or 
Seidlitz  powders,  have  been  considered  elsewhere. 
50 


752  EVACUANTS. 

Potassii  Bitartras,  bitartrate  of  potassium,  cremor  tartar,  may  also 
be  regarded  as  a  member  of  this  group,  although  it  has  but  feeble  pur- 
gative property. 

Mercurial  Purgatives. — As  the  actions  and  uses  of  the  mercurial 
preparations  have  been  sufficiently  discussed  elsewhere,  little  need  be 
said  in  addition  as  respects  their  applications  as  purgatives. 

Hydrargyri  Chloridum  Mite. — Mild  chloride  of  mercury.  Calo- 
mel. Dose  as  a  cathartic,  gr.  j — grs.  x. 

Massa  Hydrargyri. — Mercurial  pill.  Blue  mass.  Dose,  grs.  v — 
grs.  xv,  as  a  cathartic. 

ACTIONS  AND  USES. — These  mercurial  purgatives  are  rather  slow  in 
their  action.  A  dose  at  bedtime  will  usually  operate  during  the  course 
of  the  following  morning.  One  grain  of  calomel  or  five  grains  of 
mercurial  pill  will  produce  distinct  purgative  effects  in  most  persons 
in  about  twelve  hours,  unless  there  be  considerable  habitual  torpor  of 
the  bowels.  They  are  apt  to  cause  griping  pains,  nausea,  and  even 
vomiting,  when  the  purgative  effects  begin.  First  brownish  and  bad- 
smelling,  and  afterward  greenish  stools,  supposed  formerly  to  be  char- 
acteristic of  the  mercurial  action,  are  produced.  Much  heated  discus- 
sion has  arisen  as  to  the  cholagogue  action  of  mercury.  Without 
entering  into  details  on  this  point,  it  may  be  admitted  that  bile- 
elements  are  found  in  the  stools  from  the  action  of  mercury,  as  they 
are  unquestionably  found  in  the  stools  caused  by  some  other  purga- 
tives. The  presence  of  bile-elements  in  the  faeces  discharged,  only,, 
proves  that  mercurial  cathartics  swept  them  out  with  the  other 
contents  of  the  intestinal  canal,  and  does  not  prove  that  an  excitant 
action  was  exerted  on  the  secretory  function  of  the  liver.  The  stored- 
up  bile  in  the  gall-bladder  may  be  emptied  into  the  intestine  in  obe- 
dience to  a  reflex  influence  transmitted  from  the  intestinal  mucous 
membrane  irritated  by  the  purgative.  Experimental  investigations 
must  be  invoked  to  determine  the  question  whether  mercurials  actu- 
ally stimulate  the  liver  to  the  production  of  an  increased  quantity  of 
bile.  In  another  place  the  experiments  of  Hughes  Bennett's  Edin- 
burgh Committee  have  been  stated.  Since  the  report  of  that  commit- 
tee has  made  its  appearance,  the  very  accurate  and  painstaking  inves- 
tigations of  Rutherford  and  Vignal  have  been  published.  Rohrig  had 
already  determined  as  the  result  of  his  experiments  that  "  with  large 
doses  (twenty  grains  for  a  dog)  it  rarely  happened  that  the  secretion 
of  bile  was  recalled  after  it  had  come  to  a  standstill,  although  this 
agent  can  increase  the  secretion  when  it  is  only  diminishing."  Ruth- 
erford and  Vignal  arrived  at  the  following  conclusions  as  the  results 
of  their  experiments  with  calomel :  "  1.  An  increase  of  the  biliary  se- 
cretion followed  the  administration  of  two  successive  doses  of  ten 
grains  of-  calomel  in  one  case  (Experiments  30).  Diminution  of  the 


CATHARTICS.  753 

secretion  was  the  only  result  of  the  same  doses  given  under  similar 
circumstances  in  other  two  cases  (Experiments  31  and  32)  ;  and  it 
was  the  most  definite  result  of  the  administration  of  four  successive 
doses  of  three  grains  in  another  case  (Experiment  33).  2.  In  all  the 
four  experiments  the  calomel  had  a  purgative  effect.  3.  Analysis  of 
the  bile  secreted  during  the  calomel  purgation  in  Experiment  33 
showed  that,  notwithstanding  a  diminution  in  the  quantity  of  bile 
secreted,  the  percentage  amount  of  solids  had  become  less."  The 
results  of  experiment  render  it  probable  that  mercurials  do  not  in- 
crease the  secretion  of  bile  in  animals,  but  we  are  not  without  con- 
firmatory evidence  in  the  human  subject.  In  the  cases  of  biliary  fis- 
tulae  (accidental)  observed  by  Westphalen  and  Ranke,  no  increase,  but 
rather  a  diminution  in  the  amount  of  bile,  followed  the  exhibition  of 
calomel  in  purgative  doses. 

That  the  purgative  action  of  mercurials  has  a  distinctive  and  pe- 
culiar quality,  a  vast  clinical  experience  attests.  The  stools  are  rather 
different  from  those  caused  by  other  purgatives,  and  the  therapeutical 
effects  are,  it  is  generally  held,  sui  generis.  Whatever  peculiarity  per- 
tains to  the  purgative  action  of  mercurials  is  probably  due  to  the  fact 
that  they  greatly  increase  the  elimination  of  the  products  of  waste,  or 
retrograde  metamorphosis  of  tissue,  by  the  intestinal  glandular  appa- 
ratus. 

As  a  purgative,  the  use  of  mercury  is  restricted  to  those  cases  in 
which  a  deficiency  of  bile  is  supposed  to  be  the  cause  of  the  morbid 
state — clay-colored  stools,  jaundice  from  catarrh  of  the  gall-ducts  /  and 
to  those  cases,  singularly  enough,  in  which  bile  is  supposed  to  be  in  ex- 
cess— biliousness,  so  called,  jaundice  from  excessive  production  of  bile, 
etc.  For  further  remarks  on  the  actions  and  uses  of  mercury  the 
reader  is  referred  to  the  section  on  remedies  used  to  promote  destruc- 
tive metamorphosis. 

TONIC-ASTRINGENT  AND  RESIN-BEARING  PURGATIVES. 

Senna. — Senna.  The  leaflets  of  Cassia  acutifolia  Delile  (Alexan- 
dria senna),  and  of  Cassia  elongata  Vahl  (India  senna),  (Nat.  Ord. 
Leguminosce,  Ccesalpinacece).  (U.  S.  P.)  Feuittes  de  sene,  Fr.;  Sen- 
nesblatter,  Ger. 

Confectio  Sennce. — Confection  of  senna.  (Senna,  coriander-seed, 
licorice,  figs,  prunes,  tamarinds,  cassia.)  Dose,  3  j —  3  ij. 

Extractum  Sennce  Fluidum. — Fluid  extract  of  senna.     Dose,  §  ss. 

Infusum  Sennce  Compositum.  —  Infusion  of  senna.  (Senna,  60 
grm. ;  manna,  120  grm. ;  magnesium  sulphate,  120  grm.  ;  fennel,  20 
grm. ;  boiling  water,  800  c.  c. ;  cold  water  to  make  up  to  1,000  c.  c. 
Dose,  §  iv. 

Syrupus  Sennce. — Sirup  of  senna.     Dose,  3  ss —  3  ij. 

COMPOSITION. — The  active  constituents  of  senna  prove  to  be  a  pe- 


754  EVACUANTS. 

culiar  colloid  body,  and  an  acid,  to  which  has  been  given  the  name 
cathartic  acid.  It  has  been  shown  that  "  cathartate  of  ammonia  pos- 
sesses, in  a  concentrated  form,  the  purgative  activity  of  the  original 
drug."  Two  bitter  principles  have  been  obtained  from  senna — senna- 
crol  and  sennapicrin.  It  contains  also  a  peculiar  sugar — catharto- 
mannite. 

ACTIONS  AND  USES. — The  taste  of  senna  is  nauseous  and  bitter.  In 
infusion — the  form  in  which  it  is  most  usually  prescribed — it  is  most 
disagreeable  in  odor  as  well  as  taste.  It  produces  a  sense  of  warmth 
in  the  stomach,  and  causes  much  flatulence  and  griping,  which  may, 
however,  be  prevented  by  combination  with  aromatics.  Its  active 
principles  are  absorbed,  and  the  milk  of  the  mother  taking  senna  ac- 
quires a  purgative  property.  It  is  a  very  efficient  cathartic,  producing 
copious  liquid  stools  in  about  four  hours.  It  does  not  cause  inflamma- 
tion or  hypercatharsis,  and  its  purgative  action  is  not  followed  by  in- 
testinal torpor  and  constipation.  It  were,  therefore,  a  very  safe  and 
serviceable  cathartic,  if  it  were  not  so  disagreeable. 

The  confection  of  senna  is  a  palatable  preparation,  and  a  mild  laxa- 
tive, operating  without  any  disturbance.  It  is  used  chiefly  to  correct 
the  constipation  of  pregnancy,  but  it  is  highly  prized,  by  some  patients 
as  a  remedy  for  habitual  constipation.  It  is  also  taken  to  procure  soft 
and  easy  evacuations  in  haemorrhoids,  fissures  of  the  anus,  etc.  A 
large  bolus  (one  hundred  and  twenty  grains),  taken  at  bedtime,  will 
operate  gently  on  the  following  morning.  The  fluid  extract  of  senna 
is  a  form  for  the  administration  of  this  drug  more  agreeable  than  thg 
infusion.  These  two  preparations  are  very  excellent  cathartics  to  over- 
come constipation,  especially  when  ordinary  purgatives  fail. 

The  action  of  senna  is  much  improved  by  combination  with  other 
purgatives,  and  with  aromatics.  The  well-known  "  black  draught "  is 
an  infusion  of  senna  with  sulphate  of  magnesia — one  ounce  of  the  latter 
dissolved  in  four  ounces  of  the  former.  By  the  addition  of  coffee,  the 
odor  and  flavor  of  senna  may  be  rendered  more  tolerable.  Two 
drachms  of  senna  and  one  drachm  of  coffee  may  be  infused  in  three 
ounces  each  of  hot  milk  and  boiling  water,  and  the  whole  drunk  after 
twelve  hours. 

Rheum. — Rhubarb.  The  root  of  Rheum  officinale  Baillon  (Nat. 
Ord.  Polygonaeeoe).  Rhubarbe,  Fr.;  Rhabarber,  Ger. 

Extractum  Rhei. — Extract  of  rhubarb.     Dose,  gr.  x — gr.  xv. 
Extractum  Rhei  Fluidum. — Fluid  extract  of  rhubarb.     Dose,  3  ss 

-3ij. 

Pilulce  Rhei. — Rhubarb -pills.  Each  pill  contains  three  grains  of 
rhubarb  and  one  grain  of  soap. 

PiluloB  Rhei  Composite. — Compound  pills  of  rhubarb.  (Rhubarb, 
purified  aloes,  myrrh.)  Dose,  2 — 4  pills. 


CATHARTICS.  755 

Syrupus  Rhei. — Sirup  of  rhubarb.  (Fluid  extract,  §  iij ;  simple 
sirup,  3  xxix.)  Dose,  3  ss —  3  ij. 

Tinctura  Rhei  Aromatica. — Aromatic  tincture  of  rhubarb.  (Rhu- 
barb, cloves,  cinnamon,  nutmeg.)  Dose,  3  ss —  3  ij. 

Tinctura  Rhei. — Tincture  of  rhubarb.     Dose,  3  j —  §  ss. 

Tinctura  Rhei  Dulcis. — Sweet  tincture  of  rhubarb.     Dose,   §  ss — • 

iij- 

Vinum  Rhei. — Wine  of  rhubarb.  (Rhubarb,  calamus,  stronger 
white  wine. )  Dose,  3  j —  §  ss. 

Pulvis  Rhei  Compositus. — Compound  powder  of  rhubarb.  Dose, 
a  teaspoonful. 

COMPOSITION. — Rhubarb  contains  a  number  of  substances  which 
have  been  isolated,  but  its  composition  has  not  yet  been  accurately 
determined.  It  contains  two  acids,  rheo-tannic  and  rheumic,  a  resin- 
ous body,  phceoretin,  and  chrysophan,  or  chrysophanic  acid. 

PHYSIOLOGICAL  ACTIONS. — In  small  doses,  rhubarb  is  a  tonic  astrin- 
gent. It  promotes  the  appetite  and  the  digestive  power,  and,  by  virtue 
of  its  tannin,  is  astringent  and  diminishes  peristalsis.  As  it  contains 
also  a  purgative  principle,  in  sufficient  doses  cathartic  effects  follow  its 
administration.  The  stools  are  stained  by  the  coloring-matters  of  the 
rhubarb,  are  of  a  yellowish-brown  color,  and  are  rather  soft  without 
being  watery.  After  the  purgative  action  has  ended,  the  astringent 
constituents  assert  their  power  and  constipation  results.  As  the  stools 
present  an  appearance  to  which  the  term  "  bilious  "  was  applied,  it 
was  formerly  supposed  that  rhubarb  had  the  power  to  increase  the 
flow  of  bile  ;  more  recently  it  has  been  universally  conceded  that  the 
coloring-matter  of  rhubarb  produces  the  peculiar  tint  referred  to.  The 
latest  investigations  of  Rutherford  and  Vignal  have,  apparently,  very 
conclusively  shown  that  rhubarb  really  possesses  the  property  anciently 
ascribed  to  it,  and  that  it  must  be  placed  among  the  cholagogue  medi- 
cines. As  it  is  now  known  to  increase  the  flow  of  bile,  it  may  be  as- 
sumed that  the  intestinal  secretions  in  general  are  promoted  by  it. 
These  effects,  which  indeed  are  produced  by  all  the  purgatives  contain- 
ing a  resin,  are  probably  due  to  phaeoretin — the  rhubarb  resin. 

The  coloring-matters  of  rhubarb  stain  the  perspiration,  milk,  and 
urine,  and  the  milk  acquires  a  bitter  taste  and  purgative  properties. 

THERAPY. — The  infusion  of  rhubarb  is  frequently  employed  as  a 
vehicle  for  the  administration  of  alkalies  and  mineral  acids  in  sto- 
machic disorders.  In  small  doses,  the  tincture  is  an  excellent  sto- 
machic tonic  in  dyspepsia  with  deficient  biliary  and  intestinal  secre- 
tions. It  is  adapted  to  those  of  a  relaxed  habit,  and  is  inadmissible 
when  a  hypersemia  of  the  mucous  membrane  exists. 

Rhubarb  is  a  remedy  of  the  greatest  utility  in  the  duodenal  catarrh, 
and  in  the  catarrh  of  the  biliary  ducts  with  jaundice,  as  these  maladies 
occur  in  children.  The  passing  of  whitish,  pasty,  or  clay-colored  stools, 


756  EVACUANTS. 

while  the  skin  presents  an  earthy  or  jaundiced  hue,  is  the  indication  for 
the  use  of  rhubarb.  It  is  true  that  the  stools  will  be  quickly  stained, 
so  as  to  present  the  bilious  character,  without  any  improvement  having 
necessarily  taken  place  in  the  local  malady  ;  but  it  is  also  true  that 
rhubarb  is  curative  in  the  conditions  above  described.  In  the  summer 
diarrhoea  of  children,  no  remedy  is  more  generally  prescribed.  The 
aromatic  sirup  of  rhubarb  is  a  pleasant  form  in  which  to  administer  it. 
In  this  disorder,  especially  if  the  motions  are  sour,  alkalies  should  be 
prescribed  with  the  rhubarb.  Magnesia,  chalk,  or  sodium  carbonate, 
may  be  given  with  the  powder  of  rhubarb,  the  fluid  extract,  or  the 
sirup.  The  following  is  an  excellent  formula  in  these  cases  :  I£  Infus. 
rhei,  f  iij  ;  potassii  bicarb.,  3  j  ;  tinct.  cinnamomi,  3  ij  ;  syrp.  simplicis, 
3  vj.  M.  Sig.  :  A  teaspoonful  every  hour  or  two  in  cholera  infan- 
tum.  Diarrhoea  in  children  or  adults,  due  to  the  presence  of  undi- 
gested food,  or  retained  irritating  secretions,  may  not  unfrequently  be 
cured  by  a  purgative  dose  of  some  rhubarb  preparation.  After  the 
purgative  effect  is  expended,  the  bowels  are  confined  by  the  astringent. 
In  acute  dysentery  the  saline  purgatives  are  much  more  appropriate 
than  rhubarb. 

In  habitual  constipation  good  effects  may  be  obtained  by  chewing 
some  rhubarb-root.  The  astringent  after-effect  is,  however,  a  decided 
objection  to  the  frequent  use  of  this  remedy  for  this  purpose.  In  the 
rhubarb-pill  the  astringency  is  counteracted  by  soap.  The  compound 

rhubarb-pill,  which  contains  aloes,  is  a  mild  and  efficient  cathartic. 

• 

Aloe. — Aloes.  The  inspissated  juice  of  the  leaves  of  Aloe  Socotrina 
Lamarck  (Nat.  Ord.  Liliacece). 

Aloe  Puriftcata. — Purified  aloes.  In  brittle  pieces  of  a  dull-brown 
or  reddish-brown  color,  and  having  the  peculiar  aromatic  odor  of  Soco- 
trine  aloes.  It  is  almost  entirely  soluble  in  alcohol.  (U.  S.  P.)  Dose, 
gr.  j— grs.  v. 

Extractum  Aloes  Aquosum. — Watery  extract  of  aloes.  Dose,  gr. 
ss — gr.  v. 

Pilulce  Aloes. — Pills  of  aloes.  Each  pill  contains  two  grains  of 
aloes  and  two  grains  of  soap.  Dose,  1 — 5  pills. 

Pilulce  Aloes  et  Asafcetidce. — Pills  of  aloes  and  asaf cetidae.  (Aloes, 
asafcetidae,  and  soap,  in  equal  parts.)  Dose,  2 — 5  pills. 

Pilulce  Aloes  et  Mastiches. — Pills  of  aloes  and  mastic.  Lady  Web- 
ster's pills.  (Aloes,  mastic,  and  red  rose.)  Dose,  1 — 2  pills. 

Pilulce  Aloes  et  Myrrhce. — Pills  of  aloes  and  myrrh.  (Aromatic 
powder,  myrrh,  aloes.)  Dose,  grs.  v — grs.  xv. 

Tinctura  Aloes. — Tincture  of  aloes.     Etose,   3  ss —  f  j. 

Tinctura  Aloes  et  Myrrhce. — Tincture  of  aloes  and  myrrh.  Dose, 
3  ss—  3  ij. 

Vinum  Aloes. — Wine  of  aloes.     Dose,  3  j —  I  ss. 


CATHARTICS.  757 

JPulvis  Aloes  et  Canellce. — Powder  of  aloes  and  canella  (hiera 
picra).  Dose,  grs.  v — ^].  (Not  official.) 

COMPOSITION. — The  odor  of  aloes  is  due  to  a  peculiar  volatile  oil. 
It  contains  also  a  resin,  and  a  principle,  alo'ine.  The  composition  of 
aloi'ne  is  not  precisely  the  same  in  the  different  varieties  of  aloes.  The 
Barbadoes  aloes  furnishes  barbalolne,  the  Natal  aloes,  nataloine,  and 
the  Socotrine  aloes,  soalo'ine.  These  varieties,  it  is  supposed,  consti- 
tute an  homologous  series. 

ACTIONS  AND  USES. — Aloes  has  a  bitter  and  very  disagreeable  taste, 
leaving  a  rather  acrid  after-sensation  in  the  fauces.  It  is  a  stomachic 
tonic,  and,  like  bitters  in  general,  it  promotes  the  appetite  and  diges- 
tion. Accordingly,  it  is  much  prescribed  as  a  stomachic  tonic  in  cases 
of  indigestion  icith  torpor  of  the  large  intestine.  Irritable  or  inflam- 
matory states  of  the  stomach  raucous  membrane  contraindicate  its 
employment. 

The  recent  investigations  of  Rutherford  and  Yignal  have  shown 
that  aloes  has  the  power  to  stimulate  the  hepatic  functions,  and  to 
promote  the  flow  of  bile.  This  result  is  confirmatory  of  clinical  expe- 
rience. In  large  doses  (twenty  grains  or  more)  aloes  undoubtedly  in- 
creases the  intestinal  secretions  generally  ;  but,  in  the  ordinary  medici- 
nal laxative  dose,  the  stools  are  not  liquid,  and  are  but  little  altered 
in  character.  The  principal  effect  of  aloes  is  expended  on  the  large 
intestine,  the  peristaltic  movement  of  which  it  increases.  Some  tor- 
mina is  experienced  when  the  laxative  effect  begins,  and  tenesmus, 
with  heat  and  irritation  of  the  rectum,  is  produced  when  an  active 
purgative  dose  has  been  taken.  The  blood -supply  to  the  pelvic 
organs  is  increased  by  aloes  ;  the  menstrual  flow  becomes  more 
abundant,  and  abortion,  it  is  said,  may  be  caused  by  its  incautious 
administration  ;  while  in  the  male,  erections  take  place  more  fre- 
quently. 

Ten  or  twelve  hours  elapse  after  it  has  been  swallowed,  before 
cathartic  effects  are  produced.  The  rate  at  which  it  moves  to  affect 
the  intestinal  canal  is  influenced  less  by  the  size  of  the  dose  than  by 
the  condition  of  the  bowels. 

The  purgative  principle  of  aloes  diffuses  into  the  blood.  Applied 
to  an  exposed  surface,  it  is  absorbed  and  purges,  and  the  milk  of  moth- 
ers taking  it  acquires  a  purgative  action. 

Simple  jaundice,  of  an  atonic  kind,  may  be  cured  by  aloes.  No 
purgative  is  more  efficient  in  constipation,  dependent  on  weakness  and 
impaired  contractility  of  the  muscular  layer  of  the  large  intestinCc 
Jaundice,  or  at  least  a  bilious  state,  a  coated  tongue,  foul  breath,  a 
tumid  abdomen,  and  an  impacted  colon,  are  conditions  frequently 
associated  and  are  readily  relieved  by  aloes.  The  constipation  of 
hypochondriasis  and  melancholia  is  best  overcome  by  the  use  of  this 
agent,  and,  with  the  removal  of  the  impacted  faeces,  there  is  not  un« 


758  EVACUANTS. 

frequently  an  improvement  in  the  mental  state.  Aloes  is  prescribed 
in  cerebral  disorders,  when  purgatives  are  given  with  a  view  to  a 
derivative  effect. 

In  amenorrhcea  which  is  dependent  on  anaemia,  aloes  is  prescribed, 
with  other  appropriate  remedies,  to  determine  an  afflux  of  blood  to  the 
uterine  system.  Menorrhagia,  occurring  in  debilitated  and  relaxed 
subjects,  is  sometimes  relieved  in  the  same  way.  Iron  may  be  asso- 
ciated with  aloes  in  these  cases.  Congestion  of  the  pelvic  viscera  is  a 
contraindication  to  the  use  of  aloes,  and  the  existence  of  haemorrhoids, 
or  of  a  tendency  therefor,  has  heretofore  been  considered  an  equally 
positive  contraindication.  Fordyce  Barker  has,  however,  shown  that 
aloes  has  a  curative  power  in  certain  cases  of  haemorrhoids,  and  nota- 
bly those  which  occur  after  delivery.  The  local  condition,  under  these 
circumstances,  is  not  one  of  active  hypersemia,  but  really  consists  in  a 
sluggish  state  of  the  circulation  in  the  inferior  haemorrhoidal  veins. 
It  can  hardly  be  doubted  that  aloes  would  increase  the  trouble  if  pre- 
scribed for  cases  in  which  there  was  active  congestion  of  the  pelvic 
viscera.  Barker  also  advocates  the  use  of  aloes  in  non-puerperal 
hcemorrhoids,  but  the  local  condition  must  be  suitable  for  the  use  of 
this  remedy  or  the  disease  will  be  aggravated.  The  following  are  for- 
mulae proposed  by  Barker:  IJ  Pulv.  aloes  Soc.,  sapo.  Cast.,  aa  3j  ; 
ext.  hyoscyami,  3  ss  ;  pulv.  ipecacuanhas,  grs.  v.  M.  Ft.  pil.  no.  xx. 
Sig.  :  One  pill  morning  and  evening.  When  the  haemorrhoids  are 
associated  with  an  irritable  rectum,  and  with  frequent,  small,  teasing, 
thin  evacuations,  Barker  substitutes  for  the  hyoscyamus  a  small  quan- , 
tity  of  opium,  giving  also  a  less  quantity  of  the  aloes,  as  in  the  fol- 
lowing formula  :  $  Ferri  sulph.,  3j  ;  pulv.  aloes  Soc.,  ext.  opii  aq., 
sapo.  Cast.,  aa  grs.  x.  M.  Ft.  pil.  no.  xx.  Sig.  :  One  pill  morning 
and  evening.  Oppolzer  also  used  aloes  as  a  remedy  for  haemorrhoids, 
prescribing,  when  there  was  constipation,  aloes  and  quinine,  and,  when 
the  bowels  were  not  confined,  aloes  and  sulphate  of  iron. 

The  action  of  aloes,  as  well  as  of  other  resin-bearing  purgatives,  in 
the  condition  of  anaemia,  is  promoted  by  the  conjoined  use  of  the  bit- 
ters, quinine,  iron,  and  tonics  generally.  Two  grains  of  aloes,  taken  at 
bedtime,  will  cause  a  satisfactory  evacuation  on  the  following  day. 
Combination  with  soap,  as  in  the  official  pil.  aloes,  and  pil.  aloes  et 
asafcatidaB,  diminishes  the  drastic,  while  it  increases  the  efficiency  of 
the  purgative,  action.  It  is  generally  better  to  give  aloes  by  itself, 
without  combination  with  other  cathartics  ;  but  its  purgative  effects 
may  be  greatly  enhanced  by  administering  a  saline  laxative  six  or  eight 
hours  after  the  aloes  has  been  taken. 

A  gonorrhoea  may,  it  is  said,  be  cured  by  the  internal  use,  three 
times  a  day,  of  a  pill  containing  two  or  three  grains  of  aloes.  Catarrh 
of  the  uterus  has  been  treated  successfully  by  aloes  rectal  enemata. 
The  tincture  of  aloes,  diluted  to  one  half  or  even  more,  by  water,  is  a 


CATHARTICS.  759 

very  effective  injection  in  gonorrhoea  after  the  acute  symptoms  have 
subsided. 

Jalapa. — Jalap.  The  tuberous  root  of  Ipomea  jalapa  Nuttall 
(Nat.  Ord.  Convolvulacece).  Racine  de  jalap,  Fr. ;  Jalape,  Ger. 

JE/xtractum  Jalapoe,  Alcoholicum. — Dose,  gr.  \ — gr.  ij. 

Mesina  Jalapce. — Resin  of  jalap.     Dose,  gr.  ij — gr.  v. 

Pulvis  Jalapoe,  Compositus. — Compound  powder  of  jalap.  (Jalap, 
35  grm.;  bitart.  of  potassa,  65  grm.)  Dose,  gr.  x — 3  j. 

COMPOSITION. — Jalap  contains  a  resin,  to  which  its  purgative  prop- 
erty is  due.  The  resin  consists  of  two  varieties,  one  soluble,  the  other 
insoluble,  in  ether.  The  latter  has  been  named  convolvulin,  or  jalap- 
in,  and  is  the  more  active  purgative  of  the  two.  Various  secondary 
products  of  considerable  interest  are  obtained  from  the  resin,  but  these 
possess  no  special  importance  from  the  therapeutical  point  of  view. 

PHYSIOLOGICAL  ACTIONS. — As  a  cathartic  jalap  resembles,  but  it  is 
much  more  active  than,  senna.  It  is  apt  to  produce  nausea,  and  tor- 
mina and  tenesmus  invariably  accompany  its  purgative  action.  It 
usually  operates  in  from  two  to  four  hours,  but  the  rate  at  which  it 
moves  to  affect  the  intestinal  canal  is  not  influenced  by  the  amount 
administered.  The  stools  are  soft  at  first,  and  afterward  liquid.  Jalap 
does  not  produce  haemorrhoids,  nor  does  it  cause  a  tendency  to,  or 
increase  an  existing,  menorrhagia.  The  secretions  of  the  intestinal 
canal  are  increased  by  it,  and  the  recent  researches  of  Rutherford  and 
Vignal  have  demonstrated  that  jalapin  (convolvulin)  excites  the  flow 
of  bile. 

The  action  of  jalap  appears  to  be  local.  It  is  true  that  experiments 
in  support  of  a  contrary  opinion  have  been  made  ;  but?  in  the  conclu- 
sive test  of  the  intra-venous  injection  of  convolvulin,  no  purgative 
action  has  followed  (Husemann). 

THERAPY. — The  resin  of  jalap  being  the  active  constituent,  it  should 
generally  be  preferred.  It  has  the  merit  of  being  almost  tasteless,  and 
hence  may  be  given  readily  to  children. 

Jalap  is  an  efficient  cathartic  in  the  beginning  of  fevers,  inflamma- 
tions, and  acute  diseases  requiring  the  use  of  such  therapeutic  means. 
Formerly  calomel  and  jalap  were  much  prescribed,  but  this  combina- 
tion has  deservedly  fallen  into  discredit.  Occasionally  the  resin  and 
calomel,  in  less  ponderous  doses  than  formerly  given,  may  be  used  with 
advantage  as  a  cathartic  :  $  Resinse  jalapse,  hydrarg.  chlor.  mit.,  extc 
hyoscyami,  aa  gr.  j.  M.  Ft.  pil.  no.  j.  Sig.  :  Take  at  bedtime. 

As  jalap  in  sufficient  quantity  causes  free  watery  evacuations,  it  is 
a  suitable  purgative  in  anasarca  and  ascites.  The  most  generally  ap- 
proved hydragogue  purgative,  under  these  circumstances,  is  the  com- 
pound jalap-powder.  The  efficiency  of  this  may  be  increased  by  the 
addition  of  podophyllum.  A  teaspoonful  of  the  compound  powder, 


760  EVACUANTS. 

taken  in  the  early  morning,  will  usually  produce  several  very  copious, 
watery  stools.  Increased  urinary  discharge  also  is  a  not  unfrequent 
result  of  its  action. 

Jalap  has  the  power  to  cause  the  expulsion  of  lumbrici.  As  a  ver- 
mifuge it  is  not  at  all  equal  to  the  other  approved  remedies,  but  it  is 
certainly  useful  as  an  adjunct.  For  example,  santonin  at  night,  and 
the  resin  of  jalap  and  calomel  on  the  following  morning,  is  an  effective 
method  of  expelling  these  parasites. 

Jalap  is,  of  course,  contraindicated  in  inflammatory  states  of  the 
intestinal  canal.  In  overdoses  it  causes  hypercatharsis,  and  it  may 
excite  violent  gastro-enteritis  and  endanger  life.  With  proper  atten- 
tion to  the  conditions  in  which  it  is  admissible,  and  to  the  dosage,  jalap 
is  entirely  safe,  and  is  a  very  certain  and  efficient  cathartic.  An  ex- 
cellent vehicle  for  the  administration  of  the  resin  of  jalap  is  the  sirup 
of  rhubarb.  $  Resinae  jalapse,  grs.  ij — grs.  v  ;  syr.  rhei  aromat.,  f  ss. 
M.  This  is  especially  suitable  for  children. 

Scammonium. — Scammony.  A  resinous  exudation  from  the  liv- 
ing root  of  Convolvulus  scammonia  Linne  (Nat.  Ord.  Convolvulacece). 
(U.  S.  P.)  Scammonee,  Fr.;  Scammonium,  Ger. 

Resina  Scammonii. — Resin  of  scammony.     Dose,  grs.  v — grs.  x. 

COMPOSITION. — The  activity  of  scammony,  as  a  cathartic,  depends 
entirely  on  the  resin  which  it  contains.  As  the  crude  scammony  is 
much  adulterated,  the  resin  is  alone  worthy  of  confidence. 

ACTIONS  AND  USES. — Scammony  corresponds  very  closely  to  jalap* 
in  the  time  it  requires  to  cause  cathartic  action,  in  the  character  of  the 
stools  produced,  and  in  the  kind  of  irritation  which  it  excites.  Scam- 
mony is  somewhat  more  drastic  than  jalap.  As  it  has  but  little  taste, 
and  is  at  the  same  time  very  active,  the  resin  is  much  prescribed  by 
English  practitioners  as  a  cathartic  for  children.  It  may  be  given 
rubbed  up  with  milk,  or  with  sirup  of  rhubarb.  It  is  adapted  to  the 
same  class  of  cases,  and  to  the  relief  of  the  same  conditions,  as  jalap. 

ColocyntMs. — Colocynth.  The  fruit,  deprived  of  its  rind,  of  Citrul- 
lus  colocynthis  Schrader  (Nat.  Ord.  Cucurbitacece).  (U.  S.  P.)  Co- 
loquinte,  Fr.  ;  Koloquinten,  Ger. 

Extractum  Colocynthidis. — Extract  of  colocynth. 

Extractum  Colocynthidis  Compositum. — Compound  extract  of  colo- 
cynth. (Extracts  of  colocynth,  scammony,  and  aloes  ;  cardamoms, 
soap.)  Dose,  grs.  v — grs.  x. 

Pilulce  Catharticce  Composite. — Compound  cathartic  pills.  (Com- 
pound extract  of  colocynth,  abstract  of  jalap,  calomel,  gamboge.) 
Dose,  1 — 3  pills.  Each  pill  contains  one  grain  of  calomel. 

COMPOSITION. — Colocynth  contains  a  bitter  principle  (colocynthiri), 
which  is  the  purgative  principle.  Colocynthitin  is  another  substance 


CATHARTICS.  761 

contained  in  the  alcoholic  extract.  It  differs  from  colocynthin  in  being 
soluble  in  ether,  and  not  in  water.  As  colocynthitin  is  a  tasteless  crys- 
talline powder,  it  is  probably  devoid  of  purgative  property.  Colocyn- 
thin is  a  very  powerful  cathartic. 

ACTIONS  AND  USES. — Colocynth  is  a  gastro-intestinal  irritant.  In 
moderate  doses  it  hastens  the  peristaltic  movements,  and  increases  the 
intestinal  secretions.  Its  cathartic  operation  is  usually  attended  with 
griping,  and  the  stools  are  fluid.  Violent  gastro-enteritis  may  be  pro- 
duced by  a  large  quantity,  and  numerous  fatal  cases  have  been  reported 
from  its  incautious  or  criminal  administration. 

The  action  of  colocynth  is  not  merely  local.  Applied  to  the  skin 
of  the  abdomen,  it  causes  intestinal  pain,  and  more  frequent  alvine  dis- 
charges. 

Colocynth  is  never  administered  alone,  but  usually  in  combination 
with  other  purgatives.  The  compound  extract  is  a  safe,  effective,  and 
not  unpleasant  cathartic  for  the  relief  of  constipation.  I£  Ext.  colo- 
cynthidis  comp.,  3j  ;  ext.  belladonnae,  ext.  physostigmatis,  aa  grs.  v. 
M.  Ft.  pil.  no.  x.  Sig.  :  One  each  night  in  habitual  constipation. 
The  official  compound  cathartic  pill  is  a  most  serviceable  combination. 
Instead  of  calomel  the  resin  of  podophyllum  may  be  used  in  the  prepa- 
ration of  this  pill,  without  impairing  its  utility. 

In  cerebral  congestion  the  preparations  of  colocynth  are  used  as 
derivative  purgatives.  Bypochondriasis  and  melancholia,  when  asso- 
ciated with  torpor  of  the  large  intestines  and  fecal  accumulations,  are 
benefited  by  brisk  purging  with  the  colocynth  preparations,  but  other 
drastic  purgatives  are  equally  efficient. 

Colocynth  is  inadmissible  in  inflammatory  states  of  the  intestinal 
canal,  and  is  unsafe  during  the  existence  of  pregnancy.  There  is  a 
popular  notion,  which  has  led  to  its  use  in  toxic  doses,  that  colocynth 
may  cause  abortion.  Any  quantity  which  will  affect  the  gravid  womb 
must  be  sufficient  to  endanger  life. 

Podophyllum. — May-apple.  The  rhizoma  and  roots  of  Podophyl- 
lum peltatum  Linne  (Nat.  Ord.  BerberidacecB). 

Resina    Podophylli.  —  Resin    of    podophyllum.      Dose,    gr.    \ — 

gr-  J- 

Extractum  Podophylli. — Extract  of  podophyllum.  Dose,  gr.  y 
— gr.  x. 

Extractum  Podophylli  Fluidum. — Fluid  extract  of  podophyllum. 
Dose,  TH,  j —  3  ss. 

COMPOSITION. — The  medicinal  qualities  of  podophyllum  are  due  to 
a  resin,  or  to  two  resinous  substances,  one  soluble  in  alcohol  and  ether, 
and  the  other  soluble  in  alcohol  only.  Both  possess  purgative  proper- 
ties. May-apple-root  contains  the  alkaloid  berberine,  which,  however, 
contributes  nothing  to  the  therapeutical  properties  of  this  remedy, 


762  BVACUANTS. 

and,  farther,  it  is  not  peculiar  to  podophyllum,  being  found  in  ber- 
beris,  hydrastis,  and  other  plants. 

Resina  podophylli  is  the  preparation  entitled  "  podophyllin  "  by  the 
eclectic  practitioners. 

ACTIONS  AND  USES. — The  taste  of  podophyllum  is  bitter,  with  an 
after-sense  of  acridity.  It  increases  the  intestinal  secretions,  and  is 
actively  cathartic,  producing  copious  and  rather  watery  stools.  Its 
action  is  similar  to,  but  considerably  slower  than,  that  of  jalap.  From 
six  to  ten  hours  elapse  after  its  administration  before  cathartic  effects 
are  experienced.  Taken  by  itself,  it  is  apt  to  cause  nausea  and  griping, 
but  in  combination  with  other  cathartics,  or  with  belladonna  or  hyos- 
cyamus,  it  operates  pleasantly  as  well  as  efficiently.  The  Edinburgh 
committee,  Dr.  Bennett,  chairman,  ascertained,  as  they  supposed,  that 
the  resin  of  podophyllum  has  no  cholagogue  action,  but  the  more  re- 
cent as  well  as  the  more  accurately  conducted  experiments  of  Ruther- 
ford and  Vignal  have  apparently  demonstrated  that  it  decidedly  in- 
creases the  flow  of  bile,  corresponding  in  this  particular  to  the  other 
resinous  cathartics. 

Podophyllum-resin  is  the  most  generally  useful  cathartic  in  cases 
of  constipation,  in  which  the  secretions  of  the  glandular  apparatus  of 
the  intestinal  canal,  and  of  the  liver,  are  deficient.  Habitual  constipa- 
tion, due  to  torpor  of  the  muscular  layer  of  the  bowel,  may,  it  is  said, 
be  removed  by  the  nightly  use  of  a  small  dose  of  the  resin  combined 
with  belladonna.  ^  Resina?  podophylli,  grs.  vj  ;  ext.  belladonna,  ext. 
physostigmatis,  aa  grs.  iij.  M.  Ft.  pil.  no.  xij.  Sig.  :  One  pill  each 
night.  It  is  especially  in  congestion  of  the  portal  circulation,  in  catar- 
rhal  and  malarial  jaundice,  and  in  ascites,  that  podophyllum-resin  acts 
most  efficiently  and  serviceably.  Haemorrhoids  that  bleed  in  conse- 
quence of  stasis  in  the  portal  circulation,  and  that  are  of  recent  forma- 
tion, may  sometimes  be  cured  by  a  brisk  podophyllum  cathartic. 

The  clinical  experience  which  had  shown  that  the  resin  of  podo- 
phyllum possessed  cholagogue  powers,  long  before  the  experimental 
inquiry  was  instituted  to  settle  the  question,  led  also  to  a  wide  gener- 
alization in  the  therapeutical  uses  of  this  agent.  Acting  on  the  liver, 
it  was  assumed  that,  in  a  manner  similar  to  mercury,  it  must  also  pos- 
sess similar  "  alterative  "  powers.  It  came  to  be  used  as  the  "  vege- 
table calomel,"  in  the  diseases  in  the  treatment  of  which  mercury  was 
supposed  to  be  essential.  It  need  hardly  be  asserted  that  these  specu- 
lations have  no  basis,  and  that  podophyllum  possesses  no  property  in 
common  with  mercury  except  its  power  to  purge. 

Leptandra. — Leptandra.  The  rhizoma  and  roots  of  Leptandra  vir- 
ginica  Linne  (Nat  Ord.  Scrophulariacece). 

Extractum  Leptandrce. — Extract  of  leptandra.  Dose,  gr.  ij — 
gr.  x. 


CATHARTICS.  763 

Extractum,  Leptandrce  Fluidum.  —  Fluid  extract  of  leptandra. 
Dose,  in,  v —  3  j. 

COMPOSITION. — A  crystallizable  principle  has  been  obtained  from 
the  root — leptandrin  (?).  It  contains  also  a  resin  which,  in  the  impure 
form  at  present  found  in  commerce,  has  a  distinctly  purgative  quality 
and  is  known  as  leptandrin.  The  dose  of  this  preparation  is  gr.  ij — 
gr.  v. 

ACTIONS  AND  USES. — Leptandra  is  an  active  cathartic  in  the  recent 
state.  In  the  form  of  the  fluid  extract,  or  of  the  so-called  leptandrin, 
it  acts  mildly,  causing  somewhat  liquid  and  apparently  bilious  stools. 
It  is  held  to  be  cholagogue,  and,  according  to  the  rules  of  analogy,  this 
claim  may  be  well  founded,  for  other  cathartics  containing  resin,  as 
the  experiments  of  Rutherford  and  Yignal  have  shown,  possess  the 
power  to  increase  the  flow  of  bile. 

It  is  applicable  to  cases  of  disease  of  the  intestinal  canal,  attended 
by  constipation,  in  which  the  biliary  and  intestinal  secretions  are  in- 
sufficient. 

Iris. — Blue  flag.  The  rhizoma  and  roots  of  Iris  versicolor  Linne 
(Nat.  Ord.  Iridacece). 

Extractum  Iridis. — Extract  of  iris.     Dose,  gr.  j — gr.  v. 

Extractum  Iridis  Fluidum. — Fluid  extract  of  iris.  Dose,  t\[  v 
—  3j. 

Under  the  name  iridin,  there  is  to  be  found  in  the  shops  a  "resi- 
noid,"  having  more  or  less  of  the  properties  of  the  crude  drug.  The 
dose  of  this  preparation  is  from  one  to  five  grains. 

ACTIONS  AND  USES. — Iris  versicolor  has  a  bitter,  nauseous,  and 
rather  acrid  taste.  It  is  apt  to  cause  severe  nausea.  The  fresh  root 
has  actively  purgative  and  diuretic  qualities,  but  these  are  impaired 
by  age.  The  fluid  extract  and  the  "  iridin  "  are  laxative,  and  are  sup- 
posed to  have  cholagogue  powers. 

The  oleo-resin  is  prescribed  in  hepatic  and  intestinal  disorders,  and 
in  dropsy.  There  is  much  evidence  tending  to  show  that  this  remedy 
is  really  serviceable  when  the  stools  are  clay-colored,  and  the  skin 
jaundiced,  in  consequence  of  duodenal  catarrh  and  obstruction  of  the 
biliary  ducts.  It  is  said  that  malarial  jaundice  may  be  cured  by  this 
drug,  and  that  in  bilious  remittent  fever  and  in  chronic  malarial  poi- 
soning it  exerts  a  favorable  influence. 

Euonymus. — Wahoo.  The  bark  of  Euonymus  atropurpureus  Jac- 
quin  (Nat.  Ord.  Celastracece). 

Extractum  Euonymi. — Extract  of  enonymus.     Dose,  gr.  j — gr.  v. 

The  eclectic  preparation  (euonymin)  consists  of  the  resin  and  fixed 
oil,  and  is  prescribed  in  the  dose  of  a  half -grain  to  five  grains. 

COMPOSITION. — An  uncrystallizable  and  intensely  bitter  principle 


764  EVACUANTS. 

has  been  isolated  (euonymin).    It  contains  also  a  crystallizable,  a  yel- 
low and  a  brown  resin,  fixed  oil,  etc. 

ACTIONS  AND  USES. — Euonymus  possesses  cathartic  properties  simi- 
lar to  rhubarb,  but  is  much  milder,  and  is  an  excellent  remedy  in 
hepatic  and  intestinal  disorders  requiring  the  use  of  such  an  agent. 
The  eclectic  preparation  (euonymin)  is  a  convenient  form  in  which 
to  procure  the  cathartic  action  of  euonymus.  Rutherford  has  shown 
that  it  is  a  highly  efficient  cholagogue. 

Baptisia. — Wild  indigo.  The  root-bark  of  Baptisia  tinctoria.  (Not 
official.)  Preparations  corresponding  to  those  of  iris  and  euonymus 
can  be  obtained. 

Extractum  Baptisice. — Extract  of  baptisia.     Dose,  gr.  j — gr.  x. 

Baptisin,  the  resinoid,  is  much  prescribed  by  eclectic  practition- 
ers. The  dose  is  one  to  five  grains. 

ACTIONS  AND  USES. — The  taste  of  baptisia  is  bitter  and  somewhat 
acrid.  It  increases  the  secretions  of  the  glandular  appendages  of  the 
gastro-intestinal  mucous  membrane.  It  possesses  in  large  doses  emeto- 
cathartic  property,  and  may  indeed  excite  violent  gastro-intestinal  in- 
flammation ;  in  small  doses  it  is  merely  laxative.  The  resinoid  baptisin, 
so  called,  has  been  studied  by  Rutherford,  who  found  it  to  possess  ac- 
tive cholagogue  property.  Given  to  dogs,  it  distinctly  stimulates  the 
hepatic  functions  and  increases  the  production  of  bile.  It  is  probable 
that  it  deserves  to  rank  among  the  most  efficient  of  the  remedies  of 
this  group.  It  is  indicated,  therefore,  in  all  the  cases  in  which  hepatic 
stimulants  are  desirable. 

HYDRAGOGUE  CATHARTICS. 

Cambogia. — Gamboge.  A  gum-resin  obtained  from  the  Garcinia 
Hariburii  Hooker filius  (Nat.  Ord.  Guttiferce).  (U.  S.  P.)  Gomme- 
gutte,  FT.  ;  Grummigutt,  Ger.  Dose,  gr.  j — grs.  v. 

The  only  official  preparation  is  the  compound  cathartic  pill,  of 
which  gamboge  constitutes  about  a  tenth  part. 

COMPOSITION. — Gamboge  is  a  mixture  of  resin  and  gum,  the  latter 
constituting  from  fifteen  to  twenty  per  cent. 

ACTIONS  AND  USES. — Gamboge  has  no  taste  at  first,  but,  when 
chewed,  an  acrid  sensation  is  developed  in  the  mouth.  It  is  irritant  to 
the  gastro-intestinal  canal,  increases  secretion  of  the  glands,  excites 
vomiting  and  intestinal  pain,  and  purges  violently,  producing  copious 
watery  stools.  The  experiments  of  Rutherford  and  Vignal  show  that 
gamboge  is  not  an  hepatic  stimulant,  but  does  cause  hydrocath  arsis. 
Violent  gastro-enteritis  is  set  up  by  large  doses,  yet  but  few  fatal  cases 
have  been  reported.  As  vomiting  soon  follows  the  ingestion  of  a  large 
dose,  this  fact  may  explain  the  rarity  of  a  fatal  result  due  to  its  ad- 
ministration. 


CATHARTICS.  765 

Gamboge  is  rarely  prescribed  alone  as  a  cathartic,  owing  to  the  vio- 
lence and  harshness  of  its  operation.  Combination  with  other  cathar- 
tics, as  in  the  compound  cathartic  pill,  greatly  modifies  its  action.  As 
it  is  a  powerful  hydragogue  cathartic,  it  is  given  with  advantage  in 
dropsy,  when  hydrocatharsis  is  indicated.  It  is  best  administered  in 
small  doses,  at  short  intervals,  rubbed  up  with  sugar  or  made  into  a 
pill  with  soap.  Besides  its  purgative  properties,  gamboge  is  decidedly 
diuretic.  In  order  to  obtain  its  diuretic  effects  it  must  be  given  in 
small  doses,  at  short  intervals,  and  vomiting  must  be  avoided.  Admin- 
istered in  solution  with  an  alkaline  diuretic,  its  efficiency  is  much  in- 
creased. Gamboge  has  also  been  used  as  an  anthelmintic,  but  it  has  no 
powers  in  this  respect  not  possessed  by  other  drastic  purgatives. 

Oleum  Tiglii. — Croton-oil.  A  fixed  oil  expressed  from  the  seeds 
of  Croton  tiglium  Linne  (Nat.  Ord.  Euphorbiacece).  (U.  S.  P.) 
Huile  de  Croton,  Fr.  ;  Crotonol,  Ger.  Dose,  gt.  j — gtt.  ij. 

COMPOSITION. — It  contains  glycerides  of  the  fatty  acid  series — 
stearic,  palmitic,  myristic,  and  lauric  acids — and  the  more  volatile  acids, 
acetic,  butyric,  and  valerianic  (Fltickiger  and  Hanbury,  Husemann). 
Genther  and  Frohlic  have  discovered  a  peculiar  volatile  acid,  to  which 
they  have  applied  the  name  tiglinic  acid.  By  the  same  chemists  the 
so-called  crotonic  acid  is  held  to  be  an  artificial  product.  Schlippe 
has  asserted  the  discovery  of  the  vesicating  principle  of  croton-oil,  but 
other  chemists  have  failed  to  find  this  substance,  to  which  he  has  as- 
signed the  name  of  crotonol.  The  purgative  principle  of  the  oil  ap- 
pears to  exist  in  all  parts  of  the  Croton  tiglium,  but  it  has  not  yet  been 
isolated. 

ACTIONS  AND  USES. — Croton-oil  is  a  transparent  or  semitransparent 
viscid  liquid,  amber-colored,  and  having  a  rather  rancid  smell,  and  an 
oily,  acrid  taste.  Applied  by  friction  to  the  skin,  it  excites  inflamma- 
tion, and  causes  an  eruption  which  is  at  first  papular,  with  rounded 
summits,  and  afterward  becoming  pustular.  The  eruption  is  sometimes 
umbilicated,  but  is  generally  rounded.  An  areola  surrounds  the  pus- 
tules, and  there  are  considerable  heat  and  burning  in  the  part.  The 
eruption  appears  in  a  few  hours  after  the  frictions  have  been  practiced, 
reaches  its  maximum  in  about  four  days,  and  then  declines  by  abortion 
of  the  pustules  and  by  scabbing.  In  many  subjects  permanent,  small 
white  cicatrices  mark  the  site  of  the  eruption.  All  subjects  are  not 
equally  susceptible  to  the  vesicating  action  of  croton-oil. 

The  mucous  membrane  is  violently  attacked  by  croton-oil.  In  the 
fauces  it  causes  an  intensely  acrid  sensation,  and  increases  the  flow  of 
saliva.  A  sense  of  heat,  pain,  and  nausea  is  produced  when  the  oil 
is  received  into  the  stomach,  tormina  soon  follows,  and  in  an  hour  or 
two  watery  stools  are  passed  with  some  burning  and  irritation  about 
the  anus.  The  action  of  the  oil  continues  during  the  succeeding  twelve 


766  EVACUANTS. 

to  twenty-four  hours,  numerous  fluid  dejections  are  passed,  and  con- 
siderable debility  is  the  result.  When  large  doses  are  taken,  if  not 
rejected  promptly  by  vomiting,  violent  hypercatharsis  occurs  with 
great  prostration  and  collapse.  Fortunately,  when  an  overdose  is 
swallowed,  vomiting  quickly  ensues,  and  hence  very  large  quantities 
have  been  taken  without  producing  a  fatal  result.  The  lesions  caused 
by  croton-oil  are  those  of  gastro-enteritis,  but  fatal  cases  have  occurred, 
with  all  the  objective  phenomena  of  choleraic  collapse,  without  any 
evidences  of  local  inflammation. 

As  croton-oil  is  still  purgative  after  being  deprived  of  its  acrid 
principle  by  washing  with  alcohol,  it  has  been  held  that  the  oil  be- 
comes cathartic  only  by  the  action  of  the  alkaline  juices  of  the  duo- 
denum. Numerous  instances  have  been  reported,  and  some  have  fallen 
under  the  author's  observation,  in  which  croton-oil  applied  to  the 
integument  has  produced  diarrhoea.  It  must,  therefore,  act  by  absorp- 
tion into  the  blood.  In  some  cases,  without  causing  purging,  croton- 
oil  affects  the  nervous  system  in  a  peculiar  manner.  Thus  restless- 
ness, palpitation  of  the  heart,  headache,  giddiness,  confusion  of  ideas, 
etc.,  have  occurred  under  these  circumstances  (Husemann). 

Rohrig  found  that  croton-oil  stimulated  the  hepatic  function,  and 
increased  the  flow  of  bile.  Radziejewski  found  peptones,  bile,  gly- 
cogen,  leucin,  and  tyrosin,  in  the  stools.  Rutherford  and  Vignal  have 
since  shown  that  croton-oil,  although  it  causes  great  vascular  dilatation 
of  the  vessels  of  the  intestinal  mucous  membrane,  can  not  be  regarded 
as  a  cholagogue. 

The  principal  effect  of  croton-oil,  for  which  it  is  administered  in 
medical  practice,  is  that  of  a  hydragogue  cathartic.  It  is,  therefore, 
used  in  dropsies  when  it  is  desired  to  procure  free,  watery  evacuations. 
It  is  inadmissible  when  there  is  much  debility,  or  when  an  irritable  or 
inflammatory  state  of  the  intestinal  mucous  membrane  exists. 

Notwithstanding  its  great  activity,  croton-oil  is  an  easily-managed 
cathartic  for  ordinary  purposes.  It  is  the  most  efficient  purgative  when 
there  is  simple  impaction,  without  inflammatory  symptoms.  The  con- 
stipation from,  fea^maybe  overcome  by  it,  when  less  powerful  purga- 
tives will  fail.  It  is  the  most  appropriate  of  cathartics,  when  these 
agents  are  indicated  as  revulsives  in  cerebral  congestion.  Croton-oil,  by 
increasing  the  vascular  dilatation  in  the  intestines,  lowers  the  intra- 
cranial  blood-pressure.  Per  contra,  it  is  harmful  when  a  state  of  cere- 
bral anaemia  exists. 

Croton-oil  has  been  used  successfully  against  tcenia,  but  it  has  no 
special  vermifuge  property. 

The  smallness  of  the  dose  required  renders  croton-oil  a  very  useful 
purgative  in  the  maladies  of  children  and  of  the  insane.  When  the 
patient  is  unable  to  swallow  from  insensibility  or  paralysis,  a  drop  or 
two  placed  on  the  tongue  will  act  efficiently.  It  may  be  given  to  chil- 


CATHARTICS.  767 

dren,  rubbed  up  witb  sugar  of  milk.  As  washing  with  alcohol  removes 
the  acridity,  and  does  not  impair  the  purgative  property,  a  preparation 
so  treated  will  be  best  for  administration  to  children.  The  unpleasant 
effects  of  this  remedy  may  be  much  modified  by  combination  with 
other  cathartics.  ]J  Ol.  tiglii,  gtt.  iij  ;  ext.  colocynth.  com.,  3  j  ;  ext. 
belladonnae,  grs.  iij.  M.  Ft.  pil.  no.  vj.  One  of  these  will  usually 
act  efficiently.  The  following  is  the  f ormula  of  Dr.  Francis's  "  triplex 
pills  "  :  I£  Aloes  socot.,  scammonii,  pil.  hydrargyri,  aa  f  j  ;  ol.  tiglii, 
m,  xx  ;  ol.  carui,  i\\,  xc  ;  elix.  proprietatis,  q.  s.  M.  Ft.  pil.  no.  400. 
Dose,  as  a  laxative,  one  at  bedtime.  This  combination  is  very  popular 
in  New  York. 

Elaterium. — Elaterium.  A  substance  deposited  by  the  juice  of  the 
fruit  of  Momordica  elaterium,  Ecbalium  agreste.  (Not  official. )  Con- 
combre  purgatif,  Fr.  ;  SpringgurJce,  Ger.  Dose,  gr.  -fa — gr.  %. 

COMPOSITION. — The  important  constituent  of  elaterium  is  elaterin. 
Owing  to  the  uncertainty  in  the  strength  of  elaterium,  it  has  been 
omitted  from  the  official  list,  and  its  active  constituent  substituted. 

Elaterinum. — Elaterin.  A  neutral  principle  extracted  from  elate- 
rium, a  substance  deposited  by  the  juice  of  the  fruit  of  Ecbalium  ela- 
terium A.  Richard  (Nat.  Ord.  Cucurbitacece). 

Small,  colorless,  shining  hexagonal  scales  or  prisms,  permanent  in 
the  air,  odorless,  having  a  bitter,  somewhat  acrid  taste,  and  a  neutral 
reaction.  Insoluble  in  water ;  soluble  in  125  parts  of  alcohol  at  60° 
Fahr.  Dose,  gr.  -fa — gr.  £. 

Trituratio  Elaterini. — Trituration  of  elaterin.  (Elaterin,  10  grm.; 
sugar  of  milk,  90  grm.)  Dose,  gr.  ss — gr.  ij. 

ACTIONS  AND  USES. — Elaterium  excites  an  abundant  flow  of  saliva, 
and  a  persistent  bitter  taste  is  experienced  in  the  fauces  some  time 
after  it  is  swallowed.  Nausea  and  vomiting,  profuse,  watery  stools, 
and  great  weakness  and  prostration,  are  produced  by  a  considerable 
dose  of  elaterium.  The  vomited  matters  and  stools  have  an  appearance 
and  composition  similar  to  the  "rice-water"  discharges  of  cholera.  On 
animals  elaterium  acts  somewhat  differently.  "Without  causing  purg- 
ing, it  affects  the  nervous  system,  producing  irregular  respiration, 
hebetude,  convulsions,  and  death  (Kohler).  The  gastro  -  intestinal 
action  is  doubtless  local,  and  the  result  of  the  immediate  impression 
made  by  the  agent  in  its  passage  down  the  intestinal  canal.  Ac- 
cording to  Kohler,  the  presence  of  bile  is  necessary  to  the  action  of 
elaterium. 

The  chief  use  of  elaterium  is  to  procure  free  watery  evacuations  in 

ascites,  general  dropsy,  uraemia,  and  to  act  as  a  revulsive  in  cerebral 

disorders.    It  must  be  used  with  caution  in  debilitated  subjects.    Gas- 

tro-intestinal  irritation,  or  inflammation,  contraindicates  its  use.     The 

51 


768  EVACUANTS. 

depression  which  its  operation  induces  must  be  counteracted  by  stimu- 
lants and  proper  aliment. 

Authorities  referred  to : 

ANSTIE,  DR.  F.  E.  Report  on  the  Physiological  Action  of  Podophyllin.  The  Medical 
Times  and  Gazette,  vol.  i,  1863. 

BARKER,  DR.  FORDYCE.     The  Puerperal  Diseases,  p.  34. 

BRUNTON,  DR.  T.  LACDER.  On  the  Action  of  Purgative  Medicines.  The  Practitioner, 
May,  1874. 

FLUCKIGER  AND  HANBURY.     Pharmacographia.     Various  articles. 

HUSEMANN,  DRS.  AUG.  UNO  THEO.     Die  Pflanzenstoffe. 

HUSEMANN,  DR.  THEO.     Handbuch  der  gesammten  Arzneimittellehre,  zweiter  Band. 

KOHLER,  DR.  H.  Der  Fruchtsaft  von  Momordica  Elaterium  in  historischer,  chemi- 
scher  und  physiologischer  Hinsicht.  Virchow's  Archiv,  Band  xlix,  p.  434,  1,  p.  273. 

MOREAC,  ARMAND,  DR.    Archives  Generates  de  Med.,  vol.  xvi,  p.  234,  sixth  series. 

PERCY,  DR.  S.  R.     The  American  Medical  Times,  vol.  iv. 

RADZIEJEWSKI,  DR.  S.  Schmidfs  Jahrbucher,  vol.  cxlvii,  p.  20.  Zur physiolog.  Wirk- 
ung  der  Abfuhrmittel. 

RUTHERFORD  AND  VIGNAL.  Experiments  on  the  Biliary  Secretion  of  the  Dog.  The 
British  Medical  Journal,  November,  1875. 

THIRY,  DR.  L.     Schmidfs  Jahrbucher,  vol.  cxxviii,  p.  17. 

VULPIAN,  PROF.  A.     Bulletin  General  de  Therap.,  vol.  Ixxxiv,  p.  522. 

Enemata. — An  enema  is  a  rectal  injection.  The  capacity  of  the 
rectum,  it  need  hardly  be  stated,  varies  with  the  age  of  the  individual. 
For  an  infant,  half  an  ounce  to  an  ounce  ;  for  a  child  of  two  to  five 
years,  two  to  six  ounces  ;  for  five  to  fifteen  years,  six  ounces  to  a  pint; 
for  an  adult,  a  pint  to  a  quart  of  fluid  may  be  considered  as  an  ap- 
proximation to  the  capacity  of  the  rectum  at  these  ages  respectively* 
Habitual  use  of  injections  no  doubt  increases  the  tolerance,  as  also  the 
capacity  of  the  rectum. 

Injections  may  consist  of  water — cold,  tepid,  warm,  or  hot ;  of 
medicated  solutions — emollient,  anodyne,  laxative,  cathartic,  or  anthel- 
mintic.  Under  this  head  are  to  be  considered  only  enemata  adminis- 
tered with  the  view  to  cause  an  evacuation  from  the  intestinal  canal. 

Enemata  act  either  by  a  reflex  irritation  or  by  absorption.  When  a 
cold  injection  is  thrown  into  the  rectum,  or  this  organ  is  distended,  an 
action  is  set  up  for  the  expulsion  of  the  offending  substance,  and  the 
muscular  fiber  of  the  bowel  more  or  less  vigorously  contracts  according 
to  its  functional  condition.  The  quantity,  as  well  as  the  temperature 
of  the  fluid  injected,  must  therefore  be  taken  into  consideration,  when 
it  is  proposed  to  empty  the  bowels  by  a  merely  reflex  irritation.  On 
the  other  hand,  when  it  is  the  intention  to  procure  the  absorption  of 
the  medicated  fluid,  the  quantity  injected  must  be  relatively  small,  and 
its  temperature  should,  as  nearly  as  possible,  be  that  of  the  rectum.  In 
order  to  secure  absorption,  it  is  necessary  also  to  regard  the  laws  of 
diffusion.  As  the  secretions  of  the  rectum  are  alkaline,  it  is  obvious 
that  acidulated  solutions  will  diffuse  into  the  rectal  veins  with  the 


CATHARTICS.  769 

greatest  facility.  It  is  doubtful  whether  colloidal  substances  of  them- 
selves are  taken  up  in  the  rectum.  (See  NUTRIENT  ENEMATA,  p.  55.) 

Irrigation  of  the  intestines,  or  forced  injections  of  a  large  quantity 
of  water,  is  a  modern  expedient  of  great  practical  utility.  The  appa- 
ratus required  for  the  performance  of  this  operation  consists  of  a  rectal 
tube,  a  flexible  rubber  pipe  three  or  four  feet  in  length,  and  a  funnel- 
shaped  vessel  to  contain  the  fluid  to  be  injected.  The  decubitus  on 
either  side,  the  hips  being  elevated,  may  be  sufficient ;  but,  to  insure 
gravitation  of  the  fluid  to  the  ileo-caecal  valve,  the  female  patient 
should  be  placed  in  Sims's  position,  and  the  male  patient  on  his  hands 
and  knees.  The  rectal  tube  should  be  inserted,  and  passed  up  to  the 
sigmoid  flexure  ;  the  flexible  tube  should  then  be  attached.  The 
height  to  which  the  reservoir  is  raised  will  regulate  the  hydrostatic 
pressure,  and  the  flow  of  fluid  through  the  flexible  tube  can  be  lessened 
or  increased  at  the  pleasure  of  the  operator  by  compression  with  the 
fingers. 

In  administering  rectal  injections  the  utmost  gentleness  is  requisite, 
especially  when  a  large  amount  of  fluid  is  to  be  introduced.  Rude 
thrusting  of  the  pipe  into  the  rectum  may  injure  the  mucous  mem- 
brane, and  rapid  and  forcible  dilatation  of  the  bowel  will  excite  an 
imperious  desire  to  go  to  stool.  Too  great  pressure,  in  the  process  of 
irrigation,  may  cause  a  rupture  of  the  intestine,  especially  if  its  coats 
are  softened  by  disease  or  penetrated  by  ulceration.  It  is  possible 
that  sudden  and  forcible  distention  of  the  bowel  may  produce  dan- 
gerous cardiac  syncope  in  susceptible  subjects. 

The  experiments  on  the  cadaver  have  demonstrated  that,  although 
the  large  intestine  may  be  filled  with  water,  no  fluid  can  be  made  to 
pass  the  ileo-csecal  valve.  Notwithstanding  these  experiments,  it  has 
been  claimed  that  in  the  living  subject,  by  the  irrigation  method,  water 
can  be  forced  through  the  whole  length  of  the  intestine.  If  these  ob- 
servations are  correct,  it  is  probable  that  a  pathological  state  of  the 
ileo-csecal  valve  must  have  existed. 

FORMS  OF  ENEMATA. — Enema  Aloes. — $  Aloes,  3ij ;  potassii  car- 
bonat.,  grs.  xv  ;  mucil.  amyli  vel  decoct,  hordei,  |"  x.  (B.  P.) 

Enema  Magnesii  Sulphatis. — 1J  Magnesii  sulphat.,  f  j  ;  ol.  olivae, 
|  j  ;  mucil.  amyli  vel  decoct,  hordei,  §  xv.  Dissolve  the  sulphate  of 
magnesia  in  the  mucilage,  then  add  the  oil.  (B.  P.) 

Enema  Terebinthinae. — Ijc,  Ol.  terebinthinse,  f  j  ;  mucil.  amyli  vel 
decoct,  hordei,  §  xv.  (B.  P.) 

Enema  OL  Ricini  et  Terebinthince. — Ijc.  Ol.  terebinthini,  f  ss  ;  ol. 
ricini,  3  jss  ;  ovi,  j  ;  decoct,  hordei  vel  aq.  fervid.,  f  xiv. 

A  common  domestic  enema  consists  of  soap-suds,  made  somewhat 
more  stimulating  to  the  rectum  by  the  addition  of  turpentine. 

THERAPY. — A  pint  of  cold  water  is  a  good  enema  for  cases  of 
habitual  constipation,  especially  when  there  are  haemorrhoids  which 


770  EVACUANTS. 

bleed  with  every  motion.  The  enema  of  aloes,  in  quantity  correspond- 
ing to  the  age  of  the  subject,  is  an  efficient  remedy  for  the  destruction 
of  ascarides  vermiculares. 

The  purgative  enemata  above  given  are  employed  to  act  on  the 
large  intestine,  chiefly  by  virtue  of  reflex  stimulation,  but,  in  part,  ab- 
sorption of  the  purgative  principle  takes  place,  whence  it  follows  that 
they  may  affect  the  whole  canal.  They  are  used,  therefore,  as  cathar- 
tics, and  for  the  ordinary  purposes  of  these  remedies.  The  purgative 
enemata  are  not  suitable  for  habitual  use.  They  excite  irritation  of 
the  rectum,  which  may  result  in  ulceration,  ischio-rectal  abscess,  fistula 
in  ano,  fissure  of  the  anus,  and  other  serious  accidents. 

Irrigation  of  the  bowel  is  resorted  to  for  the  removal  of  impacted 
faeces,  to  overcome  intussusception,  etc. 

Cases  of  intestinal  invagination  have  been  very  quickly  relieved  by 
sudden  inflation  of  the  large  intestine  with  carbonic  acid.  The  process 
consists  in  the  injection  of  a  solution  of  sodium  bicarbonate,  followed 
by  a  solution  of  tartaric  acid — about  one  drachm  of  each  to  eight 
ounces  of  water.  The  escape  of  the  gas  through  the  sphincter  ani 
must  be  prevented  by  forcible  pressure  upon  the  anus. 

Suppositoria  Aloes. — (Aloes  and  cacao-butter.)  Each  suppository 
contains  about  five  grains  of  purified  aloes.  One  of  these,  introduced 
into  the  rectum  at  night,  will  generally  procure  one  or  two  evacua- 
tions on  the  following  day.  It  is  not  good  practice  to  employ  such  a 
method  of  treatment  frequently. 

A  piece  of  hard  white  soap  cut  into  a  conical  shape,  and  of  a  suitr 
able  size,  is  frequently  used  in  domestic  practice  to  relieve  the  consti- 
pation of  infants.  The  soap  suppository  thus  prepared  is  carefully 
introduced  into  the  rectum.  The  habit  of  a  daily  evacuation  may  be 
thus  induced.  A  piece  of  paper  rolled  into  a  conical  shape,  and  dipped 
into  oil,  may  be  used  instead  of  the  soap  suppository. 


ANTHELMINTICS. 

ANTHELMINTICS  are  remedial  agents  used  to  cause  the  expulsion  of 
parasites  from  the  intestinal  canal.  Vermifuges  are  remedies  which 
expel  worms  ;  vermicides  are  remedies  which  kill  as  well  as  expel 
worms.  Some  of  these  agents  act  mechanically,  as  mucuna  and  pow- 
dered tin ;  others  are  administered  in  such  quantity  as  to  sicken  and 
disable  the  worms,  when  their  expulsion  is  easily  effected  :  for  ex- 
ample, pumpkin-seed  emulsion.  Others  again  possess  narcotic  and 
toxic  properties,  as  turpentine,  chenopodium,  santonin,  etc. 

Anthelmintics  are  conveniently  divided  into  those  employed  against 
ascarides  vermiculares,  those  employed  against  ascarides  lumbricoides, 
and  those  employed  against  the  different  varieties  of  tsenia. 


ANTHELMINTICS.  771 

Ascarides  vermiculares  infest  the  rectum  and  large  intestine,  ex- 
tending up  occasionally  as  high  as  the  ileo-caecal  valve ;  in  females, 
they  may  also  spread  into  the  vagina.  As  they  deposit  their  ova  in 
the  folds  of  the  anus,  and  in  the  vagina,  it  is  obvious  that  the  parasiti- 
cide, to  be  effective,  must  be  applied  in  these  situations. 

Infusion  of  quassia,  decoction  of  aloes,  and  a  weak  solution  of  car- 
bolic acid,  are  the  most  frequently-prescribed  remedies  for  the  destruc' 
tion  of  ascarides.  If  carbolic  acid  is  used,  the  strength  of  the  injec- 
tion for  children  should  not  exceed  ten  grains  to  the  pint,  and  it 
should  not  be  retained.  Infusion  of  quassia  is  at  the  same  time  safe 
and  effective  ;  but,  when  this  injection  is  used,  a  solution  of  carbolic 
acid  should  be  applied  also,  by  means  of  a  sponge,  to  the  folds  of  the 
anus,  and,  in  the  case  of  female  children,  to  the  external  genitals.  If 
the  ascarides  extend  up  into  the  large  intestine  beyond  the  sigmoid 
flexure,  a  dose  of  santonin  and  calomel  should  precede  the  use  of  the 
rectal  parasiticide. 

REMEDIES  USED  FOR  THE  EXPULSION  OF  ASCARIDES  LUMBRICOIDES. 

Mueuna. — Cowhage.  The  hairs  of  the  pods  of  Mucuna  pruriens. 
This  remedy  is  now  rarely  if  ever  used.  It  is  administered  in  the 
form  of  electuary,  mixed  with  molasses.  A  teaspoonful  or  more  of 
the  mixture  should  be  administered  fasting,  and  after  the  action  of  a 
cathartic.  When  several  doses  have  been  taken  a  brisk  purgative 
should  be  given. 

When  cowhage  is  applied  to  the  skin  it  excites  intense  itching,  in- 
flammation in  the  skin,  and  pustulation.  It  has  been  proposed  as  a 
counter-irritant,  but  a  more  disagreeable  one  could  hardly  be  conceived. 
It  is  very  irritant  to  the  intestinal  mucous  membrane,  as  it  is  to  the 
skin,  and  an  action  is  speedily  set  up  for  its  expulsion.  When  by  the 
use  of  a  purgative,  and  by  reason  of  fasting,  intestinal  worms  are  un- 
covered and  exposed  to  attack,  it  is  held  that  the  mucuna-hairs  pierce 
the  parasites  and  irritate  them,  so  that  their  stay  in  the  intestine  is 
rendered  intolerable.  In  consequence  of  the  active  peristaltic  move- 
ments induced  by  the  cowhage,  and  by  the  purgative  with  which  it  is 
followed,  the  worms  are  hurried  out  with  the  remaining  contents,  if 
any,  of  the  intestines. 

Santonica.  —  Santonica.  The  unexpanded  flowers  of  Artemisia 
pauciflora  Weber  (Nat.  Ord.  Composite).  (U.  S.  P.)  Semencine, 
Fr.;  Wurmsamen,  Ger. 

COMPOSITION. — Resin,  malic  acid,  essential  oil,  and  a  crystallizable 
principle  (santonin}. 

SANTONINUM. — Santonin.  A  neutral  principle  obtained  from  san- 
tonica.  A  colorless  substance,  crystallizing  in  shining,  flattened  prisms, 


772  EVACTJANTS. 

without  smell,  and  nearly  tasteless  when  first  put  into  the  mouth,  and 
afterward  bitter.  It  is  not  altered  by  the  air,  but  becomes  yellow  on 
exposure  to  light.  Nearly  insoluble  in  cold  water,  it  is  dissolved  by 
two  hundred  and  fifty  parts  of  boiling  water.  It  is  soluble  in  forty- 
three  parts  of  cold  or  in  three  parts  of  boiling  alcohol,  and  in  seventy- 
five  parts  of  ether.  Dose,  gr.  ss — gr.  v,  according  to  age. 

Trochisci  Santonini. — Troches  of  santonin.  (Santonin,  3  grm.; 
with  sugar,  tragacanth,  orange-flower  water,  to  form  one  hundred 
troches.)  Each  troche  contains  a  half -grain  of  santonin,  and  from  one 
to  three  are  sufficient  as  a  vermifuge  in  children. 

ANTAGONISTS  AND  INCOMPATIBLES. — We  do  not  possess  any  satis- 
factory data  in  regard  to  the  physiological  antagonists  of  santonin. 
When  a  poisonous  dose  has  been  taken  the  stomach  should  be  emptied, 
and  the  systemic  effects  should  be  treated  symptomatically. 

SYNEEGISTS. — Therapeutically  the  action  of  santonin  is  aided  by 
cathartics,  especially  by  calomel. 

PHYSIOLOGICAL  ACTIONS. — In  ordinary  medicinal  doses  as  used  for 
the  expulsion  of  lumbrici,  santonin  causes  no  sensible  intestinal  dis- 
turbance. In  considerable  doses  nausea  and  vomiting  are  produced, 
and  are  followed  by  colic  and  diarrhrea.  Santonin  enters  the  blood, 
probably,  in  combination  with  soda,  for,  although  it  has  no  acid  prop- 
erties, it  has  the  power  to  form  such  combinations.  Santonin,  ac- 
cording to  Hesse  (Fliickiger  and  Hanbury),  is  the  anhydride  of  a 
crystallizable  acid,  which,  when  heated,  is  resolved  into  santonin  and 
water.  Vision  is  affected  in  a  remarkable  manner.  Usually  all  objects  < 
appear  as  if  viewed  through  yellow  glass  ;  but  other  colors  sometimes 
appear,  as  green,  blue,  or  even  red  ( Gelbsehen,  Rose).  The  chroma- 
topsia  is  probably  due,  according  to  Rose,  to  the  solution  of  santonin 
in  the  alkaline  serum,  and  its  action  on  the  perceptive  centers  (vol. 
xviii,  page  26).  In  passing  out  with  the  urine  santonin  imparts  a  yel- 
lowish, and,  when  the  amount  is  large,  a  reddish-purple,  hue  to  this 
fluid. 

In  toxic  doses  santonin  produces  very  decided  cerebral  effects  : 
trembling,  vertigo,  convulsive  movements,  tetanoid  cramps,  stupor, 
cold  sweats,  dilated  pupils,  insensibility,  etc. 

THERAPY. — Cures  of  amaurosis  have  been  reported  from  the  use 
of  santonin,  but  we  possess  no  exact  indications  for  its  administration. 
It  is,  probably,  effective  only  in  functional  derangement.  The  chief 
use  of  this  remedy  is  for  the  expulsion  of  ascarides  lumbricoides.  It 
is  the  most  effective  and  pleasant  remedy  which  can  be  employed  for 
this  purpose.  A  convenient  form  for  administration  is  the  troche,  or 
it  may  be  prescribed  in  a  powder  with  calomel.  The  following  is  a 
successful  plan  of  using  this  parasiticide  :  A  laxative  in  the  morning, 
fasting  through  the  day,  a  dose  of  santonin  and  calomel  at  bedtime,  a 
senna-draught  on  the  following  morning. 


ANTHELMINTICS.  773 

Authorities  referred  to  : 

BROWN,  DR.  DYCE.     SchmidCs  Jahrbucher,  vol.  cl,  p.  138. 
FLUCKIGER  AND  HANBURY.     Pharmacographia,  p.  347. 
HERMANN,  DR.  L.     Lehrbuch  der  exper.  Toxikologie,  p.  383. 
HUSEMANN,  DBS.  AUG.  UNO  THEOD.     Die  Pflanzenstoffe,  p.  92Y. 
KOHLER,  PROF.  DR.  HERMANN.     Handbuch,  vol.  ii,  p.  1292. 
ROSE,  E.     Virchow's  Archiv,  vols.  xvi,  xviii,  xix,  xx,  xxviii. 

Spigelia, — Pink-root.  The  rhizoma  and  roots  of  /Spigelia  mari- 
landica  Linne  (Nat.  Ord.  Loganiacece). 

Extractum  Spigelice  Fluidum. — Fluid  extract  of  spigelia.  Dose, 
3  j —  1  ss. 

COMPOSITION. — A  bitter,  uncrystallizable  principle  (spigelin .?),  vol- 
atile oil,  tannic  and  gallic  acid. 

ACTIONS  AND  USES. — In  moderate  doses  spigelia  produces  a  sensa- 
tion of  warmth  at  the  epigastrium,  stimulates  the  intestinal  movements, 
accelerates  the  action  of  the  heart,  and  promotes  the  cutaneous  trans- 
piration. In  large  doses  it  causes  cerebral  effects,  vertigo,  dimness 
of  vision,  dilated  pupils,  convulsions,  and  insensibility.  Many  of  the 
serious  symptoms  supposed  to  have  been  produced  by  it  in  certain 
cases  were  probably  really  due  to  pre-existing  cerebral  lesions.  Cases 
of  basilar  meningitis,  for  example,  have  not  unfrequently  been  con- 
founded with  "  worm-fever."  Any  vermifuge,  given  under  these  cir- 
cumstances, might  seem  to  have  caused  the  head-symptoms  which  are 
characteristic  of  the  brain-lesions. 

Spigelia  is  used  only  as  a  vermifuge,  and  against  the  round  worm, 
for  the  expulsion  of  which  it  has  proved  to  be  very  efficient.  A  low 
diet  and  a  brisk  cathartic  should  precede  the  use  of  this  remedy.  The 
best  form  for  administration  is  the  fluid  extract  of  senna  and  spigelia. 

Authorities  referred  to  : 

PORCHER,  DR.  F.  P.     Resources  of  the  Southern  Fields  and  forests. 
STILLE,  DR.  ALFRED.     Therapeutics  and  Materia  Medico. 

Chen  op  odium. — Worm-seed.  The  fruit  of  Chenopodium  anthelmin- 
ticum  Linne  (Nat.  Ord.  Chenopodiacece). 

Oleum  Chenopodii. — Oil  of  worm-seed.      Dose,  gtt.  v — gtt.  xv. 

ACTIONS  AND  USES. — The  oil  of  worm-seed  is  the  only  preparation 
of  the  plant  now  used,  and  this  is  rarely  employed,  in  consequence  of 
its  very  disagreeable  and  characteristic  odor  and  taste.  It  excites  a 
sensation  of  warmth  at  the  epigastrium,  increases  the  action  of  the 
heart,  and  promotes  cutaneous,  bronchial,  and  renal  secretions.  It  is  a 
diffusible  stimulant,  and  as  such  may  be  given  with  advantage  in  hys- 
teria and  chorea,  as  a  carminative  in  flatulence,  and  as  an  antiperiodic 
in  inter -mittents.  The  only  use  of  worm-seed  is  as  a  remedy  for  as- 
carides  lumbricoides.  It  is  one  of  the  most  efficient  of  the  class.  It 


774  EVACUAXTS. 

should  be  given  three  times  a  day  for  two  days,  and  followed  by  a 
brisk  cathartic.  An  excellent  combination  for  the  expulsion  of  the 
round  worm  is  ten  drops  of  worm-seed  oil,  and  a  teaspoonful  of  fluid 
extract  of  senna  and  spigelia.  It  may  also  be  administered  in  castor-oil. 

REMEDIES  USED  AGAINST  T^ENLE. 

The  success  of  tseniafuges  depends  largely  upon  the  preliminary 
treatment.  The  parasite  is  imbedded  in  mucus,  its  booklets  fixed  in 
the  mucous  membrane.  The  medicament  which  is  administered  for  its 
expulsion  must  come  in  contact  with  the  scolex.  To  dislodge  a  quan- 
tity, however  large,  of  the  segments  (strobila),  although  temporary 
relief  may  follow,  will  not  be  permanently  curative.  The  head  of  the 
parasite  must  be  expelled. 

Before  using  the  taeniaf uge  the  contents  of  the  intestinal  canal  must 
be  thoroughly  evacuated. 

Two  days  of  fasting,  some  milk  and  bread  only  being  taken,  must 
precede  the  treatment. 

Aspidium. — Male  fern.  The  rhizoma  of  Dryopterisfilix-mas  Schott, 
and  of  Dryopteris  marginalis  Asa  Gray  (Nat.  Ord.  Filices).  (U.  S.  P.) 
Fougere  male,  Fr.;  Wurmfarnwurzel,  Ger. 

Oleo-resina  Aspidii. — Oleo-resin  of  fern.     Dose,  3  ss —  3  ij. 

COMPOSITION. — A  green,  fatty  oil,  volatile  oil,  resin,  tannin,  etc. 
The  ethereal  extract  deposits  a  granular,  crystalline  substance  (filicic 
acid),  on  which  the  medicinal  activity  of  the  drug  appears  to  depend. 

ACTIONS  AND  USES. — The  oleo-resin  of  filix  mas  is  a  very  efficient 
remedy  for  tape-worm,  especially  the  unarmed  variety  ;  but,  if  suitable 
precautions  be  taken  to  insure  success,  it  is  quite  a  certain  remedy  for 
the  armed  taenia.  The  method  of  Trousseaux  and  Pidoux  is  as  efficient 
as  any  (vol.  ii,  page  1040).  On  the  first  day,  a  strictly  milk  diet  ;  on 
the  morning  of  the  second  day,  four  grammes  (about  3  j)  of  the  oleo- 
resin  in  four  doses,  with  an  interval  of  a  quarter  of  an  hour  between 
each  ;  on  the  third  day,  the  same  quantity  at  the  same  intervals,  fol- 
lowed by  fifty  grammes  of  the  sirup  of  ether,  and,  a  half-hour  later,  an 
emulsion  containing  three  drops  of  croton-oil.  Kuchenmeister  gives 
a  number  of  methods,  and  Cobbold  favors  the  employment  of  male 
fern  in  certain  cases. 

Granatum. — Pomegranate.  The  bark  of  the  stem  and  root  of 
Punica  granatum  Linne  (Nat.  Ord.  Lythraricoe).  (TJ.  S.  P.)  iScorce 
de  ratine  de  grenadier,  Fr.;  Granatwurzelrinde,  Ger. 

COMPOSITION. — Pomegranate-bark  contains  a  principle — -pelleterine 
— on  which  its  activity  depends.  The  tannate,  an  efficient  tzeniaf  uge, 
can  be  given  in  doses  of  five  grains  to  one  scruple. 

ACTIONS  AND  USES. — The  rind  of  the  fresh  root  only  should  be  used. 


ANTHELMINTICS.  775 

The  best  preparation  is  the  decoction,  prepared  by  boiling  gently  two 
ounces  of  the  bark  in  a  quart  of  water  down  to  a  pint.  Of  this  decoc- 
tion a  wineglassful  may  be  given  every  hour  until  all  is  taken.  It 
should  be  preceded  by  a  brisk  purgative,  and  should  be  taken  fasting. 
It  produces  more  or  less  nausea,  borborygmi,  intestinal  pain,  and  usu- 
ally purges.  If  a  purgative  effect  is  not  caused  by  it,  a  brisk  cathartic 
should  follow.  In  the  author's  experience,  this  is  a  very  certain  and 
efficient  taeniafuge.  Tanret's  preparation  of  unpurified  pelleterine,  in 
solution,  has  acted  very  efficiently  in  some  cases. 

CllSSO. — Kousso.  The  female  inflorescence  of  Hagenla  abyssinica 
Bruce  (Nat.  Ord.  Rosacece).  (U.  S.  P.)  Bray&re  anthelminthique, 
Fr.;  Kussobliithen,  Ger. 

JBxtractum  Cusso  Fluidum. — Fluid  extract  of  cusso.     Dose,  3  ij 

—  !J- 

Infusum  Brayerce, — Infusion  of  cusso  (six  parts  to  one  hundred 
of  water).  Dose,  3  iv —  §  viij — Oj,  or  more.  (Not  official.) 

COMPOSITION. — Brayera  contains  an  active  principle  (kosin,  or 
koussin),  which  crystallizes  in  rhombic  prisms.  Kosin  appears  to  be 
inert  of  itself,  and  is  active  only  when  combined  with  the  other  con- 
stituents of  the  drug. 

ACTIONS  AND  USES. — Kousso  is  used  solely  as  an  anthelmintic. 
Opinions  vary  as  to  its  utility.  On  the  whole,  it  may  be  said  that  the 
first  enthusiasm  which  attended  its  introduction  into  practice  has  died 
away.  It  brings  the  segments,  but  rarely  expels  the  head  of  the  para- 
site. It  is  necessary  to  take  it  in  large  quantity — half  an  ounce — 
mixed  with  water.  It  is  retained  with  difficulty,  and  produces  much 
intestinal  distress.  When  successful,  the  worm  is  brought  away  with- 
out the  action  of  a  purgative. 

Kamala. — Kamala.  The  glands  and  hairs  from  the  capsules  of 
Mallotus  Philippinensis  Mueller  Arg.  (Nat.  Ord.  JZuphorbiacece). 
(U.  S.  P.)  Dose,  3  j—  3  iij. 

There  are  no  official  preparations.  A  saturated  tincture  may  be 
given,  in  the  dose  of  one  to  three  drachms. 

ACTIONS  AND  USES. — It  is  an  orange  powder.  It  causes  some  nausea 
and  griping,  usually,  but  it  may  operate  without  producing  any  un- 
pleasant sensations.  It  acts  as  a  purgative,  and  causes  the  expulsion 
of  the  worm.  If  one  dose  is  insufficient,  its  administration  should  be 
continued  every  three  hours  until  five  or  six  doses  have  been  taken. 
Kamala  is  effective  not  only  against  tape-worm,  but  also  against  lum- 
brici  and  ascarides  vermiculares. 

Pepo. — Pumpkin-seed.  The  seed  of  Cucurbito  pepo  Linne  (Nat. 
Ord.  Cucurbitacece). 

ACTIONS  AND  USES. — This  is  one  of  the  most  efficient  remedies  which 


776  EVACUANTS. 

we  possess  against  tsenia.  Two  ounces  of  the  fresh  seed  are  pounded 
in  a  mortar,  with  a  half -pint  of  water,  until  the  husks  are  loosened  and 
an  emulsion  is  made.  The  mixture  is  then  strained,  and  the  whole 
amount  is  taken  fasting  ;  but  Squibb  maintains  that  all  should  be  taken, 
husks  included.  If  an  action  of  the  bowels  does  not  take  place  in  two 
hours,  the  emulsion  should  be  followed  by  castor-oil.  If  success  is  not 
attained,  the  dose  may  be  repeated  each  morning  until  the  parasite  is 
produced.  Numerous  cases  of  successful  use  of  pumpkin-seed  emul- 
sion have  been  reported. 

The  expressed  oil,  which  is  bland  and  unirritating,  like  almond-oil, 
may  be  used  as  a  substitute  for  the  seeds.  It  should  be  given  in  the 
dose  of  a  half-ounce,  two  or  more  times,  and  after  several  hours  fol- 
lowed by  castor-oil.  The  rules  already  given,  in  regard  to  preliminary 
treatment,  should  also  be  followed. 

Authorities  referred  to  : 

COBBOLD,  T.  SPENCEK.  On  Parasites.  Also  various  articles  in  The  Medical  Times  and 
Gazette,  1875. 

HUSEMANN,  DR.  THEODOR.     Handbuch,  op.  tit.,  erster  Band,  p.  202. 

KOHLER,  DR.  HERMANN.  Handbuch  der  physiologische  Therapeutik,  zweiter  Band, 
p.  1292. 

Ki'CHENMEisiER,  DR.  FREDERICK.  On  Animal  and  Vegetable  Parasites,  Sydenham  So- 
ciety, vol.  i,  p.  147,  et  seq. 

STILLE,  DR.  ALFRED.     Therapeutics  and  Materia  Medica,  vol.  ii. 

SQUIBB,  DR.  EDWARD.     The  Ephemeris,  1883. 


THESE  remedies  are  employed  chiefly  for  their  action  on  the  genito- 
urinary passages.  They  stimulate  the  kidneys  to  increased  activity, 
and  excite  the  functions  of  the  pelvic  viscera.  In  excessive  quantity, 
or  long  continued,  they  may  set  up  inflammation  of  the  kidney,  pro- 
duce strangury  and  bloody  urine,  excite  uterine  contractions,  and  stimu- 
late to  an  unnatural  degree  the  sexual  propensities.  They  contain  an 
essential  oil,  or  principle,  which  makes  its  exit  by  the  urinary  passages 
and  excites  local  irritation  by  direct  contact. 

TerebintMna. — Turpentine.  A  concrete  oleo-resin  obtained  from 
Pinus  paliistris  Miller,  and  from  other  species  of  Pinus  (Nat.  Ord. 
ConifercB). 

Oleum  Terebinthinae. — Oil  of  turpentine.  A  volatile  oil  distilled 
from  turpentine.  (U.  S.  P.)  Essence  de  terebinthine,  Fr. ;  Terpentinol, 
Ger.  Dose,  T\[  v —  §  ss. 

Linimentum  Terebinthince. — Liniment  of  turpentine.  (Resin  ce- 
rate, sixty-five  parts;  oil  of  turpentine,  thirty-five  parts.) 

Oleum  Terebinthince  Rectificatum. — Rectified  oil  of  turpentine. 
Dose,  m  j — ni  xxx.  This  should  be  dispensed  on  prescription. 


URINO-GENITALS.  777 

ANTAGONISTS  AND  INCOMPATIBLES. — All  remedies  increasing  waste, 
and  the  vaso-motor  depressants,  counterbalance  the  therapeutical  ac- 
tions of  turpentine.  In  cases  of  poisoning  the  stomach  should  be 
promptly  emptied,  and  anodynes  and  demulcents  should  be  adminis- 
tered. Elimination  should  be  favored,  and  the  toxic  symptoms  treated 
according  to  the  systemic  indications.  Ozonized  oil  of  turpentine  is 
an  antidote  to  phosphorus,  preventing  the  formation  of  phosphoric  acid 
and  converting  the  poison  into  an  insoluble  spermaceti-like  substance. 
Turpentine  worn  in  a  vial  about  the  neck  prevents  necrosis  of  the  jaw 
and  steatosis  of  organs  in  workmen  engaged  in  manufactures  employ- 
ing phosphorus. 

STNEBGISTS. — The  diffusible  and  alcoholic  stimulants  favor  the 
action  of  turpentine. 

PHYSIOLOGICAL  ACTIONS. — Turpentine-oil  is  a  limpid,  colorless  fluid, 
having  a  strong,  peculiar,  and  diffusive  odor,  and  a  hot  and  pungent 
taste.  It  is  very  slightly  soluble  in  water.  The  oil  exposed  to  the 
air  absorbs  oxygen  (ozone),  which  it  retains  with  great  tenacity.  Ap- 
plied to  the  skin,  turpentine  causes  heat,  redness  followed  by  a  vesicu- 
lar eruption,  and  sometimes  by  intractable  ulcerations.  A  few  drops 
produce  a  sense  of  heat  at  the  epigastrium,  and  a  large  dose  (medi- 
cinal) causes  intense  burning  pain,  nausea,  eructations  of  the  oil,  in- 
testinal irritation  and  purging  (usually).  Notwithstanding  its  slight 
solubility  in  water,  turpentine  diffuses  into  the  blood  with  facility,  and 
is  quickly  recognized  in  the  breath,  sweat,  and  urine.  The  action  of 
the  heart  and  arteries  is  increased  by  it,  the  arterial  tension  rises,  and 
a  general  sense  of  warmth  and  exhilaration  is  experienced.  In  large 
doses  (one  or  two  ounces)  vomiting,  thirst,  and  a  febrile  state,  are 
induced  ;  the  muscular  strength  is  diminished,  the  power  of  co-ordina- 
tion is  impaired  ;  exhilaration  of  mind,  incoherence  of  ideas,  and  ram- 
bling insensibility,  follow.  In  toxic  doses  there  are  complete  muscular 
relaxation  and  profound  insensibility  with  abolition  of  all  reflex  move- 
ments ;  the  face  is  flushed  or  cyanosed,  the  pupils  usually  dilated,  and 
the  breathing  labored  and  stertorous.  All  the  organs  by  which  tur- 
pentine is  eliminated,  especially  the  kidneys,  suffer  from  extreme  irri- 
tation when  large  doses  have  been  swallowed.  The  skin  is  usually 
moist,  and  exhales  a  turpentine-odor  ;  the  bronchial  secretion  is  in- 
creased, and  convulsive  coughing  is  induced  ;  the  urine  is  scanty  and 
bloody,  and  there  is  violent  strangury.  The  only  fatal  cases  which 
have  been  reported  have  occurred  in  children  (Taylor).  From  four 
to  six  ounces  have  not  destroyed  life  in  adults. 

As  regards  its  action  on  the  organs  of  circulation,  the  author's 
experiments  show  that  turpentine  stimulates  the  vaso-motor  nervous 
system  when  administered  in  moderate  doses.  A  large  quantity 
quickly  exhausts  the  irritability  of  the  sympathetic  ganglia,  the  action 
of  the  heart  becomes  weak,  and  the  arterial  tension  falls  ;  the  respira- 


778  EVACUANTS. 

tory  movements  are  at  first  stimulated,  but  afterward  become  shallow, 
and  carbonic-acid  poisoning  supervenes.  The  brains  of  animals  killed 
by  turpentine  smell  strongly  of  it,  and  hence  it  may  be  concluded  that 
it  has  a  direct  action  on  the  cells  of  the  cerebral  lobes. 

Turpentine  has  decided  antiseptic  power.  It  arrests  fermentation 
processes,  putrefaction,  and  is  very  destructive  of  minute  organisms 
(vibrio,  bacteria,  etc.). 

The  vapor  of  turpentine  inhaled  produces  nasal  and  bronchial  irri- 
tation, frontal  headache,  and  renal  irritation,  even  bloody  urine  and 
strangury. 

On  post  mortem  after  turpentine-poisoning,  violent  gastro-intestinal 
irritation,  ecchymoses  of  the  air-passages,  congestion  of  the  lungs,  and 
hypememia  of  the  kidneys,  are  noted. 

THERAPY. — Flatulence  may  be  quickly  relieved  by  a  few  drops 
(three  to  five)  of  turpentine,  on  a  lump  of  sugar.  This  remedy  is 
especially  indicated  in  flatulence  persisting  from  a  paretic  state  of  the 
muscular  layer  of  the  bowel.  There  is  abundant  evidence  to  prove  the 
curative  power  of  oil  of  turpentine  in  chronic  intestinal  catarrh.  It  is 
especially  indicated  when  the  tongue  is  dry  and  glazed,  when  there  is 
tympanitic  distention  of  the  bowels,  and  when  the  alvine  discharges 
consist  either  of  fluid  faeces  or  scybala,  mixed  with  mucus  and  pale, 
watery  blood.  It  is  best  administered  in  an  emulsion,  with  almond- 
oil  and  opium.  1£  Ol.  terebinthini,  3  j  ;  ol.  amygdal.  express.,  f  ss  ; 
tinct.  opii,  3  ij  ;  mucil.  acacise,  3  v  ;  aquae  laur.-cerasi,  §  ss.  M.  Sig. : 
A  teaspoonful  every  three,  four,  or  six  hours.  The  same  remedy,  in  a* 
similar  combination,  is  very  effective  in  acute  dysentery  after  the  sub- 
sidence of  the  more  acute  symptoms.  The  following  is  probably  the 
true  explanation  of  its  action  in  these  cases  :  it  gives  tonicity  to  the 
vessels,  and  to  the  muscular  fiber  of  the  intestines  ;  arrests  the  putre- 
factive and  fermentative  processes  which  take  place  in  the  vitiated 
mucus  and  articles  of  food,  and  increases  the  cutaneous  capillary  circu- 
lation, thus  relieving  congestion  of  internal  organs. 

Stimulating  enemata  are  made  of  turpentine,  mucilage,  oils,  etc. 
These  are  especially  indicated  in  constipation,  and  in  impaction  of 
the  rectum.  $  Ol.  terebinthini,  3  ij —  f  j  ;  ol.  ricini,  f  ij  ;  vitell.  ovi 
unius  ;  decoct,  hordei,  f  viij — Oj.  M.  Sig.:  As  an  enema.  Such  in- 
jections are  frequently  used  in  tympanitic  distention  of  the  large 
intestine,  in  flatulent  colic,  in  impaction  of  the  caecum,  etc. 

A  combination  of  equal  parts  of  turpentine  and  ether  constitutes 
the  well-known  remedy  of  Durand  for  the  solution  and  cure  of  biliary 
calculi.  Notwithstanding  the  unquestionable  utility  of  this  remedy, 
we  can  not  admit  with  Durand  that  its  efficacy  depends  on  its  solvent 
power  (Trousseau).  During  the  attack  of  biliary  colic  this  remedy 
may  be  administered  with  a  view  to  its  anodyne  and  antispasmodic 
effect ;  but,  as  Kohler  states,  it  is  by  no  means  equal  to  morphine  and 


URINO-GEXITALS.  779 

chloral  hydrate.  In  the  after-treatment,  clinical  experience  is  in  favor 
of  the  occasional  administration  of  Durand's  remedy  during  a  course 
of  Vichy  or  Carlsbad  water. 

Turpentine  is  one  of  the  most  effective  remedies  which  we  possess 
in  the  treatment  of  tcenice.  Full  doses  (  3  ss —  3  ij)  are  required,  and 
the  rules  for  preliminary  treatment  already  laid  down  (see  ANTHEL- 
MIXTICS)  should  be  adhered  to.  Turpentine  should  be  combined  with 
a  purgative,  in  order  to  insure  prompt  cathartic  effect.  If  absorption 
of  any  considerable  part  of  the  turpentine  takes  place,  violent  intoxica- 
tion will  follow,  and  irritation  of  the  kidneys,  hsematuria,  and  stran- 
gury, will  be  produced  in  the  efforts  at  elimination.  The  oleo-resin 
of  filix  mas  may  be  combined  with  turpentine.  IJ  Ol.  terebinthinae, 
§  j  ;  oleo-resinae  filicis,  3  j  ;  vitell.  ovi  no.  ij  ;  ol.  ricini,  3  j.  M.  Sig.: 
A  draught.  This  is  an  effective,  but  by  no  means  an  agreeable,  mix- 
ture. An  ounce  each  of  turpentine  and  castor-oil  may  be  administered, 
as  the  cathartic,  after  the  use  of  the  decoction  of  pomegranate. 

Turpentine  being  a  cardiac  stimulant,  and  an  excitant  of  the  capil- 
lary circulation,  is  contraindicated  in  hypertrophy  of  the  heart,  and 
when  advanced  atheroma  of  the  cerebral  arteries  may  be  presumed  to 
exist.  It  is  a  serviceable  cardiac  stimulant  when  the  action  of  the 
heart  is  weak,  and  the  arterial  tension  low.  In  the  passive  haemor- 
rhages we  possess  few  agents  more  generally  useful.  The  indications 
for  its  use  are  a  condition  of  debility,  relaxation  of  the  vessels,  and  an 
impoverished  condition  of  the  blood.  Transudations  on  the  free  mu- 
cous surfaces — epistaxis,  bronchial  haemorrhage,  hcematemesis,  intesti- 
nal haemorrhages,  hcematuria — when  associated  with  the  state  of  con- 
stitutional depression  defined  above,  are  forms  of  haemorrhage  in  which 
turpentine  should  be  used.  IJ  Ol.  terebinthinae,  3  iij  ;  ext.  digitalis 
fl.,  3  j  ;  rnucil.  acaciae,  3*  ss  ;  aquae  menthse  pip.,  1  j.  M.  Sig. :  A 
teaspoonful  every  three  hours.  The  haemorrhagic  transudations  which 
take  place  in  purpura,  in  scorbutus,  and  allied  states,  are  also  arrested 
by  turpentine.  It  need  hardly  be  stated  that  active  haemorrhage  and 
a  condition  of  plethora  contraindicate  the  use  of  turpentine. 

As  a  stimulant  to  the  vaso-motor  nervous  system,  turpentine  is  in- 
dicated in  fevers  when  the  action  of  the  heart  is  feeble,  the  arterial 
tension  low,  and  the  peripheral  circulation  languid.  Ten  drops  in  an 
emulsion  is  a  suitable  form,  and  every  two  hours  is  a  proper  interval 
for  its  administration  in  this  condition  of  things.  According  to  G.  B. 
Wood,  a  dry  tongue,  peeling  off  in  flakes,  leaving  a  glazed  surface  be- 
neath, is  a  special  indication  for  the  use  of  turpentine  in  fevers.  The 
intestinal  haemorrhage  of  typhoid  may  be  restrained  by  turpentine. 

Clinical  experience  is  in  favor  of  the  use  of  turpentine  in  puerperal 
fever  and  in  yellow  fever.  The  indications  for  its  employment  in 
these  maladies  are  just  the  same  as  those  mentioned  above  in  typhoid. 
Cardiac  weakness,  depression  of  the  vaso-motor  nervous  system,  a  dis- 


T80  EVACUANTS. 

solved  state  of  the  blood,  are  the  conditions  requiring  turpentine. 
Tympanitic  distention  of  the  abdomen  is  an  additional  indication  in 
puerperal  fever.  Similarly,  turpentine  is  used  in  epidemic  dysentery, 
traumatic  erysipelas,  hospital  gangrene,  etc.  In  these  various  states, 
employed  with  a  well-defined  conception  of  its  real  powers,  this  remedy 
is  more  generally  serviceable  as  a  stimulant  than  alcohol.  As  respects 
the  dosage,  in  febrile  diseases,  a  rule  may  be  formulated  as  follows  : 
for  the  intestinal  complications,  small  doses  frequently  repeated  (ten 
drops)  ;  as  a  stimulant  to  the  vaso-motor  nervous  system,  larger  doses 
(TTI  x —  3  ss)  at  somewhat  longer  intervals. 

In  the  article  on  "  PHOSPHORUS  "  attention  has  been  called  to  the 
utility  of  turpentine  in  poisoning  by  this  substance. 

The  physiological  effects  of  turpentine  indicate  its  utility  in  certain 
disorders  of  the  nervous  system.  As  an  enema,  turpentine  has  been 
used  for  its  derivative  effect  in  insolation  or  sunstroke  (Levick,  Wood), 
and  in  cerebro-spinal  meningitis  (Hirsch).  So  accurate  an  authority 
as  Topinard  maintains  the  utility  of  this  remedy  in  the  cystic  compli- 
cations of  posterior  spinal  sclerosis.  Turpentine  has  long  been  used 
successfully  in  epilepsy,  but  in  those  cases  only  in  which  the  seizures 
were  due  to  the  reflex  impression  of  intestinal  parasites  (taeniae).  Tic- 
douloureux  and  sciatica,  when  rheumatic  in  origin,  or  when  produced 
by  fecal  accumulations,  have  been  cured  by  the  vigorous  use  of  turpen- 
tine, but  we  have  now  other  means  of  treatment  more  generally  useful 
and  less  disagreeable. 

As  turpentine  is  largely  eliminated  by  the  bronchial  and  renal  mu- 
cous membrane,  decided  effects  are  produced  at  these  points.  In  dif- 
fusing outward,  a  change  in  the  tonicity  of  the  vessels,  and  in  the 
character  of  the  secretions,  must  necessarily  be  produced.  Clinical 
experience  confirms  the  deductions  of  theory.  In  chronic  bronchitis, 
with  profuse  expectoration  (bronchorrhcea),  especially  when  the  expec- 
torated matters  have  a  fetid  odor,  turpentine  is  an  excellent  remedy 
(Oppolzer).  In  gangrene  of  the  lung,  although  it  is  not  curative,  it 
acts  beneficially  in  diminishing  the  fetor.  In  pneumonia  and  capil- 
lary bronchitis,  when  the  vital  powers  are  depressed  and  the  peripheral 
circulation  is  feeble,  turpentine  is  one  of  the  best  stimulants  which  we 
can  employ.  The  depression  which  occurs  during  the  period  of  crisis 
in  pneumonia,  and  the  condition  of  purulent  infiltration,  especially  in- 
dicate the  use  of  this  remedy.  In  the  so-called  humid  asthma,  and  in 
emphysema  with  profuse  bronchial  catarrh,  good  results  are  obtained 
by  the  use  of  turpentine.  In  these  various  pulmonary  maladies,  the  ac- 
tion of  turpentine  is  largely  local,  as  already  explained,  but  it  should  not 
be  forgotten  that  the  powerful  stimulation  of  the  cutaneous  circulation 
which  it  causes  must  contribute  no  small  share  of  the  curative  action. 

In  hydro-nephrosis  and  pyo-nephrosis  turpentine  is  used  as  in  bron- 
chial catarrh,  viz.,  to  alter  by  actual  contact  the  relaxed  condition  of 


TIRING-GENITALS.  781 

the  vessels,  and  the  pathological  secretions  of  the  mucous  membrane. 
It  is,  of  course,  contraindicated  during  the  existence  of  acute  symptoms. 
Chronic  catarrh  of  the  bladder  is  not  unfrequently  much  improved  by 
the  use  of  this  agent.  It  is  most  serviceable  in  those  cases  resulting 
from  a  transference  of  urethral  inflammation,  or  due  to  prostatic  dis- 
ease. Incontinence  of  urine,  the  result  of  atony  of  the  muscular  layer 
of  the  bladder,  is  sometimes  removed  by  small  doses  of  turpentine. 
Chronic  gonorrhoea,  gleet,  spermatorrhoea,  and  prostorrhcea,  when  the 
discharges  peculiar  to  these  maladies  are  due  to  a  relaxed  condition  of 
the  affected  parts,  are  not  unfrequently  remarkably  benefited  by  mod- 
erate doses  of  turpentine. 

EXTERXAL  USES  OF  TuKPENTiNE. — The  author  long  ago  pointed 
out  the  fact  that  turpentine  is  one  of  the  most  efficient  applications  in 
hospital  gangrene.  The  mortified  parts  are  first  removed  with  the 
scissors,  and  the  remedy  is  then  applied  directly  to  the  affected  sur- 
face, by  means  of  a  piece  of  cotton  cloth  saturated  with  it.  Fetor  is 
removed  and  sloughing  is  arrested,  and  but  little  pain  attends  the 
application. 

Turpentine-stupes  are  much  employed  as  a  local  and  external  means 
of  treating  internal  inflammations.  A  piece  of  spongio-piline,  or  of 
flannel,  large  enough  to  cover  the  affected  part,  is  first  moistened  with 
hot  water,  and  then  a  few  drops  of  turpentine  (five  to  ten  drops  only) 
are  sprinkled  on  it.  As  very  severe  smarting,  inflammation,  and  vesi- 
cation  of  the  skin  may  occur  from  the  application,  and  be  experienced, 
indeed,  some  time  subsequently  to  the  removal  of  the  stupe,  care  must 
be  used  not  to  continue  it  too  long. 

Liniment  of  turpentine  is  a  convenient  counter-irritant  in  cases  of 
myalgia,  superficial  neuralgia,  lumbago,  etc.  An  excellent  counter- 
irritant  application  is  made  by  mixing  equal  parts  of  oil  of  turpentine, 
acetic  acid,  and  liniment  of  camphor  (Stille).  The  most  successful 
treatment  of  severe  burns  is  by  the  plan  of  Kentish,  which  consists  in 
first  washing  the  injured  surface  with  turpentine,  and  then  applying  an 
ointment  made  by  mixing  basilicon-ointment  with  turpentine.  Ery- 
sipelas has  been  treated  by  the  same  measures  by  Meigs,  and  the  same 
applications  are  generally  in  use  in  chilblains. 

Inhalations  of  turpentine-vapor,  or  atomized  turpentine,  is  an  effi- 
cient means  of  local  treatment  in  chronic  laryngeal  and  bronchial  af- 
fections. As  a  matter  of  curious  therapeutics,  it  may  be  mentioned 
that  gonorrhoaa  has  been  successfully  treated  by  having  the  patient 
inhale  the  vapor  of  turpentine  in  an  apartment  filled  with  it. 

Terebenum. — Terebene.  A  colorless  or  slightly  yellowish  thin 
liquid,  having  a  rather  agreeable  thyme-like  odor,  and  an  aromatic 
taste.  Only  slightly  soluble  in  water,  but  soluble  in  an  equal  volume 
of  alcohol.  Dose,  TTIV — 3  ss. 

Terpini  Hydras. — Terpin  hydrate.     Colorless,  lustrous,  rhombic 


782  EVACUANTS. 

prisms,  nearly  odorless,  and  having  a  slight  aromatic  and  somewhat 
bitter  taste.  Soluble  at  59°  Fahr.  in  about  250  parts  of  water  and  in 
10  parts  of  alcohol.  Dose,  gr.  ss — gr.  v. 

By  the  distillation  of  turpentine  with  an  alkali,  a  hydrocarbon 
(C10H16),  which  is  now  designated  by  our  French  colleagues  by  the  name 
terebinthine,  is  produced.  This  is  converted  by  hydration  into  a  solid 
crystalline  body — terpine.  When  terpine  is  acted  on  by  an  acid  it  is 
converted  into  terpinol,  so  named  because  it  has  an  oily  appearance 
and  consistence.  Terebene,  as  known  to  English-speaking  therapeutists, 
is  derived  from  turpentine  by  the  action  of  an  acid  (sulphuric). 

The  dose  of  the  hydrate  of  terpin  is  from  five  to  twenty  grains. 
Terebene  is  given  in  from  five  to  twenty  minims.  They  are  but  feebly 
soluble  in  water,  and  require  alcohol  to  effect  a  solution.  They  can 
be  made  into  an  emulsion,  or  dropped  on  a  lump  of  sugar,  or  put  into 
gelatine  capsules.  To  obtain  the  best  effects  of  which  they  are  ca- 
pable, maximum  doses  are  necessary.  Their  most  important  uses, 
also,  are  in  the  treatment  of  affections  of  the  mucous  membranes — of 
bronchitis,  emphysema,  capillary  bronchitis  or  broncho-pneumonia, 
asthma,  etc.  These  therapeutical  results  are  for  the  most  part  due  to 
the  local  action  at  the  points  of  elimination — bronchial  and  renal.  The 
same  action,  therefore,  occurs  in  pyo-nephritis  and  in  the  catarrhal 
process  affecting  the  bladder.  Dujardin-Beaumetz,  in  arranging  these 
medicaments  in  the  order  of  their  relative  utility,  places  them  thus  : 
in  bronchial  affections,  terpinol  or  terebene  is  first,  but  in  renal  affec- 
tions terebinthene  or  terpine. 

Given  in  full  medicinal  doses  these  remedies  cause  a  feeling  of 
warmth  in  the  epigastric  region,  and,  if  no  local  irritation  exists,  rather 
stimulate  appetite  and  digestion  than  impair  them.  They  possess  car- 
minative properties,  and  cause  the  expulsion  of  gases.  Secretion  is 
increased  and  the  peristaltic  movements  are  also  somewhat  accelerated. 
In  respect  to  these  actions,  these  remedies  have  properties  correspond- 
ing to  those  of  turpentine.  When  the  tongue  is  dry  and  exfoliates 
in  large  flakes,  the  terebinthinate  preparations  act  favorably.  When 
intestinal  haemorrhage  takes  the  form  of  oozing  from  a  large  surface, 
the  general  condition  being  one  of  debility,  and  the  blood  impover- 
ished, terebinthene  will  no  doubt  act  favorably. 

The  authorities  who  have  contributed  most  to  the  existing  knowl- 
edge are  as  follows : 

DA  COSTA,  DR.  J.  M.     The  American  Journal  of  the  Medical  Sciences,  January,  1866. 

DUJARDIN-BEATJMKTZ.     Lectures  on  New  Medicaments. 

LEPINE,  PROF.     Bui.  Gen.  de  Therapeutique  and  Journal  de  Therapeutique  for  1886. 

LEVICK,  DR.  R.  J.      The  American  Journal  of  the  Medical  Sciences,  January,  1869. 

LITTLE,  DR.      The  Practitioner,  vol.  ix,  p.  369. 

MURRELL,  DR.     The  British  Medical  Journal,  1886,  etc. 


URINO-GEXITALS.  783 

OPPOLZER,  PROF.     Allgem.  Wiener  med,  Zeit.,  No.  xxxiii,  1866. 

SEE,  PROF.  G.     Ibid. 

TOPINARD,  DR.  L.     De  VAtaxie  Locomotrice,  etc.,  Paris,  1864. 

TROUSSEAU,  DR.  A.     Clinique  Medicare  de  V Hotel  Dieu. 

TROUSSEAU  ET  PIDOUX.     Traite  de  Therapeutique  et  Matiere  Medicale,  vol.  ii,  p.  802. 

WOOD,  DR.  GEORGE  B.     The  Practice  of  Medicine,  fourth  edition,  vol.  i,  p.  346. 

Copaiba. — Copaiba.  The  oleo-resin  of  Copaiba  Langsdorfii  Des- 
fontaines,  and  of  other  species  of  Copaifera  (Nat.  Ord.  Leguminosce^ 
Papilionacece).  Baume  de  copahu,  Fr.  ;  Copaiva-Balsam,  Ger. 
Dose,  TTI,  x —  3  j. 

Jfassa  Copaibce. — Mass  of  copaiba.  (Copaiba,  94  gnu.  ;  magne- 
sia, 6  grin.) 

Oleum  Copaibce. — Oil  of  copaiba.  A  volatile  oil  distilled  from 
copaiba.  Dose,  in  v —  3  ss. 

Eesina  Copaibce. — Resin  of  copaiba.  The  residue  left  after  dis- 
tilling off  the  volatile  oil  from  copaiba.  Dose,  gr.  j — gr.  v. 

COMPOSITION. — Balsam  of  copaiba  differs  from  the  true  balsams  in 
not  containing  cinnamic  acid.  It  is  an  oleo-resin,  the  volatile  oil  con- 
stituting from  forty  to  sixty  per  cent.  The  oil  of  copaiba  is  isomeric 
with  the  oil  of  turpentine,  but  it  differs  in  some  of  its  physical  prop- 
erties from  the  latter.  The  resin  has  an  acid  reaction,  and  has  been 
entitled  copaivic  acid. 

ACTIONS  AND  USES. — Copaiba  has  a  nauseous,  bitter,  and  very  dis- 
agreeable taste.  When  taken  into  the  stomach  it  causes  some  heat, 
and  offensive  eructations,  tasting  of  the  balsam,  occur.  Indigestion, 
heaviness  at  the  epigastrium,  anorexia,  are  frequently  produced  by  it, 
and  diarrhea  is  an  occasional  result  of  its  use.  It  is,  therefore,  a  gas- 
tro-intestinal  irritant.  Both  the  oil  and  the  resin  diffuse  into  the  blood. 
The  various  excretions,  the  sweat,  the  bronchial  mucus,  the  urine,  ac- 
quire a  peculiar  and  rather  a  fragrant  odor  from  its  presence.  This 
odor  is  especially  observable  in  the  urine,  and  in  this  secretion  the  resin 
may  be  discovered  also  by  the  addition  of  nitric  acid,  which  causes  a 
precipitate.  At  the  points  of  elimination  more  or  less  irritation  is  pro- 
duced, and,  as  a  result  of  the  irritation,  increased  secretion  ;  hence  co- 
paiba is  said  to  be  diaphoretic,  diuretic,  and  expectorant.  Very  serious 
injury  may  be  done  to  the  gastro-intestinal  canal,  and  to  the  kidneys, 
by  the  use  of  this  agent  in  large  doses.  The  author  has  known  gastro- 
intestinal catarrh  to  persist  many  months  after  a  course  of  copaiba,  and 
he  has  reason  to  believe  that  desquamative  nephritis  and  fibroid  kid- 
ney have  resulted  from  its  free  administration  for  a  lengthened  period. 
While  small  doses  of  balsam  will  increase  the  gross  amount  of  urine 
and  of  the  solid  contents,  large  doses  will  actually  cause  a  diminution 
in  the  amount  both  of  water  and  solids  by  setting  up  renal  irritation. 
Although,  during  a  course  of  balsam,  nitric  acid  causes  a  precipitation 
52 


784  EVACUANTS. 

of  the  resin,  which  is  dissolved  on  the  addition  of  alcohol,  the  author 
has,  in  several  instances  at  least,  detected  albumen  in  the  urine  of  those 
taking  this  remedy. 

Copaiba  is  contraindicated  when  a  condition  of  gastro-intestinal  ir- 
ritation and  hyperaemia  of  the  kidneys  exist. 

Gonorrhoea  is  the  disease  to  which  copaiba  is  most  especially 
adapted.  Its  administration  should  not  be  begun,  however,  until  after 
the  acuter  symptoms  have  subsided.  As  the  action  of  the  remedy  is 
local  or  direct,  acute  symptoms  are  rather  aggravated  by  it.  Combina- 
tion with  liquor  potassae  promotes  its  curative  action  by  diminishing 
the  acidity,  and  hence  the  irritation  produced  by  the  urine.  Combina- 
tion with  agents  acting  synergistically,  as  oils  of  cubebs  and  sandal- 
wood,  is  also  desirable.  The  following  formulae  exemplify  these  thera- 
peutical facts  :  $  Copaibas,  pulv.  cubeba3,  aa  §  ij  ;  aluminis,  §  j  ;  opii, 
gr.  v.  M.  Sig. :  One  to  two  drachms,  night  and  morning.  $  Ol. 
copaibas,  ol.  cubebae,  ol.  santal.  flav.,  aa  3  j  ;  magnesias,  3  ij.  M.  Ft. 
pil.  no.  Ix.  Sig.  :  Two  pills  every  four  hours. 

In  chronic  catarrh  of  the  bladder,  copaiba  is  useful  by  virtue  of  the 
local  action  which  it  has  upon  the  mucous  membrane.  Its  nauseous 
taste  and  the  gastric  and  renal  irritation  produced  by  it  are  serious 
objections  to  its  use  in  a  malady  which  requires  the  persistent  and 
long-continued  application  of  remedies  in  order  to  even  moderate  its 
symptoms. 

For  acute  bronchitis  after  the  subsidence  of  the  fever,  for  chronic 
bronchitis  with  profuse  secretion,  for  bronchorrhoea  (dilated  bronchi)^, 
copaiba  is  the  most  generally  serviceable  expectorant.  Unfortunately, 
it  is  so  disagreeable  that  it  is  difficult  to  overcome  the  repugnance  of 
patients.  Even  when  administered  in  capsules,  or  in  pill-form  with 
magnesia,  the  nauseous  eructations  excite  disgust.  $  Copaibae,  bal- 
sam, tolutan.,  pulv.  acaciae,  aa  §  ss  ;  acid,  sulphur,  aromat.,  3  ss  ;  aquae 
destil.,  |  vj.  M.  Sig.  :  A  tablespoonful,  two  or  three  times  a  day,  in 
chronic  bronchial  affections,  whooping-cough,  etc.  $  Copaibae  ;  syrp. 
tolutan.,  aa  |  ss  ;  aquae  menthae  pip.,  f  ij  ;  spirit,  etheris  nitrosi,  §  j. 
M.  Sig.  :  A  teaspoonful  every  four  hours. 

Excellent  results  have  been  obtained  from  the  use  of  copaiba  in 
dropsy,  especially  in  ascites.  In  these  cases  it  acts  powerfully  on  the 
kidneys.  Wilks  holds  that  copaiba-resin  is  a  more  efficient  diuretic 
than  the  balsam.  IJ  Res.  copaibae,  3  iij  ;  alcohol.,  3  v  ;  spirit,  chloro- 
form i,  3  j  ;  mucil.  acaciae,  §  ij  :  aquae  ad  f  xij.  M.  Sig.  :  A  table- 
spoonful  ter  in  die.  It  is  conveniently  given  in  pill-form  also. 

In  some  subjects  possessed  of  an  irritable  skin,  copaiba  produces  an 
eruption  of  urticaria,  or  roseola,  or  erythema.  This  is  not  in  conse- 
quence of  a  selective  action  on  the  skin,  but  is  the  result  merely  of  the 
gastro-intestinal  disturbance.  Influenced,  probably,  by  this  fact  that 
an  eruption  may  be  caused  by  copaiba,  this  agent  has  been  proposed 


URINO-GENITALS.  785 

as  a  remedy  in  certain  cutaneous  diseases — in  those  characterized  by 
torpor  of  the  peripheral  circulation. 

Authorities  referred  to  : 

BERNATZIK,  PROF.  DR.  W.  Prag.  Vjhrschr.,  c,  p.  239.  Schmidt's  Jahrbucher,  voL 
cxli,  p.  278. 

FLUCKIGER  AND  HANBCRY.     Pharmacographia,  p.  200,  et  seq. 

GDBLER,  DR.  A.     Commentaires  Therapeutiques,  p.  86,  et  seq. 

HCSEMANN,  DR.  THEODOR.     Handbwh,  p.  1195,  et  seq. 

KOHLER,  DR.  HERMANN.     Handbuch,  erste  Halfte,  p.  370,  et  seq. 

TROUSSEAU  ET  PIDOUX.     Traite  de  Therap.  et  de  Mat.  Med.,  vol.  ii. 

WEIKART,  DB.  H.  Archiv  der  Heilk.,  i,  ii,  p.  176,  1860.  Schmidt's  Jahrbiicher,  vol. 
cvi,  p.  162. 

WILES,  DR.  S.     The  Lancet,  1873,  vol.  i,  p.  410. 

Cubeba. — Cubeb.  The  unripe  fruit  of  Piper  Cubeba  Linne  filices 
(Nat.  Ord.  Piperacece).  (U.  S.  P.)  Cubebes,  Fr.  ;  Cubeben,  Ger. 

Extractum  Cubebce  Fluidum. — Fluid  extract  of  cubeb.  Dose,  3  ss 
-3ij. 

Oleum  Cubebce. — Oil  of  cubeb.     Dose,  TTJ,  v —  3  ss. 

Oleo-resina  Cubebce. — Oleo-resin  of  cubeb.     Dose,  m  v —  3  ss. 

Tinctura  Cubebce. — Tincture  of  cubeb.     Dose,  3  ss — 3  ij. 

Trochisci  Cubebce. — Troches  of  cubeb. 

COMPOSITION. — Cubeb  contains  a  volatile  oil  which  varies  in  pro- 
portion from  six  to  fifteen  per  cent.  It  is  polymeric  with  oil  of  turpen- 
tine. This  volatile  oil  separates  in  the  cold  into  two  distinct  substances 
— a  camphoraceous  substance  (cubebene),  and  a  liquid  portion  (cubeben). 
Besides  these,  a  neutral  crystallizable  principle  (cubebin)  has  been  iso- 
lated. Cubeb  also  contains  a  resin,  divisible  into  two  distinct  sub- 
stances, an  indifferent  portion  and  an  acid  (cubebic  acid).  The  thera- 
peutical properties  of  the  drug  reside  chiefly,  if  not  exclusively,  in  the 
oil  and  resin,  hence  the  oleo-resin  is  an  efficient  preparation. 

ACTIONS  AND  USES. — The  taste  of  cubeb  is  aromatic,  pungent,  and 
somewhat  camphoraceous.  In  the  stomach  it  excites  a  sensation  of 
warmth,  and,  in  moderate  doses,  promotes  the  appetite  and  the  diges- 
tive capacity.  In  considerable  doses  it  is  laxative,  and  produces  a  feel- 
ing of  heat  and  irritation  about  the  rectum.  Ingested  in  a  large  quan- 
tity, cubeb  sets  up  a  gastro-intestinal  catarrh,  and  may  even  cause  acute 
inflammatory  symptoms.  The  active  principles  diffuse  into  the  blood. 
The  action  of  the  heart  and  vascular  system  is  increased  by  cubeb,  the 
surface  becomes  warm  and  perspiring  under  its  use,  and  the  bronchial 
and  urinary  secretions  are  more  abundant.  The  odor  of  cubeb  is  im- 
parted to  the  breath  and  to  the  urine,  and  the  resin  may  be  precipi- 
tated from  the  urine  by  the  addition  of  nitric  acid.  As  explained  in 
the  previous  article  (COPAIBA),  the  resin  precipitated  by  nitric  acid  re- 
sembles albumen,  but  differs  from  the  latter  substance  in  being  soluble 
in  alcohol. 


786  EVACUANTS. 

Cubeb  stimulates  the  venereal  appetite  in  man,  and  promotes  the 
catamenial  flux  in  women. 

Finely-powdered  cubeb  is  an  efficient  local  application  in  chronic 
nasal  catarrh.  It  is  blown  into  the  nares  by  an  insufflator.  It  gives 
considerable  relief  also  in  hay-asthma,  when  there  is  no  fever,  and  the 
secretion  of  the  nasal  mucous  membrane  is  profuse  and  watery.  Pow- 
dered cubeb  is  useful  as  a  topical  application  when  the  mucous  mem- 
brane of  the  fauces  is  relaxed,  or  the  seat  of  chronic  inflammation  (fol- 
licular  pharyngitis).  The  official  cubeb-troches  are  employed  by  sing- 
ers and  public  readers,  to  maintain  the  tonicity  of  the  mucous  mem- 
brane and  to  prevent  or  relieve  hoarseness. 

Cubeb  may  also  be  used,  in  small  doses,  to  promote  secretion  and 
increase  digestion  in  cases  of  atonic  dyspepsia.  Chronic  catarrh  of  the 
colon  and  rectum,  with  a  relaxed  condition  of  the  mucous  membrane 
and  of  the  inferior  haemorrhoidal  vessels,  may  be  removed  by  cubeb. 
Sometimes  these  cases  take  the  form  of  a  mucous  dysentery. 

The  most  important  application  of  cubeb  is  in  the  treatment  of 
gonorrhoea.  Unlike  copaiba,  it  may  be  administered  with  good  effect 
during  the  acute  stage.  The  best  results  are  obtained  from  a  mixture 
of  the  two  agents.  Catarrh  of  the  bladder,  prostorrhcea,  spermator- 
rhoea, are  maladies  in  which  cubeb  may  be  employed  with  more  or  less 
advantage.  When  the  sexual  appetite  is  weak,  and  the  erections  fee- 
ble, cubeb  will  sometimes,  if  the  troubles  are  functional,  remove  them. 

Irritability  of  the  bladder,  nervous  or  functional  in  character,  espe- 
cially as  it  occurs  in  women,  is  generally  relieved  by  cubeb  ;  but  caar 
tjiarides  is  a  more  efficient  remedy  for  this  troublesome  affection. 

In  chronic  bronchial  affections,  with  profuse  expectoration,  cubeb 
has  a  remedial  effect  similar  to  that  possessed  by  copaiba,  and  is  useful 
under  the  same  conditions. 

Piper.  —  Black  pepper.  The  unripe  berries  of  Piper  nigrum  Linne" 
(Nat.  Ord.  Piperacece).  (U.  S.  P.)  Poivre  noir,  Fr.  ;  Schwarzer 


COMPOSITION.  —  Pepper  contains  a  resin  and  an  essential  oil,  and  a 
neutral  crystallizable  principle  (piperin). 

Oleo-resina  Piperis.  —  Oleo-resin  of  black  pepper.  This  contains  the 
active  constituents  of  pepper,  and  is  an  eligible  preparation.  Dose, 

m  j—  m  v. 

Piperinum.  —  Piperin.  A  proximate  principle  of  feebly  alkaloidal 
power,  prepared  from  pepper,  and  occurring  also  in  other  plants  of  the 
natural  order  Piperacece.  Colorless  or  pale  yellowish,  shining,  four- 
sided  prisms,  permanent  in  the  air,  odorless  and  almost  tasteless  when 
first  put  in  the  stomach,  but  on  prolonged  contact  producing  a  biting 
sensation.  It  has  a  neutral  reaction,  is  almost  insoluble  in  water,  but 
soluble  in  thirty  parts  of  alcohol  at  60°  Fahr.  Dose,  gr.  j  —  gr.  x. 


URIXO-GEXITALS.  787 

Capsicum. — Capsicum.  The  fruit  of  Capsicum  faatigiatum  Blurae 
(Nat.  Ord.  Solanacece).  (TJ.  S.  P.)  Poivre  cTJnde,  Fr. ;  Spanischer 
Pfeffer,  Ger. 

COMPOSITION. — The  acrid,  pungent  qualities  of  capsicum  are  due  to 
a  peculiar  substance  (capsiciri),  a  thick,  yellowish-red  liquid.  Felle- 
tar,  whose  observations  have  been  confirmed  by  Fliickiger,  has  isolated 
a  volatile  alkaloid  having  the  odor  of  conine. 

Extractum   Capsici  Fluidum. — Fluid  extract  of  capsicum.     Dose, 

m  v—  3  j. 

Oleo-resina  Capsici. — Oleo-resin  of  capsicum.     Dose,  m,  j — m,  v. 

Tinctura  Capsici. — Tincture  of  capsicum.     Dose,  m,  x —  3  j. 

ACTIONS  AND  USES. — Notwithstanding  black  and  red  pepper  belong 
to  different  orders,  they  are  closely  related  therapeutically  and  in  their 
physiological  actions.  They  may  with  propriety  be  considered  together. 

When  applied  to  the  skin,  pepper  excites  redness,  heat,  and  super- 
ficial inflammation.  Red  pepper,  if  in  contact  with  the  skin  a  sufli- 
cient  length  of  time,  will  produce  vesication.  It  also  causes  great  irri- 
tation of  the  mucous  membrane.  It  has  a  hot,  pungent,  and  rather 
acrid  taste,  and  increases  the  flow  of  saliva.  In  the  stomach  a  sensa- 
tion of  warmth  is  produced  by  it,  the  secretions  are  more  abundant, 
digestion  is  more  active,  and  the  appetite  is  promoted.  In  an  exces- 
sive quantity  gastritis  may  be  produced.  The  intestinal  secretions  are 
no  doubt  increased,  and  the  alvine  evacuations  rendered  more  easy  and 
copious. 

The  action  of  the  heart  and  arteries  is  increased  by  pepper,  a  sub- 
jective sensation  of  warmth  is  experienced  throughout  the  system,  and 
cutaneous  transpiration  becomes  more  abundant.  Elimination  takes 
place  chiefly  through  the  kidneys.  The  flow  of  urine  is  increased, 
micturition  is  more  frequent,  and  more  or  less  vesical  tenesmus  occurs. 
Decided  aphrodisiac  effects  are  produced  by  red  pepper. 

The  tincture  of  capsicum  may  be  usefully  employed  as  a  stomachic 
in  atonic  dyspepsia.  It  is  especially  indicated  in  the  dyspepsia  of 
chronic  alcoholism,  when  there  are  present  trembling  and  insomnia. 
Flatulent  colic  may  be  relieved  by  capsicum,  especially  when  this  dis- 
order occurs  in  hysterical  subjects.  The  author  has  seen  excellent  re- 
sults from  the  use  of  this  remedy  in  the  dyspepsia  and  flatulence  of 
hypochondriacal  subjects,  and  of  women  at  the  climacteric  period. 

Capsicum  is  an  excellent  addition  to  beef -tea  when  this  aliment  is 
administered  in  fevers,  and  other  low  conditions  of  the  system.  The 
tincture  may  be  employed  under  the  same  circumstances  as  a  cardiac 
stimulant.  Piperin  has  been  used  in  cholera  as  a  stimulant,  local  and 
general,  and  in  low  conditions  of  the  system  from  any  cause  except 
gastro-intestinal  inflammation.  At  one  time  it  was  much  prescribed 
in  malarial  fevers  as  an  adjunct  to  quinine  chiefly,  and  antiperiodic 
powers  were  ascribed  to  it ;  but  such  views  are  no  longer  entertained. 


788  EVACUANTS. 

The  evidence  is  conclusive  that  capsicum  quiets  restlessness  and 
induces  sleep  in  delirium  tremens.  It  may  be  administered  mixed  with 
beef -tea  or  other  animal  broths,  or  thirty  grains  made  into  a  bolus, 
with  sirup  or  honey,  may  be  given.  As  capsicum  belongs  to  the  fam- 
ily Solanacece,  and  as  Felletar  discovered  in  it  a  volatile  alkaloid,  a  ra- 
tional explanation  is  afforded  of  its  action  on  the  cerebrum.  Accord- 
ing to  Ringer,  the  tincture  of  capsicum  is  the  best  substitute  for  the 
stimulant  when  an  attempt  is  made  to  break  the  alcohol-habit.  It 
is  also  very  serviceable  in  the  treatment  of  the  opium-habit.  The  good 
effect  of  the  remedy  in  these  cases  is  in  part  due  to  its  action  as  a 
stomachic  stimulant,  and  partly,  doubtless,  to  its  cerebral  effects. 

The  oleo-resins  of  black  and  red  pepper  have  been  used  with  good 
results  in  the  treatment  of  intermittent  fever.  They  are  useful  chiefly 
as  adjuvants  to  more  efficient  remedies. 

Capsicum  is  contraindicated  in  all  acute  affections  of  the  genito- 
urinary apparatus.  In  chronic  parenchymatous  nephritis  it  checks  the 
waste  of  albumen.  In  chronic  pyelitis,  chronic  cystitis,  and  prostor- 
rhcea,  it  has  a  beneficial  effect ;  but,  although  similar  in  action  to,  it 
is  less  efficient  than,  cubeb.  Excellent  results  are  often  obtained  from 
it  in  functional  impotence,  and  in  spermatorrhoea  from  deficient  tone. 
In  these  genito-urinary  maladies,  the  oleo-resin  is  the  best  preparation 
for  administration.  $  Oleo-resinae  capsici,  3j  ;  ergotin  (aq.  ext.), 
3  ij.  M.  Ft.  pil.  no.  xx.  Sig. :  One  three  times  a  day. 

A  capsicum-plaster  is  a  mild  counter-irritant.  The  infusion  is  em- 
ployed as  a  gargle  in  tonsillitis,  diphtheria,  and  scarlet  fever.  As  it  is 
a  very  irritating  application,  its  use  should  be  restricted  to  cases  char- 
acterized by  a  low  grade  of  action. 

Junipems. — Juniper.  The  fruit  of  Juniperus  communis  Linne 
(Nat.  Ord.  Coniferce).  (U.  S.  P.)  Bales  de  genievre,-  Fr.  ;  Wach- 
holderbeeren,  Ger. 

Tnfusum  Juniperi. — Infusion  of  juniper  (  f  j — Oj).  Dose,  §  ss — 
I  ij.  (Not  official.) 

Oleum  Juniperi. — Oil  of  juniper.     Dose,  vc\.  v — ni  xx- 

Spiritus  Juniperi  Compositus. — Compound  spirit  of  juniper.  (Oil 
of  juniper,  8  c.  c.  ;  alcohol,  1,400  c.  c.  ;  water,  sufficient  to  make  2,000 
c.  c. ;  oils  of  caraway  and  fennel,  each  1  c.  c.  Dose,  §  ss —  §  j. 

Spiritus  Juniperi. — Spirit  of  juniper.  (Oil  of  juniper,  50  c.  c.  ; 
alcohol,  950  c.  c.)  Dose,  3  j —  'j,  j. 

Oleum  Cadinum. — Oil  of  cade.  A  product  of  the  dry  distillation 
of  the  wood  of  Juniperus  oxycedrus. 

COMPOSITION. — Juniper  contains  a  volatile  oil,  upon  which  its  me- 
dicinal effects  chiefly  depend.  A  non-crystallizable  principle  (juni- 
perine)  exists  in  the  berries  in  very  small  quantity. 

ACTIONS  AND  USES. — Juniper  increases  the  appetite  and  digestion, 


URINO-GENITALS.  789 

but  in  overdoses  will  disorder  the  stomach.  The  volatile  oil  diffuses 
into  the  blood  with  facility.  Increased  action  of  the  heart  and  of  the 
arteries,  a  subjective  sensation  of  warmth,  diaphoresis,  and  diuresis, 
are  produced  by  it. 

The  oil  is  eliminated  by  the  kidneys  chiefly,  and  imparts  an  odor 
of  violets  to  the  urine.  It  powerfully  stimulates  the  renal  functions, 
and  in  large  doses  causes  strangury  and  bloody  urine.  It  may  set  up 
a  high  degree  of  irritation  of  the  kidneys,  leading  to  suppression  and 
uraemic  intoxication.  In  common  with  the  other  remedies  of  this 
group,  juniper  excites  the  venereal  appetite;  in  large  doses  may  cause 
priapism,  and  in  women  promotes  the  menstrual  flow. 

The  principal  use  of  juniper  is  as  a  diuretic.  It  is  contraindicated 
in  acute  affections  of  the  kidneys.  It  is  largely  employed  as  a  diuretic 
in  cardiac  and  renal  dropsy.  The  infusion  is  an  excellent  vehicle  for 
the  exhibition  of  saline  diuretics  in  these  affections.  The  oil  of  juniper 
acts  similarly  to,  and  is  indicated  under  the  same  conditions  as,  tur- 
pentine in  chronic  pyelitis,  chronic  cystitis,  gleet,  prostorrhoea,  etc. 
Diuretic  effects  may  be  obtained  by  inhalation  of  the  vapor  of  the  oil. 
For  this  purpose  a  few  drops  may  be  put  into  hot  water,  and  the  vapor 
be  inhaled. 

The  empyreumatic  oil  of  juniper  (oleum  cadinum),  obtained  by  de- 
structive distillation  from  Juniperus  oxycedrus,  is  a  thick,  black  liquid, 
similar  in  appearance  to  and  smelling  like  common  tar.  It  is  much 
employed  as  a  local  application  in  chronic  eczema,  impetigo,  ichthyosis, 
psoriasis,  acne  rosacea,  etc.  It  is  usually  combined  with  German  soft- 
soap.  ^  Alcoholis,  saponis  mollis,  ol.  cadini,  aa  f  j  ;  ol.  lavendulse, 
3  jss.  M.  I£  Ol.  juniperis  empy.  (ol.  cadini),  saponis  mollis,  aa  3  j ; 
ol.  lavend.,  3  ss.  M.  Sig.  :  Ointment.  I£  Ol.  juniperis  empy.,  3  j — 
§  j  ;  sevi,  f  ss  ;  adipis,  §  j.  M.  Sig.  :  Ointment. 

Fix  Liquida. — Tar. 

Oleum  Picis  Liquidce. — A  volatile  oil  distilled  from  tar. 

Balsamum  Tolutanuin.— A  balsam  obtained  from  Toluifera  balsa- 
mum  Linne  (Nat.  Ord.  Leguminosce). 

Syrupus  Tolutanus. — Dose,  3  ss —  3  ij. 

These  preparations  are  employed  internally  for  their  stimulating 
expectorant  qualities,  and  topically  in  various  affections  of  the  skin — 
notably  those  characterized  by  a  chronic  scaly  quality  and  those  given 
to  itching. 

The  sirup  of  tolu  has  mildly  expectorant  effects,  but  is  used  chiefly 
as  a  vehicle  for  the  more  active  remedies  of  this  kind. 

Tar-water  and  sirup  of  tar  have  long  been  used  in  the  treatment 
of  cough  and  chronic  bronchial  affections.  The  sirup  may  be  pre- 
pared extemporaneously  by  adding  the  volatile  oil  to  simple  sirup. 


790  EVACUANTS. 

Buehu. — Buchu.  The  leaves  of  Barosma  betulina  and  of  other 
species  of  Barosma  (Nat.  Ord.  MutacecB).  (U.  S.  P.)  Feuilles  de  bucco, 
Fr.  ;  Bukublatter,  Ger. 

Infusum  Buchu. — Infusion  of  buchu  (  §  j — Oj).  Dose,  §  ss —  f  ij. 
(Not  official.) 

Extractum  Buchu  Fluidum. — Fluid  extract  of  buchu.     Dose,  m,  x 

-3j- 

COMPOSITION. — Buchu  contains  a  volatile  oil  in  the  proportion  of 
about  1*5  per  cent.  This  volatile  oil  consists  of  a  crude  oil  and  a 
camphor — barosma  camphor.  The  latter  has  a  nearly  pure  peppermint 
odor.  The  existence  of  barosmin,  so  called,  is  doubtful. 

Uva  Ursi. — Uva  ursi.  The  leaves  of  Arctostaphylos  uva  ursi 
Sprengel  (Nat.  Ord.  Ericacece).  (U.  S.  P.)  Feuilles  de  busseroley 
Fr.  ;  Barentraubenblatter,  Ger. 

Extractum  Uvce  Ursi. — Extract  of  uva  ursi.     Dose,  gr.  j — gr.  v. 

Extractum  Uv(s  Ursi  Fluidum. — Fluid  extract  of  uva  ursi.  Dose, 
3  ss— ij. 

COMPOSITION. — Uva  ursi  contains  a  bitter,  neutral,  crystallizable 
substance,  arbutin  /  a  very  bitter  amorphous  principle,  ericolin ;  and 
a  tasteless,  crystallizable,  neutral  principle,  ursone.  It  is  rich  in  gallic 
and  tannic  acids.  Its  therapeutical  properties  are  due  to  these  several 
constituents. 

Pareira. — Pareira  brava.     The  root  of  Chondodendron  tomentosum 
Ruiz  et  Pavon  (Nat.  Ord.  Menispermacece).     (U.  S.  P.)     Racine  de* 
pareira-brava,  Fr.  ;   Grieswurzel,  Ger. 

Infusum  Pareira}. — Infusion  of  pareira  brava  (  f  j — Oj).  Dose, 
§  ss —  f  ij.  (Not  official.) 

Extractum  Pareira}  Fluidum. — Fluid  extract  of  pareira.  Dose, 
3  ss—  |  ij. 

COMPOSITION. — It  contains  a  principle,  buxin,  but  it  is  not  known 
whether  this  is  the  active  ingredient. 

Chimaphila. — Pipsissewa.  The  leaves  of  Chimaphila  umbettata 
Nuttall  (Nat.  Ord.  Ericaceae). 

Decoctum  Chimaphila}. — Decoction  of  chimaphila.  Dose,  f  ss — 
|  ij.  (Not  official.) 

Extractum  Chimaphila}  Fluidum. — Fluid  extract  of  chimaphila. 
Dose,  3  ss —  3  ij. 

COMPOSITION. — Pipsissewa  contains  a  crystallizable  principle,  chi- 
maphilin,  tannic  acid,  extractive  matters,  etc. 

Scoparius. — Broom.  The  tops  of  Cystisis  scoparius  Linne  (Nat. 
Ord.  Leguminosm).  (U.  S.  P.)  Genet  d  balais,  Fr. ;  Pfriemenkraut, 
Ger. 


URINO-GENITALS.  791 

COMPOSITION. — Scoparius  contains  an  indifferent  or  somewhat  acid 
crystallizable  principle,  scoparin,  and  an  oily,  colorless,  liquid  alkaloid, 
sparteine.  The  latter  has  very  decided  basic  qualities,  and  agrees 
with  conine  and  nicotine  in  being  constituted  without  oxygen.  Its 
actions  and  uses  as  a  cardiac  remedy  have  been  given  elsewhere,  in 
connection  with  remedies  therapeutically  cognate.  Here  scoparius  as 
a  diuretic  comes  under  consideration. 

ACTIONS  AND  USES. — Buchu,  uva  ursi,  pareira,  pipsissewa,  and  sco- 
parius, form  a  group  of  diuretics  with  properties  in  common.  They 
are  tonic,  astringent  diuretics.  They  promote  appetite  and  digestion, 
and  restrain  intestinal  movements,  except  pareira,  which  has  rather  a 
laxative  action.  Their  active  constituents  diffuse  into  the  blood  and 
are  eliminated  by  the  kidneys.  In  passing  over  the  genito-urinary 
tract  these  principles  act  topically  upon  the  mucous  membrane.  As  a 
rule  they  are  actively  diuretic  ;  that  is,  they  increase  the  amount  of 
urinary  water.  Pipsissewa  and  scoparius  are  rather  more  actively  diu- 
retic than  buchu  and  uva  ursi,  and  hence  are  more  useful  in  dropsy. 
By  English  physicians  generally,  and  notably  the  late  Dr.  Pereira,  sco- 
parius is  held  in  much  esteem  as  a  remedy  for  dropsy.  It  is  adapted 
especially  to  the  treatment  of  cardiac  dropsy,  and  the  general  anasarca 
of  chronic  parenchymatous  nephritis,  but  is  inadmissible  in  acute  af- 
fections of  the  kidney.  Our  indigenous  remedy,  pipsissewa,  may  be 
substituted  for  scoparius  in  the  treatment  of  dropsy. 

Buchu,  uva  ursi,  and  pareira,  are  more  particularly  useful  in  chronic 
pyelitis,  catarrh  of  the  bladder,  chronic  gonorrhoea,  etc. ;  and  of  these 
the  most  efficient,  probably,  is  buchu.  The  fluid  extract  is  the  most 
eligible  form  in  which  these  remedies  can  be  administered. 

Carota. — Carrot-seed.  The  fruit  of  Daucus  carota.  The  wild  car- 
rot. (Not  official.) 

The  seeds  of  carrot  have  a  hot,  pungent,  and  bitter  taste,  due  to  a 
volatile  oil  which  they  contain,  and  to  which  their  medicinal  activity  is 
due.  As  they  impart  their  virtues  to  water,  an  infusion  of  the  seeds 
is  an  eligible  form  in  which  to  administer  the  remedy.  Carrot-seeds 
act  similarly  to  juniper,  and  produce  diuresis,  augment  the  menstrual 
flux,  and  cause  aphrodisiac  effects  in  the  male. 

Taraxacum. — Dandelion.  The  root,  gathered  in  the  autumn,  of  Ta- 
raxacum officinale  Weber  (Nat.  Ord.  Composites).  (U.  S.  P.)  Pis- 
senlit,  Fr.;  Lowenzahnwurzel,  Ger. 

Extractum  Taraxaci. — Extract  of  taraxacum.     Dose,  gr.  v — 3  j. 

Infusum  Taraxaci. — Infusion  of  taraxacum  (  f  ij — Oj).  Dose, 
§  ss —  3  ij.  (Not  official.) 

Extractum  Taraxaci  Fluidum. — Fluid  extract  of  taraxacum.  Dose, 


792  EVACUANTS. 

COMPOSITION. — According  to  Kromayer,  taraxacum  contains  tarax* 
acine,  an  amorphous,  intensely  bitter  principle,  and  a  crystalline  sub- 
stance, taraxacerine.  Nothing  is  definitely  known  as  to  the  action  of 
these  substances. 

ACTIONS  AND  USES. — Taraxacum  possesses  the  properties  of  a  sim- 
ple bitter,  in  that  it  promotes  the  appetite  and  digestion.  It  has 
been  long  held,  both  popularly  and  professionally,  to  possess  the  power 
to  promote  the  flow  of  bile.  Recent  investigations  have  demonstrated 
the  inaccuracy  of  these  opinions.  It  is  a  mild  laxative,  and  as  such, 
doubtless,  may  cause  by  reflex  stimulation  an  emptying  of  the  gall- 
bladder. It  is  a  diuretic,  although  not  a  very  active  one.  It  is  still 
prescribed  as  a  laxative  in  catarrhal  jaundice,  in  ascites  from  hepatic 
disease,  and  in  dyspepsia  and  indigestion  associated  with  torpor  of  the 
liver.  By  German  physicians,  muriate  of  ammonia  and  dandelion  are 
frequently  associated  together  in  the  treatment  of  the  affections  above 
named.  Taraxacum  is  occasionally  used  as  a  diuretic  in  dropsy,  but 
its  utility  is  very  limited. 

The  fluid  extract  of  taraxacum  is  a  good  vehicle  for  the  administra- 
tion of  such  remedies  as  the  muriate  of  ammonia  and  quinine,  the  taste 
of  which  it  somewhat  covers. 

Scilla. — -'Squill.  The  bulb  of  Urginea  maritima  (Linn6)  Baker  (Nat. 
Ord.  Liliacece).  (IT.  S.  P.)  Ognon  marin,  Fr.;  Meerzwiebel,  Ger. 

Acetum  Scillce. — Vinegar  of  squill  ( f  iv — Oij.)     Dose,  v\,  xx —  3  j. 

Syrupus  Scillce. — Sirup  of  squill.     Dose,  3  ss —  3  j. 

Syrupus  Scillce  Compositus. — Compound  sirup  of  squill.  Hive- 
sirup.  This  preparation  contains  squill,  senega,  and  tartar-emetic,  the 
last  named  in  the  proportion  of  one  grain  to  the  ounce.  Dose,  m  v —  3  j. 
This  is  a  very  active  preparation,  due  chiefly  to  the  tartar-emetic. 

Mctractum  Scillce  Fluidum. — Fluid  extract  of  squill.    Dose,  Kl]— 

HI  V. 

Tinctura  Scillce. — Tincture  of  squill.     Dose,  ity  v —  3  ss. 

COMPOSITION. — The  important  constituent  of  squill  is  an  acrid,  bit- 
ter principle,  scillitin,  or  skuleln — which  has  not  yet  been  isolated. 
According  to  Schroff,  scillitin  is  a  glucoside,  and  the  active  principle 
is  an  acrid,  non-volatile  substance  (Fltlckiger  and  Hanbury). 

ACTIONS  AND  USES. — The  taste  of  squill  is  bitter  and  somewhat 
acrid.  It  is  an  irritant  to  the  mucous  membrane,  and  excites  nausea, 
vomiting,  and  purging,  when  introduced  into  the  stomach  in  a  suffi- 
cient dose.  Very  violent  gastro-enteritis  may  be  produced  by  its 
incautious  administration  in  large  doses.  A  state  of  hyperaemia  or 
inflammation  of  the  gastro-intestinal  mucous  membrane,  therefore, 
contraindicates  its  use. 

The  active  constituents  of  squill  diffuse  into  the  blood.  Its  sys- 
temic effects  are  produced  by  application  to  the  external  integument. 


URINO-GENITALS  793 

Paralysis  and  convulsions  are  induced  in  warm-blooded  animals  by 
toxic  doses  ;  and  similar  cerebral  symptoms  occur  in  man,  in  addition 
to  the  phenomena  which  usually  attend  the  action  of  an  irritant  poison. 
In  ordinary  medicinal  doses  squill  increases  the  bronchial  mucus  and 
facilitates  expectoration.  In  toxic  doses  rapid  breathing  has  usually 
occurred.  It  is  highly  probable  that  a  portion  of  the  active  constituents 
of  squill  is  eliminated  by  the  broncho-pulmonary  mucous  membrane. 

Squill  stimulates  the  functions  of  the  kidneys  and  increases  the 
urinary  discharge  when  used  in  medicinal  doses,  but  in  excessive 
quantity  it  excites  violent  inflammation,  with  strangury  and  bloody 
urine.  Suppression  of  urine  may  be  a  result  of  its  irritating  action  on 
the  kidneys. 

The  use  of  squill  is  confined  to  its  expectorant  and  diuretic  effects. 
The  acetum  and  syrupus  scillce  enter  into  the  composition  of  expec- 
torant mixtures  employed  in  the  treatment  of  catarrh  of  the  bronchial 
tubes,  after  the  subsidence  of  acute  symptoms,  and  the  chronic  forms 
of  the  disease.  Squill  is  more  particularly  indicated  when  the  sputa 
are  tenacious,  and  are  coughed  up  with  difficulty.  Ipecacuanha  is  ad- 
vantageously combined  with  it  in  the  more  recent  cases.  1J  Acet. 
scillae,  f  SB  ;  extract,  ipecac,  fluid.,  3  ss  ;  tinct.  opii  deod.,  3  j  ;  syrup, 
tolutan.,  3  x.  M.  Sig.  :  A  teaspoonful  every  two,  three,  or  four  hours. 
~fy  Scillae,  ipecac.,  aa,  gr.  vj  ;  ext.  hyoscyami,  gr.  iij  ;  morphinse  sulph., 
gr.  ss — gr.  j.  M.  Ft.  pil.  no.  xij.  Sig.  :  One  pill  every  four  hours. 
In  chronic  bronchitis  with  emphysema  or  dilated  right  cavities  of  the 
heart,  squill  is  better  associated  with  the  stimulating  expectorants, 
ammoniac,  asafoetida,  benzoin,  etc.  IJ  Syrup,  scillae,  |  ss  ;  tinct.  opii 
camphor.,  3  ij  ;  ammoniac,  3  ss  ;  syrup,  tolu.,  3  x.  M.  Sig.  :  A  tea- 
spoonful  as  necessary.  Squill  is  an  improper  remedy  when  there  are 
present  fever  and  an  acute  inflammatory  condition  of  the  air-passages. 
Squill  is  a  very  effective  diuretic.  Since  in  overdoses  it  will  pro- 
duce great  irritation  of  the  kidneys,  it  is  inadmissible  in  acute  affec- 
tions of  these  organs.  In  dropsy  caused  by  any  of  the  chronic  dis- 
eases of  the  kidneys,  squill  must  be  used  with  caution.  As  a  diuretic 
this  remedy  is  more  especially  useful  in  cardiac  dropsy.  It  may  be 
combined  with  digitalis  or  the  saline  diuretics.  3,  Infus.  digitalis, 

§  iijss;  acet.  scillae,  §  ss.  M.  Sig.:  A  tablespoonful  two  or  three  times 
a  day.  $  Digitalis,  3j;  scillqe,  gr.  x  ;  ext.  colchici  acet.,  3j.  M.  Ft. 
pil.  no.  xx.  Sig.  :  One  pill  every  four  or  six  hours.  When  anaemia  is 
present,  iron  may  be  added  to  the  above  formula.  IJ  Acet.  scillae, 

§  ss  ;  liq.  potassii  citratis,  §  iijss.  M.  Sig.  :  A  tablespoonful  every 
four  hours. 

Authorities  referred  to  : 
FLUCKIGER  AND  HANBURY.     Pharmacographia. 
HUSEMANN,  DR.  THEOD.     Handbuch,  zweiter  Band,  p.  1175 
KOHLER,  DR.  HERMANN.     Handbuch,  p.  515. 


794  EVACUANTS. 

Petroselinum. — Parsley-root.  The  root  of  Petroselinum  sativum* 
(Xot  official.) 

COMPOSITION. — The  most  important  constituent  of  parsley  is  apiol, 
an  oily,  non-volatile,  yellowish  liquid,  having  a  distinctive  odor  and  an 
acrid  taste.  It  contains,  also,  a  gelatinous  substance,  apiine  (pectin  ?), 
and  a  volatile  oil. 

ACTIONS  AND  USES. — Petroselinum  has  a  hot,  pungent  taste,  with 
an  after  acrid  sensation.  It  is  somewhat  laxative — a  property,  doubt- 
less, dependent  on  the  irritation  which  it  produces.  It  is  stimulant  in 
its  effects  on  the  circulation,  and  promotes  the  cutaneous  and  bronchial 
secretions.  It  is  diuretic,  by  reason  of  the  local  irritant  action  of  the 
principles  which  are  eliminated  by  the  kidneys. 

Apiol  has  decided  properties,  and  in  its  action  strongly  resembles 
quinine.  It  produces  headache,  tinnitus  aurium,  vertigo,  intoxication, 
etc. 

Petroselinum  is  rarely  employed  for  its  diuretic  effects.  Its  use  is 
indicated  in  dropsy  under  the  same  conditions  as  juniper,  squill,  and 
other  stimulating  diuretics.  It  may  be  given  in  the  form  of  infusion 
( |  j — Oj),  one  to  three  ounces  at  each  dose. 

Apiol  is  a  remedy  of  considerable  value  in  the  treatment  of  mala- 
rial diseases,  but  it  is  inferior  in  every  respect  to  quinine.  Its  use  is 
only  justifiable  in  the  treatment  of  intermittents,  and  when  the  preju- 
dices or  idiosyncrasies  of  the  patient  forbid  the  use  of  quinine.  Fif- 
teen grains  should  be  administered  in  one  dose,  or  in  divided  doses, 
within  an  hour,  in  order  to  procure  the  maximum  effect,  and  about 
four  hours  previous  to  the  paroxysm. 

The  evidence  is  conclusive  that  apiol  has  decided  emmenagogue 
power.  It  is  a  stimulant  to  the  uterine  system,  and  therefore  is  con- 
traindicated  in  plethora  of  these  organs,  and  should  not  be  adminis- 
tered as  an  antiperiodic  to  pregnant  women.  It  is  indicated  when  a 
state  of  torpor  of  the  ovaries  and  uterus  exists.  The  amenorrhcea  of 
anaemia,  of  functional  inactivity,  is  the  form  of  the  malady  in  which 
apiol  is  serviceable.  The  condition  of  the  blood  should  be  corrected 
by  iron,  constipation  should  be  removed  by  aloetic  purgatives,  and  the 
apiol,  in  a  considerable  dose  (fifteen  grains),  should  then  be  adminis- 
tered at  the  time  of  the  menstrual  molimen,  or  just  preceding  the  time 
when  the  flow  should  begin.  If  the  case  has  been  obstinate,  a  daily 
dose  of  apiol  may  be  given  for  a  week,  or  at  least  for  several  days  be- 
fore the  menstrual  period.  The  neuralgic  form  of  dysmenorrhcea  is 
also  benefited  by  this  remedy.  Other  neuralgias,  are,  it  is  said,  relieved 
by  apiol,  but  the  existence  of  a  malarial  cause  is,  no  doubt,  the  ex- 
planation of  its  curative  action  in  such  cases. 

Authorities  referred  to  : 

DELORME,  DR.     Gazette  des  Hopitaux,  1860,  p.  511. 

JORET  AND  HOMOLLE.     Bulletin  General  de  Therapeutique,  vol.  xlviii,  p.  32. 


URINO-GENITALS.  795 

MAROTTI,  DR.     Ibid.,  1863,  p.  295. 

STILLE,  DR.  A.     Therapeutics  and  Materia  Medica,  vol.  ii,  p.  631. 

Polygonum  Hydropiperoides.  —  Water  -  pepper.  This  indigenous 
plant  is  not  recognized  by  the  United  States  Pharmacopoeia.  A  fluid 
extract  prepared  according  to  the  general  directions  of  the  United 
States  Pharmacopoeia  may  be  prescribed  in  the  dose  of  in,  x  to  3  j.  A 
solid  extract  is  also  to  be  found  in  the  shops — dose,  gr.  j — gr.  v. 

ACTIONS  AND  USES. — The  taste  of  hydropiper  is  hot,  pungent,  and 
acrid.  The  juice  excites  inflammation  and  vesication  when  applied  to 
the  external  integument.  In  medicinal  doses  it  causes  a  sensation  of 
warmth  in  the  stomach,  and  a  "  peculiar  tingling  sensation  throughout 
the  whole  system"  (Eberle).  Unless  given  in  an  overdose  it  does 
not  excite  vomiting  or  produce  purging.  It  stimulates  the  heart  and 
arteries,  increases  the  warmth  of  the  surface,  and  promotes  the  cuta- 
neous, bronchial,  and  renal  secretions.  It  stimulates  the  menstrual 
flow,  and  is  aphrodisiac. 

This  indigenous  but  little  known  remedy  is  a  very  efficient  stimu- 
lating diuretic  and  emmenagogue.  The  author  can  confirm  the  state- 
ment of  Eberle,  who  reports  that  "  with  no  other  remedy  or  mode  of 
treatment  has  he  been  so  successful  as  with  this,"  in  amenorrhoea.  It 
is  adapted  to  cases  of  amenorrhcea  due  to  functional  inactivity  or  tor- 
por of  the  uterine  system,  and  is  contraindicated  when  a  condition 
of  plethora  or  congestion  exists.  The  administration  of  this  remedy 
should  be  begun  about  a  week  before  the  menses  ought  to  appear. 
Thirty  minims  of  the  fluid  extract  should  be  administered  four  times 
a  day.  If  anaemia  exist,  iron  should  be  given  ;  if  constipation,  aloes. 

Hydropiper  is  a  remedy  of  considerable  power  in  functional  impo- 
tence. When  the  erections  are  feeble,  the  seminal  fluid  watery,  and  the 
testes  soft,  good  results  will  be  obtained  from  the  use  of  this  remedy, 
provided  no  structural  alterations  hinder  or  prevent  improvement. 

When  hydropiper  is  administered  in  these  disorders  of  the  sexual 
system,  it  causes  a  feeling  of  weight  and  tension,  and  dragging  of 
the  pelvic  viscera.  As  it  tends  to  increase  the  blood-supply  to  these 
organs,  it  is  inadmissible  when  a  state  of  congestion  or  inflammation 
exists. 

Authorities  referred  to  : 

EBERLE,  DR.  JOHN.     A  Treatise  of  the  Materia  Medica  and  Therapeutics,  fourth  edi- 
tion, vol.  i,  p.  441. 

PORCHER,  DR.  F.  PETRE.     Resources  of  the  Southern  Fields  and  Forests,  p.  409. 

Ruta. — Rue.    The  leaves  of  Rutagraveolens.     (Not  official.) 
COMPOSITION. — The  medicinal  activity  of  this  plant  depends  on  the 
presence  of  a  volatile  oil.     Only  the  fresh  leaves  should  be  employed, 
and,  as  drying  impairs  the  quality  of  the  drug,  the  oil  should  be  pre- 
scribed. 


796  EVACUANTS. 

Oleum  Rutce. — Oil  of  rue.  This  is  a  volatile  oil,  of  a  greenish- 
yellow  color,  very  disagreeable  and  characteristic  odor,  and  pungent, 
acrid  taste.  Dose,  u[  j — TH,  v. 

ACTIONS  AND  USES. — In  its  local  action  rue  is  an  irritant ;  applied 
to  the  skin,  the  oil  causes  heat,  inflammation,  and  vesication.  In  ordi- 
nary medicinal  doses  a  sensation  of  warmth  follows  its  introduction 
into  the  stomach,  and  increased  action  of  the  heart  and  arterial  system 
and  a  subjective  feeling  of  peripheral  heat  are  subsequently  produced. 
The  cutaneous,  bronchial,  and  urinary  excretions  become  more  abun- 
dant, and  the  odor  of  the  volatile  oil  is  apparent  in  the  breath,  the  sweat, 
and  the  urine.  In  toxic  doses  the  oil  of  rue  produces  violent  gastro- 
enteritis, prostration,  convulsive  muscular  movements,  hebetude  of 
mind,  etc.,  strangury  and  suppression  of  urine.  In  women  the  use  of 
rue  increases  the  menstrual  flow,  and  large  doses  may  cause  abortion 
to  take  place.  In  men  this  agent  promotes  the  sexual  appetite,  and 
increases  the  vigor  of  the  erections. 

A  tincture  of  the  oil  of  rue  is  an  efficient  carminative  and  antispas- 
modic  remedy  in  the  flatulent  colic  and  hysteria  of  women.  Almost 
the  only  use  of  rue  at  present  is  in  the  treatment  of  amenorrhcea.  It 
is  one  of  the  most  efficient  emmenagogues.  Plethora,  congestion,  or 
inflammation  of  the  pelvic  viscera,  contraindicate  its  use.  Functional 
inactivity  of  the  ovaries  and  uterus  is  the  condition  which  justifies  the 
employment  of  rue.  It  has  been  recommended  in  menorrhagia  when 
the  vascular  tonus  is  low,  and  in  uterine  hcemorrhage  after  miscar- 
riage. It  need  hardly  be  remarked  that  the  condition  of  pregnancy 
forbids  the  use  of  rue. 

Sabina. — Savine.  The  tops  of  Juniperus  sabina  Linne  (Nat.  Ord. 
Coniferce).  Sabine,  Fr. ;  Sabenkraut,  Ger. 

COMPOSITION. — Savine  contains  an  essential  oil,  in  the  proportion 
of  two  to  two  and  a  half  per  cent  in  the  tops  and  about  ten  per  cent 
in  the  berries.  The  oil  of  savine  is  isomeric  with  the  oil  of  turpentine. 

Oleum  Sabince. — Oil  of  savine.     Dose,  TS\,  j — TTJ,  v. 

Extractum  Sabince  Fluidum. — Fluid  extract  of  savine.  Dose,  nj,  v 
— Til  xv. 

ACTIONS  AND  USES. — Savine  has  a  strong,  disagreeable  odor,  and  a 
pungent,  acrid  taste.  Applied  to  the  skin,  the  oil  causes  inflammation 
and  vesication,  if  the  contact  be  sufficiently  prolonged.  Introduced 
into  the  stomach  in  a  full  medicinal  dose,  a  sensation  of  heat,  eructa- 
tions tasting  of  the  oil,  flatulence,  and  nausea,  are  produced.  A  toxic 
dose  sets  up  a  violent  gastro-enteritis.  The  oil  diffuses  readily  into 
the  blood,  and  is  excreted  by  various  channels — the  breath,  the  sweat, 
and  the  urine  smelling  strongly  of  it.  Increased  action  of  the  heart 
and  a  rise  of  tension  of  the  arterial  system,  followed  by  diminished 
tonus  of  the  vessels,  result  from  its  administration  in  full  medicinal 


URINO-GENITALS.  797 

doses.  The  cutaneous,  bronchial,  and  urinary  excretions  are  rendered 
more  abundant  by  savine.  Strangury  and  bloody  urine  are  caused  by 
it  in  overdoses.  The  evidence  is  conclusive  that  savine  exerts  a  pow- 
erful influence  on  the  uterine  system.  It  increases  the  menstrual  flux, 
and  in  toxic  doses  may  originate  uterine  action  and  cause  abortion. 
The  abortifacient  effect  can  not  be  obtained  unless  by  the  administra- 
tion of  a  quantity  sufficient  to  endanger  life. 

The  only  use  to  which  savine  is  now  applied  is  in  the  treatment  of 
amenorrhcea.  It  is  generally  conceded  that  the  estimate  of  its  pow- 
ers made  by  Pereira  is  not  extravagant,  namely,  thac  "  it  is  the  most 
certain  and  powerful  emmenagogue  of  the  whole  materia  medica." 
Savine  is  indicated  in  amenorrhcea  dependent  on  deficient  activity  of 
the  sexual  system,  accompanied  by  general  atony.  It  is  inadmissible 
when  a  tendency  to  congestion  of  the  pelvic  viscera  is  present,  or  in  a 
condition  of  general  plethora.  Cases  of  dysmenorrhoza  are  benefited 
by  savine  when  the  subject  is  of  relaxed  habit,  the  menstrual  flow  be- 
ing scanty,  provided  narrowing  of  the  cervical  canal  is  not  the  cause 
of  the  painful  and  difficult  menstruation.  Menorrhagia,  when  due  to 
an  enlarged,  relaxed,  and  passively  congested  uterus,  and  haemorrhage 
after  abortion,  may  sometimes  be  arrested  by  this  agent. 

The  most  effective  preparation  of  savine  is  the  oil.  This  may  be 
prescribed  in  gelatin-capsules,  in  an  emulsion,  or  in  pilular  form.  The 
fluid  extract,  if  made  from  the  fresh  tops,  is  an  excellent  preparation. 
Combination  with  other  remedies  of  the  same  group  increases  the  action 
of  savine.  $  Ol.  sabinae,  3  j  ;  ol.  rutae,  3  j  ;  tinct.  polygon,  hydropi- 
Per>  1  j  j  °1-  amygdal.  express.,  mucil.  acacias,  aquae  menth.  pip.,  aa  3  ij. 
M.  Sig. :  A  teaspoonful  twice  or  three  times  a  day  as  an  emmenagogue, 

Authorities  referred  to  : 

ARAN,  M.     Bulletin  General  de  Therapeutiqite,  vol.  xxx,  p.  61. 

BEAU,  M.  LE  DR.     Ibid.,  vol.  xliii,  p.  140. 

FLUCKER  AND  HANBTJRY.     Pharmacographia. 

HUSEMANN,  DR.  THEODOR.     Handbuch,  zweiter  Band,  p.  1200. 

KOHLER,  DR.  HERMANN.     Handbuch,  p.  SSY. 

TAYLOR,  DR.  A.  S.     On  Poisons,  third  edition,  London,  p.  494. 

VAN  DE  WARKER,  DR.  ELY.     The  Detection  of  Criminal  Abortion,  1872. 

Cantharis.—  Cantharides.  Cantharis  vesicatoria.  Cantharide,  Fr.  j 
Spanische  Fliegen,  Ger. 

Tinctura  Cantharidis. — Tincture  of  cantharides.    Dose,  TTJ,  ij — m  xv. 

(The  other  preparations  of  cantharides,  which  are  used  externally 
only,  will  be  taken  up  in  Part  III  of  this  work.) 

COMPOSITION. — The  principal  constituent  of  cantharides  is  a  neu- 
tral, crystallizable  principle,  cantharidin.  It  contains  also  an  oil,  fatty 
matter,  and  an  odorous  material. 

ANTAGONISTS  AND  INCOMPATIBLE. — There  is  no  chemical  or  physio- 


798  EVACUANTS. 

logical  antagonist  to  cantharides.  Poisoning  by  this  substance  should, 
therefore,  be  treated  on  general  principles.  The  stomach  should  be 
evacuated  by  emetics  or  the  stomach-pump  ;  mucilaginous  substances 
should  be  freely  administered  ;  the  gastro-enteritis  should  be  treated 
by  opium,  etc. 

SYNERGISTS. — Oils  and  fats  increase  the  solubility  and  favor  the 
absorption  of  cantharidin.  The  physiological  actions  of  this  agent  are 
promoted  by  the  other  members  of  this  group. 

PHYSIOLOGICAL  ACTIONS. — The  odor  of  cantharides  is  nauseating, 
fetid,  and  peculiar.  In  contact  for  a  sufficient  time  with  the  skin  or 
mucous  membrane,  it  excites  considerable  burning,  inflammation,  and 
vesication.  In  the  stomach  it  causes  a  sensation  of  heat,  severe  gas- 
tralgia,  nausea,  and  vomiting.  Notwithstanding  the  insolubility  of 
cantharidin,  it  readily  diffuses  into  the  blood.  It  is  actively  stimulating 
to  the  circulatory  system,  and  a  rise  of  temperature,  with  thirst,  follows 
in  an  hour  or  two.  Under  these  circumstances,  the  urine  becomes 
scanty  and  burns  the  passages  ;  severe  pain  is  experienced  in  the  back 
and  loins  ;  priapism  occurs  ;  and  the  urine,  voided  with  great  difficulty, 
frequently  contains  albumen  and  blood.  To  this  excitement  of  the 
circulatory  system  and  of  the  genital  organs  succeeds  a  condition  of 
depression,  in  which  the  pulse  falls,  the  arterial  tension  is  lowered, 
and  the  temperature  declines  (Radecki). 

When  a  toxic  dose  is  swallowed,  in  a  short  time  a  sense  of  constric- 
tion of  the  oesophagus,  with  difficulty  of  swallowing,  and  ptyalism, 
occur.  Intense  gastric  pain,  vomiting  of  glairy  mucus  streaked  with 
blood,  intestinal  pain,  abdominal  tenderness,  tenesmus,  and  mucous 
and  bloody  stools,  are  produced.  Violent  irritation  of  the  genito-uri- 
nary  organs  is  also  experienced,  manifested  by  lumbar  pain,  strangury 
and  bloody  urine,  priapism,  swelling  and  inflammation  of  the  external 
genitals.  In  most  cases  of  poisoning  by  cantharides,  cerebral  effects, 
consisting  of  muscular  trembling,  partial  or  general  convulsions,  coma, 
and  insensibility  are  produced.  Abortion  has  been  caused  by  toxic  doses 
of  cantharides,  and  after  death  violent  metro-peritonitis,  gastro-enteri- 
tis, and  general  peritonitis,  have  been  observed.  It  is  questionable 
whether  abortion  can  be  caused  by  a  dose  less  than  toxic. 

Cantharides  has  frequently  caused  dangerous  symptoms,  when  used 
with  a  view  to  induce  venereal  excitement.  That  it  does  promote  the 
sexual  appetite  is  probably  true,  but  this  result  is  accomplished  only  by 
the  use  of  a  quantity  sufficient  to  cause  vascular  turgescence  of  the 
sexual  organs. 

THERAPY. — In  acute  desquamative  nephritis,  after  the  subsidence 
of  the  acuter  symptoms,  good  results  are  obtained  from  cantharides. 
The  local  condition  in  which  this  remedy  is  serviceable  consists  in 
hyperaemia  with  loss  of  vascular  tonus.  Chronic  pyelitis  and  chronic 
catarrh  of  the  bladder  are  occasionally  remarkably  benefited  by  the 


URINO-GEXITALS.  799 

long-continued  use  ot  small  doses  of  cantharides.  Irritability  of  the 
bladder,  more  especially  as  it  occurs  in  women,  without  the  existence 
of  acute  inflammation,  and  not  produced  by  uterine  displacements,  is 
sometimes  quickly  and  entirely  relieved  by  this  remedy.  The  irritable 
state  of  the  bladder  and  the  vesical  tenesmus,  which  accompany  chronic 
prostatic  disease,  are  also  sometimes  surprisingly  relieved  by  canthari- 
des, but  the  author  is  unable  to  indicate  the  special  circumstances  to 
which  it  is  adapted. 

Gleet  and  prostorrhoea  are  benefited  by  cantharides  when  these 
maladies  occur  in  subjects  of  a  relaxed  fiber,  with  feeble  circulation. 
Ringer  makes  the  extraordinary  statement  that  one  drop  of  the  tincture 
given  three  times  a  day  will  prevent  chordee. 

When  spermatorrhoea  actually  exists,  and  is  due  to  deficient  tone  of 
the  seminal  vesicles,  the  erections  being  feeble,  and  the  sexual  feeling 
torpid,  good  results  are  obtained  by  the  use  of  cantharides.  In  cases 
of  scanty  menstruation,  occurring  in  women  of  lax  fiber,  with  cold 
hands  and  feet,  improvement  follows  the  use  of  this  remedy.  It  some- 
times happens  that  menorrhagia  is  due  to  relaxed  vessels  and  a  general 
lowering  of  the  vascular  tonus  :  under  such  circumstances  cantharides 
may  render  important  service.  In  these  disorders  of  the  sexual  system, 
characterized  by  deficient  power,  the  good  effects  of  cantharides  are 
promoted  by  the  use  of  iron.  The  tincture  of  cantharides  is  the  most 
eligible  preparation  for  internal  administration.  In  chronic  affections 
of  the  genito-urinary  passages  the  dose  will  range  from  five  to  fifteen 
drops,  rarely  the  latter,  three  times  a  day. 

Liebreich  has  brought  forward  cantharidin  as  a  remedy  for  phthisis, 
based  on  the  action  of  this  agent  on  the  capillaries  whereby  an  abun- 
dant diffusion  of  blood  serum  takes  place  about  pathological  new  for- 
mations. Now  it  is  a  well-known  fact  that  blood  serum  is  destructive 
of  pathogenic  micro-organisms.  Hence  his  contention  that  to  arrest 
the  progress  of  tuberculosis  it  is  only  necessary  to  inject  subcutane- 
ously  an  agent  like  cantharidin,  which  environs  the  organism  and  cuts 
it  off  from  further  extension  by  causing  an  outpouring  of  serum  about 
the  tubercular  deposit.  Cantharidin  has  acid  properties  and  combines 
with  bases  to  form  salts.  Liebreich  recommends  the  following  com- 
bination :  Cantharidin  (cryst.),  3  grains  (0'2  grm.)  ;  potassium  hydrox- 
ide (pure),  6  grains  (0-4  grm.)  ;  water,  5£  drachms  (20  grm.).  Heat 
over  a  water  bath  until  clear  ;  then  add,  while  still  on  the  water  bath, 
and  very  cautiously,  cold  water  enough  to  make  when  cooled  1  litre 
(32  fluidounces).  The  dose  should  never  exceed  -^fa  grain  of  can- 
tharidin, and  the  initial  quantity  ought  not  be  greater  than  one  third 
of  that. 

Good  results  have  apparently  followed  this  treatment,  and  the 
views  of  Liebreich  have  been  supported  by  Frankel,  Guttman,  and 

others. 

53 


800  EVACUANTS. 

Authorities  referred  to  : 

CASPER'S  Practisches  Handbuch  der  gerichttichen  Medicin,  by  Liman,  zweiter  Band^ 
p.  576. 

HCSEMANN,  DB.  THEOD.     Handbuch,  zweiter  Band,  p.  538  el  seq. 

RADECKI,  FR.  Die  Cantharidinvergiftung.  Inaug.  Diss.  Schmidfs  Jahrbucher,  voL 
cxxxviii,  p.  17. 

RINGER,  DR.  SYDNEY.     Handbook  of  Therapeutics. 

TAYLOR,  DR.  A.  S.     On  Poisons,  fourth  edition,  London,  p.  524. 

Urotropin. — From  uron,  urine,  and  trepo,  to  change,  a  proprietary 
designation  of  a  remedy  intended  to  remove  certain  morbid  states  of 
the  genito-urinary  apparatus.  It  is  formed  by  the  combination  of 
ammonia  and  formaldehyde,  and  occurs  as  colorless  crystals,  readily 
soluble  in  water.  The  dose  for  internal  administration  is  usually  about 
thirty  grains  per  diem,  or  five  to  ten  grains  every  four  hours.  It  is 
readily  diffusible,  and  appears  in  the  urine  in  about  fifteen  minutes 
after  it  is  swallowed.  Either  urotropin  or  its  constituent,  formalde- 
hyde, is  always  to  be  found  in  the  blood  or  urine  in  its  passage  through 
the  system.  When  given  in  full  doses,  it  may  cause  a  sensation  of 
heat,  even  burning  along  the  course  of  the  urethra  or  at  the  neck  of 
the  bladder,  and  increase  the  desire  to  urinate. 

The  most  important  property  of  urotropin  is  to  render  urine  acid 
again  that  had  become  alkaline.  This  it  accomplishes  by  inhibiting 
the  septic  organisms,  that  being  about  the  alkalinity. 

Urotropin  has  been  used  with  success  in  effecting  the  solution  of 
uric  acid  calculi.  In  pyonephrosis,  with  or  without  phosphatic  concre- 
tions, it  has  restored  the  integrity  of  the  mucous  membrane,  and* 
stopped  permanently  the  process  of  suppuration.  Much  relief  has 
been  effected  by  its  use  in  enlarged  prostate,  with  the  resulting  altera- 
tions in  the  bladder. 


PAET    III. 
II.     TOPICAL  REMEDIES. 


COUNTER-IRRITATION. 

The  Theory  of  Counter-Irritation. — The  application  of  counter- 
irritation  as  an  expedient  of  therapeutics  has  never  failed  of  appre- 
ciation, how  vague  soever  have  been  the  notions  as  to  its  mode  of 
action,  and  how  much  these  notions  have  varied  from  age  to  age. 
Before  physiology  had  obtained  the  data  on  which  a  proper  theory 
could  be  founded,  the  dogma  of  some  master  was  submissively  ac- 
cepted by  his  followers,  until  a  more  specious  theory  was  brought 
forward  to  displace  it. 

When  the  work  of  Magendie,  the  pioneer,  and  of  Bichat,  the  in- 
terpreter and  clinician,  laid  the  foundations  of  physiological  thera- 
peutics, a  true  conception  of  the  methodus  medendi  was  dimly  fore- 
shadowed. Then  the  relation  of  the  nervous  centers  to  certain  dis- 
orders of  nutrition — e.  g.,  the  myopathies  of  spinal  origin — and 
the  alterations  of  the  structure  of  nerve-centers  induced  by  patho- 
logical states  of  the  peripheral  nerves,  became  established  facts,  and, 
in  consequence,  the  influence  of  counter-irritation  began  to  be  ration- 
ally interpreted.  Already  the  doctrine  of  reflexes  had  been  universally 
established,  and  now  the  condition  of  the  vessels  as  regulated  by  a 
system  of  dilator  and  constrictor  organic  muscular  fibers,  which  are 
influenced  by  sensory  impressions  at  distant  points,  has  become  a  well- 
recognized  fact  of  physiology.  These  data  given,  the  principles  of 
counter-irritation  are  no  longer  obscure,  and  no  dogma  is  needed  to 
give  them  concrete  expression. 

When  the  skin  is  irritated,  by  a  mustard-plaster,  for  example,  the 
superficial  vessels  of  the  part  dilate,  and  an  increased  amount  of  blood 
is  present  in  them.  For  a  short  distance  around  the  part  irritated, 
also,  more  or  less  dilatation  of  the  vessels  takes  place.  In  this  way  a 
small  amount  of  blood  may  be  temporarily  imprisoned.  The  influ- 
ence which  the  retention  in  an  external  part  of  so  small  an  amount  of 
blood  has  on  the  general  circulation,  must  be  very  slight.  The  obvi- 


802  TOPICAL   REMEDIES. 

ous  relief  often  afforded  by  a  mustard-plaster  can  hardly,  therefore,  be 
ascribed  to  this  limited  withdrawal  of  blood. 

An  irritation  established  in  the  neighborhood  of  a  part  in  which  a 
morbid  action  is  proceeding  may,  by  reason  of  the  contiguity  of  the 
tissues,  affect  the  vascular  supply  to  the  diseased  textures.  Ubi  irri- 
tatio,  ibi  fluxus  ;  but,  in  order  that  the  fluxion  shall  modify  diseased 
action,  it  is  necessary  that  there  be  a  continuity  of  the  vascular  con- 
nections. The  method  of  Furneux  Jordan,  which  consists  in  the  appli- 
cation of  the  counter-irritant  to  the  neighboring  vascular  area,  is  based 
on  this  principle. 

An  irritation  which  consists  in  a  local  fluxion,  and  a  state  of  altered 
sensibility  in  the  nerves  of  the  part,  may  affect  the  functions  of  distant 
organs.  Counter-irritation  applied  to  a  considerable  surface  increases 
the  action  of  the  heart,  raises  the  temperature  of  the  body,  and  exalts 
the  irritability  of  the  nervous  system.  These  are  the  general  or  sys- 
temic effects.  Distinctly  localized  results  are  also  produced.  When 
one  hand  is  immersed  in  cold  water,  a  positive  fall  of  temperature  takes 
place  in  the  other.  Irritation  of  the  lumbar  region,  as  Brown-Sequard 
has  shown,  is  followed  by  contraction  of  the  vessels  of  the  kidneys. 
Extensive  injury  to  the  surface  of  the  body,  by  burning  or  scalding, 
may  excite  ulcerative  action  in  the  duodenum,  or  may  set  up  a  pneumo- 
nia. Injury  to  a  motor-nerve  trunk  may  be  followed  by  ascending  neu- 
ritis and  serious  atrophic  changes  in  the  multipolar  ganglion-cells  of 
the  anterior  columns.  It  follows  from  these  facts  that  an  irritation  of 
the  surface  which  involves  the  end-organs  of  the  nervous  system  will  < 
affect  the  caliber  of  the  arterioles  and  modify  the  functions  of  the 
trophic  nerves.  In  these  results  we  find  a  rational  explanation  of  the 
methodus  medendi  of  counter-irritation. 

Certain  other  physiological  laws  deserve  attentive  consideration  in 
this  connection.  An  irritation  which  first  produces  a  tetanic  state  of 
the  vaso-motor  nervous  system  may,  if  too  long  continued,  exhaust  the 
irritability  of  the  organic  muscular  fiber,  and  cause  paresis.  Moderate 
irritation  will  exalt  the  functional  power  of  the  trophic  centers  ;  but 
excessive  and  long-continued  injury  to  the  surface  may  set  up  atrophic 
changes,  of  which  there  are  numerous  examples.  In  these  physiologi- 
cal facts  also  we  find  a  rational  explanation  of  the  injury  not  unfre- 
quently  done  by  too  powerful  or  too  protracted  counter-irritation. 

Vesicants,  in  addition  to  the  effects  of  counter-irritants  sketched 
above,  cause  an  exudation  of  serum*  This  exudation  may  have  a  two- 
fold effect :  1.  To  lessen  the  gross  amount  of  the  blood-serum,  and 
thus  diminish  the  blood-pressure  ;  and,  2.  To  remove  toxic  or  patho- 
logical materials  from  the  tissues  and  fluids  of  the  inflamed  part.  More 
powerful  systemic  effects  are  produced,  and  vaso-motor  paresis  and 
trophic  changes  are  more  quickly  induced,  by  blisters  than  by  rubefa- 
cients. 


FORMS   OF   COUNTER-IRRITANTS.— RUBEFACIENTS.  803 


FORMS   OF   COUNTER-IRRITANTS. 

The  remedies  employed  for  the  purpose  of  external  irritation  are 
divisible  into  two  groups. 

1.  Rubefacients  ; 

2.  Epispastics. 

A  rubefacient  is  a  remedy  which  causes  heat  and  redness  ;  but,  if 
the  contact  with  the  skin  be  sufficiently  prolonged,  vesication  may  be 
produced.  An  epispastic  is  a  remedy  which  excites  inflammation  and 
vesication.  The  first  group  of  remedies  are  restricted  in  their  applica- 
tion to  such  therapeutical  results  as  can  be  attained  by  a  superficial  and 
temporary  action  in  the  skin.  The  second  group  are  intended  for 
more  permanent  action  and  a  deeper  impression  on  internal  organs. 
These  remedies  differ  not  only  in  the  degree,  but  in  the  character  of 
the  effects  produced.  An  impression  on  the  periphery  induces  some 
kind  of  molecular  modification  at  the  center.  According  as  the  im- 
pression is  slight  or  severe  are  the  centric  modifications  localized  to- 
the  point  of  reception  or  transferred  to  distant  points  (reflex  impres- 
sions). According  to  the  severity  of  the  peripheral  impression  are 
the  resulting  local  centric  disturbance  and  the  reflex  changes  (trophic 
alterations).  Thus  a  slight  peripheral  rubefaction  may  cause  a  trivial 
centric  vascular  spasm,  but  an  extensive  burn  on  the  body  may  induce 
vaso-motor  paresis,  and  consequent  inflammatory  changes  in  remote 
organs. 

RUBEFACIENTS. 

Sinapis  Alba. — White  mustard.  The  seed  of  Brassica  alba  Linne" 
(Nat.  Ord.  Cruciferce). 

Sinapis  Nigra. — Black  mustard.     The  seed  of  Brassica  nigra. 

Charta  Sinapis. — Mustard-paper. 

COMPOSITION. — When  water  is  added  to  pulverized  black  mustard, 
pungent,  irritating  fumes  are  given  off.  These  fumes  consist  of  the 
volatile  oil  of  mustard  (allyl  sulphocyanide).  This  volatile  oil  is  pro- 
duced by  a  reaction  between  certain  constituents  of  the  seeds — sini- 
grin  (myronate  of  potassium)  and  myrosin — in  presence  of  water,  and 
at  a  temperature  below  100°  Fahr.  The  boiling-temperature  destroys 
the  ferment,  myrosin,  and  hence  prevents  the  formation  of  the  volatile 
oil.  Mustard  contains  also  a  bland  fixed  oil,  which  may  be  procured 
by  expression. 

White  mustard  contains  an  indifferent,  crystalline  substance,  sinal- 
bin,  and  myrosin.  Sulphocyanate  of  acrinyl,  a  product  of  the  reac- 
tion between  sinalbin  and  myrosin,  is  the  rubefacient  principle  of  white 
mustard  (Fltickiger  and  Hanbury).  White  mustard  contains  also  an 
alkaloid — sinapine.  The  chemical  composition  of  the  two  kinds  of 
mustard  is,  it  will  be  seen,  closely  analogous.  Myrosin  exists  in  white 


804  TOPICAL   REMEDIES. 

mustard  in  larger  proportion  than  in  black,  hence  a  considerably  larger 
quantity  of  the  volatile  oil  of  mustard  is  formed  when  an  addition  of 
white  mustard  is  made  to  the  black. 

A  great  variety  of  plasters  and  liniments  (some  referred  to  already 
in  their  appropriate  connections)  are  employed  to  induce  a  rubefacient 
action. 

EMPLASTRA. 

Emplastrum  Capsici. — Capsicum  plaster  (a  resin  plaster  on  which 
is  spread  a  thin  layer  of  oleo-resin  of  capsicum). 

Emplastrum  Resince. — Resin  plaster  (resin,  lead  plaster,  and  yellow 
wax). 

Emplastrum  Saponis. — Soap  plaster  (soap,  100  grm.  ;  lead  plaster, 
900  grm.). 

Emplastrum  Arnicce. — Plaster  of  arnica  (extract  of  arnica-root, 
330  grm.  ;  resin  plaster,  670  grm.). 

Emplastrum  Picis  Burgundicce. — Burgundy -pitch  plaster  (Bur- 
gundy pitch,  800  grm.  ;  yellow  wax,  150  grm.  ;  olive-oil,  50  grm.). 

Emplastrum  Picis  Cantharidatum. — Plaster  of  pitch  with  can- 
tharides  (Burgundy  pitch,  920  grm.  ;  cerate  of  cantharides,  80  grm.). 

LINIMENT  A. 

Linimentum  Calcis. — Lime  liniment  (equal  parts  of  lime  solution 
and  cotton-seed  oil). 

Linimentum  Cantharidis. — Cantharides  liniment  (cantharides,  15 
parts  ;  turpentine,  q.  s.  to  make  100  parts). 

Linimentum  Sinapis  Compositum. — Compound  mustard  liniment 
(volatile  oil  of  mustard,  extract  of  mezereurn,  camphor,  castor-oil,  and 
alcohol). 

Linimentum  Ammoniac. — Liniment  of  ammonia  (water  of  ammonia, 
350  c.  c.  ;  cotton-seed  oil,  600  c.  c. ;  alcohol,  50  c.  c.). 

Linimentum  Camphorce. — Liniment  of  camphor  (camphor,  200 
grm.  ;  cotton-seed  oil,  800  grm.). 

Linimentum  Saponis. — Soap  liniment  (soap,  70  grm. ;  camphor,  45 
grm.  ;  oil  of  rosemary,  10  c.  c. ;  water,  q.  s.  to  make  1,000  c.  c. ;  alcohol, 
750  c.  c.). 

Linimentum  Terebinthinoe. — Liniment  of  turpentine  (resin-cerate, 
650  grm. ;  oil  of  turpentine,  350  grm.). 

Linimentum  Saponis  Mollis. — Liniment  of  soft  soap  (soft  soap, 
650  grm.  ;  oil  of  lavender,  20  c.  c.  ;  alcohol,  300  c.  c. ;  water,  q.  s.  to 
make  1,000  c.  c.). 

Linimentum  Chloroformi. — Chloroform  liniment  (chloroform,  300 
c.  c. ;  soap  liniment,  700  c.  c.). 

Linimentum  Belladonnm.  —  Belladonna  liniment  (camphor,  50 
grm.  ;  fluid  extract  of  belladonna,  q.  s.  to  make  1,000  c.  c.). 


EPISPASTICS.  805 

A  turpentine-stupe,  which  is  one  of  the  most  frequently-used  ex- 
temporaneous counter-irritants,  is  made  as  follows  :  A  piece  of  flannel 
folded  in  several  layers,  or  a  piece  of  spongio-piline,  is  wrung  out  in 
hot  water,  and  a  few  drops  (five  to  fifteen)  of  turpentine  are  sprinkled 
over  it.  This  is  placed  over  the  affected  region,  and  is  confined  by  a 
towel  or  napkin  pinned  around  the  part.  Turpentine,  applied  in  this 
way,  is  a  very  active  rubefacient,  and  may  even  vesicate,  so  that  atten- 
tion is  required  to  avoid  overaction. 

EPISPASTICS. 

Ceratum  Cantharidis. — Cantharides  or  blistering  cerate. 

Ceratum  Extracti  Cantharidis. — Cerate  of  extract  of  cantharides. 

Charta  Cantharidis. — Cantharides-paper. 

Collodium  Cantharidatum. —  Collodion  with  cantharides. 

Linimentum  Cantharidis. — Liniment  of  cantharides. 

Firing. — By  the  method  of  firing,  merely  rubefacient  or  vesicating 
effects  are  produced.  Firing  is  accomplished  by  the  application  of  an 
iron  disk  provided  with  a  suitable  handle  (Mayer's  hammer).  It  is 
dipped  into  boiling  water,  and  then  passed,  more  or  less  rapidly,  over 
the  skin  of  the  part  to  be  acted  on.  Very  brief  contact  suffices  to 
vesicate,  and  this  is  the  usual  effect  of  the  application. 

Of  the  above  preparations  the  most  efficient  is  the  ceratum  extracti 
cantharidis,  the  most  elegant  the  charta  Cantharidis,  and  the  most 
convenient  the  collodium  cum  cantharide.  The  cerates  should  be 
spread  on  adhesive  plaster,  leaving  a  margin  of  the  plaster  to  secure 
adhesion  to  the  skin.  Before  the  application  of  a  blister,  if  prompt 
action  is  necessary,  a  mustard-plaster  should  be  laid  on  long  enough  to 
produce  rubefaction,  or  the  skin  should  be  rubbed  with  turpentine. 
When  the  skin  is  very  thin  and  sensitive,  the  blister  should  be  covered 
with  tissue-paper.  When  the  vesication  is  to  be  permitted  to  heal  in 
a  short  time,  or  when  young  and  irritable  subjects  are  to  be  blistered, 
the  cantharides-plaster  should  be  removed  when  distinct  redness  of  the 
skin  is  produced,  and  a  poultice  applied,  which  will  develop  the  vesi- 
cles. The  length  of  time  required  for  a  blister  "  to  draw "  is  influ- 
enced by  the  age  of  the  subject  and  the  condition  of  the  skin.  From 
two  to  twelve  hours,  as  a  rule,  will  elapse  before  vesicles  appear  ;  and, 
when  a  very  deep  impression  is  intended,  the  blister  may  remain  even 
twenty-four  hours.  In  infants  and  in  certain  states  of  the  constitution 
(scorbutus,  purpura,  scarlatina,  etc.),  prolonged  contact  of  a  canthari- 
des-plaster may  cause  deep  sloughing  and  very  severe  nervous  symp- 
toms, and  adynamia. 

When  the  vesicles  are  fully  developed,  they  should  be  punctured  at 
the  most  dependent  point,  and  the  serum,  as  it  escapes,  absorbed  by  a 
soft  cloth.  If  the  blistered  surface  is  to  be  allowed  to  heal,  a  dressing 
of  raw  cotton  suffices.  If  discharge  is  to  be  encouraged,  resin-cerate 


806  TOPICAL   REMEDIES. 

or  savine-cerate  may  be  applied,  spread  on  a  cloth  perforated  to  permit 
the  discharge  to  exude,  and  covered  with  raw  cotton  to  absorb  the 
fluid.  If  the  blister  is  slow  to  heal,  boracic-acid  lotion  is  an  efficient 
application,  or  a  weak  lead-lotion  may  be  used. 

THERAPY. — Various  methods  of  counter-irritation  are  employed  in 
the  treatment  of  diseases  of  the  abdominal  viscera.  For  the  relief  of 
nausea,  vomiting,  diarrhoea,  colic,  cholera-morbus,  etc.,  no  expedient  is 
more  generally  useful  than  a  mustard-plaster.  In  persistent  vomiting, 
a  small  blister  applied  to  the  epigastrium  will  often  afford  permanent 
relief.  The  good  effects  of  a  blister  in  such  cases  are  enhanced  by 
dusting  over  the  exposed  derma  some  powdered  morphine.  In  acute 
inflammatory  affections  —  typhlitis,  peritonitis,  puerperal  peritonitis, 
pelvic  cellulitis,  etc. — the  best  results  are  obtained  by  the  use  of  tur- 
pentine-stupes during  the  acute  stage,  and  the  application  of  blisters 
after  the  acuter  symptoms  have  subsided.  The  prolonged  contact  of 
blisters  with  the  abdominal  wall  of  thin  subjects  has  set  up  peritonitis 
by  contiguity  of  structures.  The  author  has  observed  instances  of 
this  kind,  and  analogous  cases  have  been  reported. 

In  chest-diseases — -pleuritis,  pneumonia,  pericarditis^  etc. — some 
form  of  counter-irritation  is  invariably  employed,  and  is  often  greatly 
abused.  At  the  onset  of  these  maladies  a  large  mustard-plaster  to  the 
chest,  allowed  merely  to  redden  the  skin,  is  an  excellent  expedient ; 
during  the  progress  of  the  inflammation  the  turpentine-stupe  is  gener- 
ally the  best  application  ;  to  assist  in  the  process  of  resolution  and  re- 
pair, the  more  permanent  action  of  a  blister  will  be  serviceable.  Much 
has  been  said  about  the  "  blistering-point "  in  pneumonia.  The  discus- 
sion is  resolvable  into  this  :  during  the  inflammatory  stage,  blisters  are 
harmful,  because  they  stimulate  the  nervous  and  vascular  systems,  and 
are  useful  when  the  crisis  occurs,  to  assist  in  the  liquefaction  and  ab- 
sorption of  inflammation  products.  At  the  very  inception  of  an  acute 
thoracic  disease  a  flying  blister  may  render  the  same  service  as  a  mus- 
tard-plaster, but  it  possesses  no  advantage  over  the  latter.  A  succes- 
sion of  "  flying  blisters  "  appears  to  be  useful  in  hydrothorax,  to  pro- 
mote absorption. 

Counter-irritants  are  much  abused  in  the  treatment  of  phthisis  at 
its  various  stages.  The  chest-pains  which  accompany  this  disease  can 
usually  be  relieved  by  mustard  and  belladonna  plasters.  Intercurrent 
attacks  of  pleuritis  and  pneumonia  may  be  treated  by  the  milder  forms 
of  irritation.  The  pustulation  of  the  chest  with  croton-oil  or  tartar- 
emetic  ointment  is  rarely  if  ever  justifiable,  and  deep  blistering  is  al- 
ways harmful. 

In  acute  inflammation  of  the  meninges,  cerebral  or  spinal,  blisters 
are  often  employed,  but  there  is  singularly  little  proof  of  their  utility. 
When  used,  they  should  be  confined  to  the  mastoid  processes  or  to 
the  nape  of  the  neck.  Under  no  circumstances  is  it  ever  justifiable  to 


EPISPASTICS.  807 

shave  and  blister  the  scalp,  as  was  formerly  not  unfrequently  done  in 
various  forms  of  cerebral  disease.  An  aura  proceeding  from  an  ex- 
tremity may  be  intercepted,  and  attacks  of  epilepsy  averted,  by  encir- 
cling the  limb  with  a  strip  of  blistering-plaster.  Various  instances  of 
the  success  of  such  a  blister  have  been  reported.  Hysterical  paraly- 
sis is  most  successfully  treated  by  encircling  the  affected  extremity 
with  narrow  blisters  (Reynolds),  and  hysterical  aphonia  may  some- 
times be  very  quickly  cured  by  a  blister  to  the  larynx.  The  curative 
effect  of  such  an  application  is  doubtless  due  to  the  moral  impression 
of  the  counter-irritant.  Blisters  over  the  course  of  the  affected  nerve 
are  of  great  service  in  neuritis.  The  good  effect  of  the  blisters  is  in- 
creased by  treating  the  blistered  surface  with  morphine.  There  can  be 
no  doubt  of  the  curative  value  of  blisters  in  neuralgias.  According  to 
Anstie,  it  is  not  the  mental  impression  produced  by  the  pain  of  the 
blister,  and  not  the  withdrawal  of  serum  from  the  focus  of  pain,  which 
explain  their  efficacy,  but  they  act  "  as  true  stimulants  of  nerve-func- 
tion." The  best  point  at  which  to  apply  the  blister  is  "  as  close  as  may 
be  to  the  intervertebral  foramen  from  which  the  painful  nerve  issues." 
Flying  blisters  are  to  be  preferred,  and,  as  a  rule,  exudation  of  serum 
is  not  to  be  encouraged. 

Lumbago,  myalgia,  and  fugitive  but  recurring  muscular  pains,  are 
sometimes  relieved  by  the  warming  plasters  given  at  the  head  of  this 
article,  or  by  frictions  with  ammonia-liniment,  turpentine-liniment,  etc. 

Blisters  are,  as  a  rule,  inadmissible  in  acute  affections  of  the  kid- 
neys and  bladder.  A  succession  of  blisters  to  the  perinseum  is  unques- 
tionably serviceable  in  chronic  prostatitis  and  in  gleet. 

Inflammatory  affections  of  the  eye  and  ear  are,  as  a  rule,  benefited 
by  the  application  of  blisters  in  the  neighborhood  of  these  organs. 

The  application  of  blisters  is  an  effective  method  of  treating  acute 
rheumatism.  According  to  the  plan  of  Davies  and  Dechilly,  the 
affected  joints  are  enveloped  in  blisters,  which  are  allowed  to  remain 
until  thorough  vesication  is  produced  and  serum  is  abundantly  dis- 
charged. The  author,  who  has  had  considerable  experience  in  the 
treatment  of  rheumatism  by  this  method,  finds  that  a  number  of  small 
blisters  applied  around  the  joint  are  as  effective  and  less  painful.  The 
good  effects  of  the  blister-treatment  are  these  :  the  pain  and  swelling 
are  abated,  the  danger  of  cardiac  complication  lessened,  and  the  dura- 
tion of  the  disease  shortened.  It  is  a  singular  fact  that  the  urine  be- 
comes neutral  or  alkaline  under  the  action  of  blisters.  The  curative 
effect  of  blisters  is  not,  probably,  to  be  ascribed  to  the  withdrawal  of 
acid  serum  from  the  affected  joints,  but  rather  to  an  influence  exerted 
through  the  trophic  nerves  on  the  metamorphosis  of  tissue. 

As  general  stimulants,  rubefacients  and  vesicants  are  employed  to- 
arouse  the  vital  processes  in  a  condition  of  great  depression  or  col- 
lapse from  any  cause,  e.  g.,  cholera,  pernicious  malarial  fever,  uraemia,, 
narcotic  poisoning,  etc. 


808  TOPICAL  REMEDIES. 

CONTRAINDICATIONS  OF  BLISTERS. — The  acute  stage  of  an  inflam* 
mat  ion  ;  pregnancy  ;  scorbutus  and  purpura  ;  infancy  ;  debility  ;  are 
conditions  rendering  their  use  improper  and  injurious. 

The  strangury  produced  by  blisters  is  lessened  by  the  free  use  of 
diluent  drinks,  and  is  relieved  when  it  occurs  by  an  enema  of  lauda- 
num or  the  hypodermatic  injection  of  a  minute  quantity  of  morphine. 
A  decoction  of  uva-ursi  freely  drunk  will,  it  is  said,  prevent  strangury, 
but  the  effect  of  this  remedy  is,  probably,  not  greater  than  that  of  an 
ordinary  diluent. 

The  method  of  "firing"  is  sometimes  very  beneficial  in  neuralgia, 
spinal  irritation,  myalgia,  etc.  The  effects  can  be  regulated  by  the 
temperature  of  the  hammer,  and  by  the  duration  of  the  contact  with 
the  skin,  and  may  vary  in  severity  from  the  mildest  rubefaction  to 
vesication,  and  even  destruction  of  the  skin. 

ACUPUNCTURE. — Needles  about  three  inches  in  length,  and  having 
a  red  wax,  hard-rubber,  or  metal  head,  are  employed  for  this  purpose. 
They  are  introduced  by  a  rapid  rotary  motion.  Insulated  needles  are 
used  in  the  same  way  for  conveying  the  galvanic  current  to  deeply- 
placed  nerves. 

BAUNSCHEIDTISMUS. — This  is  a  form  of  acupuncture,  so  named  from 
Baunscheidt,  its  inventor.  "  The  instrument  employed  consists  of  a 
heavy  disk,  about  half  an  inch  in  diameter,  having  inserted  into  it 
about  twenty-five  sharp  needles,  each  about  nine-sixteenths  of  an  inch 
in  length.  To  this  disk  a  strong  wire  spiral  spring  (five  and  a  half 
inches  in  length)  is  attached,  and  the  other  extremity  of  the  spring  is 
inserted  into  an  elongated  spindle-shaped  handle."  The  spring  and 
needles  are  contained  in  a  cylinder,  the  handle  attached.  The  follow- 
ing is  the  mode  of  using  it :  the  open  extremity  of  the  cylinder  is 
placed  firmly  on  the  skin  ;  the  handle  is  then  drawn  up,  which  com- 
presses the  spring  ;  now,  if  suddenly  loosed,  the  recoil  of  the  spring 
drives  the  needles  smartly  into  the  skin.  The  punctures  may  be  rubbed 
with  a  weak  mixture  of  croton-oil,  with  cajeput-oil,  or  other  suitable 
counter-irritant. 

ACTIONS  AND  USES. — These  are  methods  of  counter-irritation  which 
appear  to  possess  peculiar  powers.  The  theories  which  have  been  pro- 
posed to  explain  their  mode  of  action  are  far  from  satisfactory.  The 
method  of  Baunscheidt  is  that  of  an  ordinary  counter-irritant  added 
to  the  effects  of  acupuncture  ;  but  no  explanation  has  hitherto  been 
offered  which  accounts,  in  a  rational  manner,  for  the  curative  effects 
of  acupuncture  in  certain  maladies. 

In  tic-douloureux,  sciatica,  lumbago,  and  myalgia,  it  occasionally 
happens  that  remarkable  and  instantaneous  relief  is  obtained  by  the 
insertion  of  acupuncture-needles  deep  enough  to  reach  near  the  affected 
nerve. 

When  the  patient  is  timid,  the  sensibility  of  the  skin  may  be  dimin- 


EPISPASTICS.  809 

ished  by  the  application  of  chloroform  for  a  minute,  or  of  the  ether- 
spray  or  methyl  chloride.  If  rapidly  rotated  by  the  finger  and  thumb, 
the  needle  will  penetrate  with  little  suffering. 

AQUAPUisrcTURE. — The  method  of  aquapuncture  consists  in  the  in- 
troduction of  water  subcutaneously,  or  into  the  substance  of  muscles. 
A  special  instrument  has  been  invented  for  this  purpose,  the  advan- 
tage of  which  consists  in  its  being  armed  with  several  needles,  which 
permit  the  introduction  of  the  water  at  various  points  simultaneously. 
Ordinarily,  the  hypodermatic  syringe  will  suffice  for  the  performance 
of  this  little  operation,  and,  if  patients  object  to  repeated  punctures, 
the  sensibility  of  the  skin  may  be  obtunded  by  ether-spray. 

When  water  is  injected  under  the  skin,  more  or  less  pain,  accom- 
panied by  burning,  is  produced.  A  wheal  is  formed  about  the  site  of 
the  puncture,  and  redness  of  the  skin  and  elevation  of  the  temperature 
at  that  point  follow.  It  is  a  remarkable  circumstance  that  aquapunc- 
ture has  the  power  to  relieve  pain  in  a  superficial  nerve.  So  decided 
is  this  effect  that  there  are  physicians  who  hold  that  the  curative  effect 
of  the  hypodermatic  injection  of  morphine  is  due,  not  to  the  morphine, 
but  to  the  water  !  In  order  that  aquapuncture  shall  relieve  pain,  it  is 
necessary  that  the  water  be  injected  into  the  neighborhood  of  the  pain- 
ful nerve.  Injection  at  a  remote  and  indifferent  point  would  certainly 
fail  of  any  effect  except  that  reflex  effect  which  is  produced  by  any 
counter-irritant.  Aquapuncture,  however,  has  unquestionable  power 
as  a  counter-irritant. 

The  method  of  aquapuncture  has  been  employed  with  success, 
which  must  be  regarded  as  extraordinary,  in  neuralgice,  facial,  sciatic, 
and  lumbo-abdominal ;  in  lumbago,  irritability  of  the  bladder,  uterine 
colic,  gastralgia,  etc.  The  author  has  produced  excellent  effects  from 
the  injection  of  water  into  paralyzed  and  wasting  muscles.  It  promotes 
the  nutrition  of  muscles,  and  contributes  to  the  regeneration  of  volun- 
tary power.  In  the  various  cases  to  which  this  treatment  is  appli- 
cable, the  quantity  which  should  be  injected  will  vary  from  thirty 
minims  to  a  drachm.  When  the  first  injection  does  not  relieve  in  two 
minutes,  another  should  be  practiced.  It  is  insisted  upon  (Lafitte)  that 
the  water  be  injected  at  the  painful  points  (points  douloureux).  There 
need  be  no  limit  to  the  number  of  the  injections,  if  they  afford  relief ; 
for,  of  course,  no  injury  will  result,  unless  it  be  the  production  of  an 
abscess  at  the  site  of  the  injections,  which  is  very  rare. 

Authorities  referred  to  : 

ANSTIE,  DR.  F.  E.  On  Neuralgia  and  the  Diseases  that  resemble  it,  London  and  New 
York,  1871,  p.  192,  et  seq. 

IBIDEM.     TJie  Practitioner.      On  the  Theory  of  Counter-Irritation,  vol.  iv,  p.  156. 

BENNETT,  DR.  JAMES  RISDON.  Remarks  on  Counter-Irritation.  The  Practitioner,  voL 
ii,  p.  321. 

DATIES,  DR.  HERBERT.     The  Lancet,  vol.  ii,  1865. 


810  TOPICAL   REMEDIES. 

DICKINSON,  DR.  W.  H.  On  the  Practice  of  Counter-Irritation.  The  Practitioner,  voL 
iii,  p.  97. 

DIEULAFOT,  DR.  GEORGES.     Nouv.  Diet,  de  Med.  et  de  Chirurg.  Prat.,  article  Douleur. 

LAFITTE,  DR.  LEOPOLD.     L'1  Union  Medicate,  October  5,  1875. 

DELUT,  DR.     Ibid. 

Ross,  DR.  JAMES.     On  Counter-Irritation.     The  Practitioner,  vol.  iv,  p.  73. 

SEBVAJAN,  JOANNES.     De  rAquapuncture,  Paris,  1872,  p.  56. 

Jequirety. — Seed  of  Abrus  precatorius  of  the  Natural  Order  Legu- 
fninosce. 

DESCRIPTION. — The  name  jequirety  is  a  local  designation,  used  by 
the  rude  peoples  of  Brazil  to  indicate  its  action  in  some  forms  of  eye- 
diseases.  The  seeds — the  part  employed  for  topical  purpose — are  of 
a  bright-scarlet  color,  very  hard,  ovoid  in  shape,  and  have  a  hilum 
surrounded  by  a  black  border. 

There  are  differences  of  opinion  as  to  the  source  of  the  pathogenic 
local  action  possessed  by  jequirety.  It  contains  a  bitter  principle — 
abrin — a  large  proportion  of  vegetable  albumin,  and  a  ferment.  An 
infusion,  prepared  at  a  proper  temperature  (below  60°  C.),  in  a  few 
hours  is  found  to  contain  a  vast  number  of  microbes  in  active  de- 
velopment, the  albumin  of  the  seeds  being  a  soil  peculiarly  fitted  for 
their  sustenance  and  growth. 

The  infusion  is  the  preparation  used.  The  formula  proposed  by 
De  Wecker  is  the  following  : 

Thirty-two  grains  of  jequirety  are  well  pulverized  and  thoroughly 
triturated  with  two  ounces  of  cold  water.     The  mixture  is  allowed  to« 
macerate  for  twenty-four  hours.     Two  ounces  of  warm  water  is  then 
added,  and  the  infusion  filtered  immediately  on  cooling.     With  this 
the  part  to  be  acted  on  is  washed  three  times  a  day. 

De  Wecker  also  proposes  a  solution  somewhat  stronger  than  the 
foregoing  :  One  hundred  and  fifty  grains  of  the  seeds  (decorticated) 
are  macerated  for  twenty-four  hours  in  two  ounces  of  cold  water,  and 
filtered.  This,  or  the  infusion  given  above,  is  applied  to  the  eyelids 
for  fifteen  to  thirty  minutes,  and  a  little  is  allowed  to  penetrate  through 
the  lids  to  the  conjunctiva.  The  applications  are  kept  up  for  three 
days,  as  a  rule.  This  period  is  the  "  incubation  period  "  of  Sattler. 
As  respects  the  pathogenic  activity  of  the  solutions,  they  differ  some- 
what according  to  their  strength,  but  more  according  to  their  age. 
Deneffe,  of  Brussels,  and  Sattler  (De  Wecker's  assistant),  have  de- 
scribed minutely,  and,  as  our  observations  go,  accurately,  the  process 
of  inflammation  resulting. 

The  application  of  the  infusion  to  the  eyes  is  free  from  pain,  and 
it  is  not  until  the  incubation  period  (three  hours)  has  passed  that  the 
characteristic  inflammation  begins.  Slowly  at  first,  but  then  more 
rapidly,  an  acute,  suppurative,  and  membranous  inflammation  develops, 
the  lids  are  tumefied,  glued  together,  and  the  conjunctiva  coated  with 


JEQUIRETY.  811 

a  yellowish- white  croupous  membrane,  which  reaches  its  maximum  in 
twenty-four  hours,  continues  at  that  point  for  the  same  period,  and 
then  slowly  subsides,  the  last  trace  disappearing  in  four  to  six  days. 
During  the  greatest  height  of  the  inflammation  there  is  fever,  some- 
times as  high  as  104°  Fahr. 

The  infective  activity  of  a  solution  of  jequirety  is  the  greater  the 
longer  it  is  macerated — within  suitable  limits — and  hence,  by  this 
expedient,  solutions  can  be  prepared  to  be  adapted  to  all  the  varying 
conditions  of  disease.  The  strength  most  used  is  from  0'5  to  1  per 
cent. 

A  final  decision  has  not  been  reached  as  to  the  constituent  setting 
up  the  peculiar  inflammation.  Sattler,  who  discovered  the  ferment 
action  and  the  formation  of  microbes,  referred  the  inflammation  to  the 
pullulation  of  these  organisms.  Klein  has  proved,  as  he  supposes,  that 
the  microbes  do  not  have  this  pathogenic  power.  In  turn,  abrin  has 
been,  and  has  not  been,  considered  the  agent.  Recent  observations  by 
Robert  indicate  that  abrin  is  the  active  agent  in  setting  up  the  charac- 
teristic destructive  inflammation.  Abrin  is  so  powerful  an  irritant, 
that  if  brought  in  contact  with  the  mucous  membrane  or  any  wounded 
surface  it  causes  violent  reaction,  and  must  therefore  be  handled  with 
care. 

ACTIONS  AXD  USES. — To  apply  a  suggestive  term  to  the  action,  je- 
quirety sets  up  a  substitutive  inflammation  to  take  the  place  of  the 
existing  morbid  process.  To  what  end  ?  It  is  only  the  papillary 
granulations  of  the  eye  that  are  cured  by  jequirety.  True  granula- 
tions— trachoma — remain  unchanged  after  the  jequirety  inflammation 
has  passed.  According  to  Deneffe,  it  is  absolutely  useless  in  the  treat- 
ment of  pannus.  There  are,  however,  ophthalmologists  of  high  char- 
acter who  find  jequirety  very  useful  in  these  cases,  and  who  explain 
failures  by  asserting  that  sufficient  time  was  not  given,  and  that  per. 
severing  applications,  extending  over  many  months,  are  necessary  in 
obstinate  cases  (Soloveitchik,  Smirnoff,  Tangeman,  and  others). 

Jequirety  has  been  successfully  used  in  the  treatment  of  fungous 
granulation  of  the  external  auditory  canal.  Chronic  metritis  of  a 
severe  type  has  been  successfully  treated,  and  skin-diseases,  of  hy- 
pertrophic  character,  resisting  all  other  agencies,  have  been  cured 
by  painstaking  applications.  Lupus  and  epithelioma,  especially  the 
latter,  old  ulcers  with  thickened  margins  and  sluggish  in  character, 
are  quickly  changed  in  condition,  and,  if  curable  at  all,  are  disposed 
for  healing. 

The  author  must  couple  some  cautions  with  these  recommendations 
of  jequirety.  The  subcutaneous  injection  of  the  microbe-laden  in- 
fusion causes  such  general  destructive  changes  in  cold-blooded  ani- 
mals, and  so  much  local  mischief  in  mammals,  that  it  should  be  prac- 
ticed in  man  with  great  caution,  if  at  all. 


812  TOPK3AL   REMEDIES. 

Authorities  referred  to  : 

BORDE,  DR.  L.     Bui.  Gen.  de  Therap.  for  1884. 
CORNIL  ET  BERLIOZ,  MM.     Journal  de  Therapeutigue,  1883,  p.  814. 
DENEFFE,  DR.     Ibid.,  p.  521,  et  seq. 

SATTLER,  DR.,  AND  DE  WECKER,  DR.  Semaine  Medicale  in  Annuaire  de  Therap.  for 
1884. 

SOLOVEITCHIK  AND  SMIRNOFF,  DRS.     London  Medical  Record  of  March  15,  1886. 

BLOODLETTING. 

Venesection,  arteriotomy,  cupping,  leeching. — The  manner  of  bleed- 
ing, whether  by  opening  a  vein  or  an  artery,  is  a  surgical  subject,  which 
it  is  not  necessary  to  consider  in  this  work. 

PHYSIOLOGICAL  ACTIOXS. — Bloodletting  may  be  employed  for  a 
systemic  or  local  effect.  Bleeding  from  a  vein  or  an  artery,  by  dimin- 
ishing the  whole  quantity  of  the  circulating  fluid,  and  by  altering  its 
quality,  affects  the  functions  of  every  organ,  and  especially  of  organs 
the  seat  of  an  acute  hypersemia.  Cupping  and  leeching,  if  carried  far 
enough,  may  diminish  the  general  blood-pressure  and  the  proportion  of 
the  morphotic  elements  ;  but  their  action  is  largely  local  and  revulsive. 

The  effects  of  bloodletting  on  the  composition  of  the  blood  are 
these  :  the  water  is  increased  and  the  globules,  fibrin,  and  salts  are 
diminished  in  relative  amount ;  an  artificial  anaemia  is  thus  induced. 
The  action  of  the  heart  becomes  more  rapid  and  its  force  lessened  ; 
the  arterial  tension  falls,  and  the  pulse  assumes  the  dicrotic  character. 
The  functions  of  organs,  especially  of  the  brain  and  nervous  system, 
lose  energy.  Nausea,  vomiting,  faintness,  syncope,  and  epileptoid  seiz- 
ures occur,  when  the  loss  of  blood  is  considerable.  Epileptiform  con- 
vulsions is  a  constant  phenomenon  in  animals  bled  to  death  (Kussmaul 
and  Tenner). 

When  the  quantity  of  fluid  in  the  vessels  is  lessened  by  bleeding, 
thirst  is  experienced,  and  absorption  is  more  rapid  ;  the  sensibility  to 
pain  is  diminished,  probably,  because  the  perceptive  centers  are  func- 
tionally inactive  ;  and.  the  power  to  evolve  force,  muscular,  digestive, 
nervous,  etc.,  is  greatly  restricted.  Only  one  function,  therefore,  is 
rendered  more  active  by  bleeding  ;  all  the  others  are  depressed  in  con- 
sequence of  the  inadequate  supply  of  nutrient  material. 

It  is  a  remarkable  fact,  perfectly  well  known  to  old  practitioners, 
and  to  which  Sir  James  Paget  has  recently  called  attention,  that  the 
ill  effects  of  bleeding,  in  healthy  subjects,  are  very  temporary  and 
easily  repaired.  The  blood-globules,  which  are  relatively  more  affected 
by  bleeding  than  the  other  constituents,  are  quickly  reproduced,  and 
the  functions  of  organs  suddenly  very  much  depressed  soon  recover 
their  normal  energy.  That  any  permanent  injury  is  done  to  the 
healthy  human  system  by  a  moderate  bleeding  seems,  therefore,  to  be 
highly  improbable. 


BLOODLETTING.  813 

THERAPY. — The  limits  of  this  work  will  not  permit  the  introduc- 
tion of  any  controversial  discussions.  The  author  is  to  be  ranked  with 
those  who  do  not  employ  general  bloodletting,  but  he  does  not  deny 
that  it  is  occasionally  useful ;  and  that,  indeed,  it  may  be  indispensa- 
ble. A  summary  of  the  physical  conditions  in  which  venesection  may 
be  useful  or  indispensable  should  not,  therefore,  be  omitted  from  a 
work  on  therapeutics. 

The  therapeutical  effect  of  a  general  bloodletting  in  congestion  and 
inflammation  is  largely  mechanical.  In  acute  congestion  of  the  lungs, 
when  aeration  of  the  blood  is  seriously  impeded  ;  when  there  are  ex- 
tensive stasis  on  the  venous  side,  and  ischaemia  on  the  arterial  side  of 
the  systemic  circulation,  great  relief  may  be  afforded  by  the  abstrac- 
tion of  from  four  to  sixteen  ounces  of  blood.  In  the  apoplectiform 
variety  of  acute  cerebral  congestion,  damage  to  the  brain  may  be  pre- 
vented by  letting  blood.  The  effect  of  the  bleeding  is  to  dimmish  the 
intra-cranial  pressure,  and  thus  relieve  the  strain  on  the  cerebral  ves- 
sels. In  eclampsia,  especially  of  the  puerperal  variety,  accompanied 
with  the  evidences  of  cerebral  congestion,  great  relief  may  be  procured 
by  the  timely  abstraction  of  blood.  The  quantity  of  blood  to  be  taken 
will  depend  in  part  on  the  character  of  the  subject  and  on  the  amount 
of  congestion. 

The  mechanical  effect  of  the  withdrawal  of  blood  from  the  systemic 
circulation  may  be  most  advantageous  in  cases  of  sudden  over-disten- 
tion  of  the  right  cavities  of  the  heart. 

Pulmonary  haemorrhage,  when  dependent  on  acute  congestion  of 
the  lungs,  the  general  condition  being  one  of  plethora,  may  be  promptly 
arrested  by  opening  a  vein  in  the  arm. 

The  pain  of  acute  pleuritis,  and  acute  peritonitis,  can  be  quickly 
relieved  by  bloodletting. 

Although  it  is  undeniable  that  the  important  results  above  men- 
tioned may  be  obtained  from  general  bleeding,  it  is  equally  certain  that 
as  good  results  in  most  of  the  conditions  may  be  had  by  other  methods. 
Acute  diseases  make  such  serious  demands  on  the  vital  resources  of  pa- 
tients, that  the  practitioner  should  seriously  ponder  the  propriety  of 
taking  blood  even  in  those  cases  to  the  relief  of  which  it  may  seem  to 
be  adapted.  Large  bleedings,  experience  has  abundantly  shown,  ren- 
der the  convalescence  from  acute  diseases  tedious — for  the  patient 
has  to  make  up  the  losses  by  venesection  as  well  as  the  ravages  of  the 
disease. 

BLEEDING  BY  CUPS  AND  LEECHES. — A  large  number  of  cups  and 
leeches  may  produce  the  systemic  effects  of  a  general  bleeding.  But, 
as  a  rule,  these  applications  are  intended  to  withdraw  blood  from  the 
affected  part,  and  thus  act  in  the  manner  entitled  revulsive.  The  local 
irritation  caused  by  cups  and  leeches  must,  through  the  agency  of  the 
nervous  system,  affect  distant  parts  in  the  same  manner  as  other  coun- 
ter-irritants. 


814  TOPICAL   REMEDIES. 

Leeches  are  preferable  to  cups  when  the  parts  are  very  sensitive  or 
inaccessible.  The  quantity  of  blood  drawn  can  be  more  accurately 
measured  when  cups  are  used.  The  counter-irritant  effects  are  much 
more  pronounced  from  cups  than  from  leeches. 

The  amount  of  blood  drawn  by  a  leech  will  depend  on  its  size,  and 
the  subsequent  loss  of  blood,  when  the  bleeding  is  encouraged,  is  de- 
termined by  the  vascularity  of  the  part.  As  a  general  rule  it  may  be 
stated  that  a  leech  will  draw  about  four  times  its  own  weight — about 
one  to  two  drachms.  To  obtain  from  any  given  patient  four  ounces 
of  blood,  one  ounce  of  leeches  must  be  applied. 

In  acute  gastric,  enteric,  and  peritoneal  inflammations,  if  the  patient 
be  plethoric,  and  there  is  decided  sthenic  reaction,  leeches  to  the  abdo- 
men are  very  serviceable.  The  number  to  be  applied  will  always  de- 
pend on  the  effect  to  be  produced,  employing  the  rules  given  above  as 
the  basis  of  the  estimate.  In  typhlitis  and  perityphlitis,  the  author 
has  seen  such  good  results  produced  by  leeches,  that  he  holds  they 
should  never  be  omitted  when  the  tenderness  and  fever  begin.  In 
acute  hepatitis  and  congestion  of  the  liver,  and  in  acute  dysentery,  the 
best  results  are  obtained  by  the  application  of  leeches  to  the  margin  of 
the  anus.  Haemorrhoids  that  are  swollen,  painful,  and  irreducible 
without  great  suffering,  are  much  relieved  by  the  application  of  leeches 
directly  to  them.  Pruritus  of  the  anus,  when  due  to  engorgement  of 
the  portal  circulation,  and  accompanied  by  heat  of  the  anal  region, 
may  sometimes  be  cured  by  leeching  the  parts  affected. 

Acute  desquamative  nephritis,  pyelitis,  and  congestion  of  the  kid- 
neys, are  ameliorated  by  the  application  of  cups  to  the  lumbar  region. 

The  following  acute  affections  of  the  respiratory  organs,  when  they 
occur  in  robust  persons,  and  are  accompanied  by  sthenic  reaction,  are 
favorably  influenced  in  their  course  and  duration  by  the  application  of 
cups  or  leeches — usually  the  former  :  pleuritis,  pericarditis,  acute  ton- 
sillitis, acute  laryngitis,  and  inflammatory  croup. 

In  acute  inflammations  of  the  uterus  and  its  appendages,  decisively 
good  results  are  obtained  by  the  application  of  leeches  to  the  hypogas- 
tric  region,  to  the  iliac  fossae,  or  to  the  uterus. 

Cupping  the  nape  of  the  neck,  or  leeches  to  the  mastoid  process,  are 
probably  of  service  in  acute  congestion  or  inflammation  of  the  intra- 
cranial  structures  ;  but  the  indiscriminate  employment  of  bloodletting 
in  any  case  of  cerebral  disease  is  to  be  condemned.  The  correct  rule 
may  be  formulated  as  follows  :  When  bloodletting  is  indicated  in  in- 
tracranial  maladies,  venesection  or  arteriotomy  (temporal  artery)  is  to 
be  preferred  to  the  use  of  cups  or  leeches. 

Although  good  results  are  obtained  by  the  local  abstraction  of  blood 
in  the  diseases  above  mentioned,  the  author  must  express  his  convic- 
tion that  the  chief  utility  of  cupping  and  leeching  consists  not  in  the 
blood  withdrawn,  but  in  the  derivant  and  counter-irritant  effect  which 


ESCHAROTICS.  815 

they  produce.  Dry  cups,  a  mustard-plaster,  a  turpentine-stupe,  or 
other  counter-irritant  application,  may  render  the  painful  process  of 
cupping  or  leeching  unnecessary. 

ESCHAROTICS. 

The  substances  belonging  to  this  group  are  employed  for  the  pur- 
pose of  destroying  the  tissues  to  which  they  are  applied.  They  differ 
in  their  mode  of  action,  in  the  extent  of  the  destruction  which  they 
effect,  in  their  capacity  for  diffusion  into  the  blood,  and  in  the  results 
which  they  severally  accomplish. 

They  are  prescribed  for  the  purpose  of  cauterizing  poisoned  wounds 
— syphilitic  ulcers,  snake-bites,  the  bites  of  rabid  animals — for  the  re- 
moval of  gangrenous  parts,  foul  or  exuberant  granulations,  and  espe- 
cially for  the  destruction  of  malignant  growths.  When  the  diseased 
parts,  to  the  destruction  of  which  they  are  devoted,  have  been  fully 
acted  upon,  the  caustic  action  is  ended  ;  poultices  are  applied  to  favor 
the  entire  separation  of  the  sloughs,  and  a  healthy  surface  is  finally 
left  to  heal  by  granulations. 

The  members  of  this  group  have,  with  one  exception,  been  dis- 
cussed elsewhere  : 

The  mineral  acids. 

The  chloride  and  sulphate  of  zinc. 

Potassa  fusa  and  potassa  cum  calce. 

Arsenious  acid. 

The  acid  nitrate  of  mercury. 

Bromine. 

Acidum  Chromicum.  —  Chromic  acid.  In  deep-red,  needle-form 
crystals,  deliquescent,  and  very  soluble  in  water,  forming  an  orange- 
red  solution. 

ACTIONS  AND  USES. — Chromic  acid  is  an  oxidizing  caustic.  When 
the  action  ceases,  sesquioxide  of  chromium  remains.  It  is  slow  in  ac- 
tion, and  not  very  painful,  but  it  penetrates  deeply  and  is  remarkably 
destructive.  Small  animals,  as  mice  and  birds,  are  dissolved  entirely, 
bones  and  all,  by  chromic  acid.  Owing  to  the  fact  that  it  penetrates 
deeply  without  much  pain,  care  must  be  used  in  its  application  as  a 
caustic,  lest  it  injure  parts  which  are  not  intended  to  be  affected. 
When  it  is  applied  as  a  caustic,  the  surrounding  tissues  must  be  well 
protected.  For  the  destruction  of  malignant  growths,  hcemorrhoids, 
warts,  etc.,  the  acid  should  be  made  into  a  paste  by  the  addition  of 
sufficient  water.  The  part  to  which  it  is  applied  first  becomes  yellow, 
then  brownish,  and  ultimately  black,  and  the  eschar  is  detached  in 
from  twenty-four  to  forty-eight  hours. 

A  solution  of  chromic  acid  of  the  strength  of  one  hundred  grains  to 
an  ounce  of  distilled  water  is  an  efficient  local  application  in  syphilitic 
54 


816  TOPICAL   REMEDIES. 

warts  and  vegetations,  condylomata,  lupus,  sycosis,  tinea  tonsurans^ 
etc.  A  still  stronger  solution  (grs.  xv  —  3  j  of  hot  water)  has  been  in* 
jected  into  the  uterine  cavity  with  success  in  cases  of  uterine  haemor- 
rhage and  uterine  catarrh  (Wooster). 

Authorities  referred  to  : 

BUSCH,  DR.  F.     Annuaire  de  Therapeutique,  vol.  xxiv,  p.  229. 

HELLER,  DR.     Ibidem,  1853,  p.  283. 

MARSHALL,  JO^N.     The  Lancet,  1857,  vol.  i,  p.  88. 

WOOSTER,  DR.     The  American  Journal  of  the  Medical  Sciences,  1869,  p.  36  Y. 

EMOLLIENTS,   DEMULCENTS,   AND  PROTECTIVE  AGENTS. 

Glycerinum. — Glycerin.  A  colorless,  inodorous,  sirupy  liquid,  of  a 
sweet  taste,  and  having  the  specific  gravity  of  1'25.  It  is  soluble  in 
water  and  in  alcohol,  but  not  in  ether. 

Suppositoria  Glycerini. — Suppositories  of  glycerin.  (Glycerin,  60 
grm.;  sodium  carbonate,  3  grin.;  stearic  acid,  5  grm.  To  make  ten 
rectal  suppositories.) 

Glyceritum  Vitetti. — Glyconin.  An  emulsion  of  glycerin  and  the 
yelk  of  eggs — 45  grm.  of  the  yelks  and  55  grm.  of  glycerin.  (U.  S.  P.) 

Glycerin- Cream. — (Glycerin,  1;  soft  soap,  1;  cherry -laurel  water, 
1.)  (Squire.) 

Glycerin- Cream  with  Camphor. — (Glycerin,  2;  camphor,  1;  recti- 
fied spirit,  1.)  (Squire.) 

Glyceritum  Amyli. — Glycerite  of  starch.     (Starch,  10  grm.;  gly-, 
cerin,  80  grm.;  water,  10  c.  c.) 

PROPERTIES. — Exposed  to  the  air,  glycerin  slowly  absorbs  moist- 
ure, but  it  does  not  evaporate,  and  it  does  not  become  rancid  or  under- 
go fermentation  spontaneously.  It  is  unctuous  to  the  touch,  and  is 
obstinately  sticky.  Glycerin  possesses  remarkable  solvent  powers. 
One  part  of  iodine  and  one  of  iodide  of  potassium  dissolve  in  two  parts 
of  glycerin.  Bromine,  the  iodide  of  sulphur,  the  chlorides  of  potas- 
sium and  sodium,  the  alkalies,  some  of  the  alkaline  earths,  many  of  the 
neutral  salts,  the  vegetable  acids,  especially  tannic,  most  of  the  alka- 
loids (morphine,  quinine,  strychnine,  veratrine,  and  atropine),  and  car- 
bolic acid,  are  soluble  in  glycerin.  The  fatty  acids,  cocoa-butter, 
camphor,  chloroform,  calomel,  iodide  of  lead,  and  the  resins,  do  not 
dissolve  in  glycerin. 

The  antiseptic  property  of  glycerin  is  decided.  Vaccine  lymph 
may  be  preserved  unchanged  almost  indefinitely  when  stored  up  in 
pure  glycerin  ;  and  anatomical  preparations,  and  specimens  of  natural 
history,  are  kept  in  preservative  solutions  consisting  chiefly  of  this 
substance.  Microscopical  and  pathological  specimens  are  after  a  time 
softened  and  disintegrated  by  pure  glycerin. 

Applied  to  the  tissues  of  the  body,  glycerin,  if  pure,  is  perfectly 


EMOLLIENTS.  817 

bland  and  unirritating,  as  a  rule,  but  in  some  subjects  severe  smarting 
is  produced  on  contact  of  the  purest  glycerin  with  the  mucous  mem- 
brane. When  it  contains  the  fatty  acids,  oxalic  or  formic  acids,  it 
possesses  very  positive  irritant  qualities.  It  abstracts  water  from  the 
tissues. 

THERAPY. — No  systemic  effects  are  produced  by  the  stomach  ad- 
ministration of  glycerin.  It  is  an  efficient  remedy  in  acidity,  pyrosis, 
and  flatulence,  in  the  dose  of  a  drachm,  before,  with,  or  after  meals. 

Glycerin  has  been  proposed  and  used  as  a  substitute  for  cod-liver 
oil,  in  the  various  cachectic  states  in  which  the  latter  is  prescribed.  It 
has  been  conclusively  shown  that  it  is  inferior  to  cod-liver  oil  in  every 
respect.  As  a  vehicle  for  the  administration  of  cod-liver  oil,  it  is 
extremely  serviceable  (glyconin,  a  teaspoonful  ;  cod-liver  oil,  a  tea- 
spoonful  ;  tincture  of  cinnamon,  ten  drops). 

Good  results  have  been  reported  from  the  use  of  glycerin  in  dia- 
betes, but  the  data  are  as  yet  insufficient  to  enable  a  correct  estimate  of 
its  real  value  to  be  made.  The  internal  administration  of  glycerin 
has  been  resorted  to  for  the  removal  of  acne  with  success.  It  is 
said  to  destroy  intestinal  trichina,  and  may  be  given  freely  in  trichi- 
nosis. 

The  most  important  applications  of  glycerin,  besides  its  numerous 
uses  as  a  vehicle,  are  topical  as  an  emollient.  Applied  to  the  affected 
mucous  membrane  by  means  of  a  camel's-hair  pencil,  pure  glycerin 
affords  great  relief  in  acute  coryza.  Chronic  follicular  pharyngitis, 
accompanied  with  profuse  secretion,  is  generally  improved  by  the  same 
application,  but  the  addition  of  tannic  acid  greatly  enhances  its  cura- 
tive power  in  this  affection.  A  solution  of  morphine  in  glycerin,  ap- 
plied to  the  fauces  with  a  brush,  relieves  the  cough  of  phthisis.  A 
better  application  in  many  respects  is  a  mixture  of  glycerin,  crystal- 
lized sugar,  and  whisky.  This  mixture,  allowed  to  trickle  slowly  down 
the  fauces,  allays  irritability  and  keeps  the  mucous  membrane  moist 
(glycerin,  two  parts  ;  whisky,  one  part ;  crystallized  sugar,  a  suffi- 
ciency). 

An  enema  of  glycerin  and  infusion  of  flaxseed  (one  to  four)  allays 
the  tenesmus  in  cases  of  acute  dysentery. 

For  chapped  hands  or  face,  glyconin  is  an  excellent  application. 
In  seborrhoea,  glycerin-cream  gives  good  results.  For  fissures  of  the 
nipple,  Stille  strongly  recommends  a  u  liniment  made  by  adding  one 
part  of  tincture  of  benzoin  to  six  or  eight  of  glycerin,  and  filtering 
the  mixture." 

In  pityriasis  and  in  the  papular  eruptions,  glycerin  is  serviceable, 
but,  in  general,  it  may  be  stated  that  its  use  in  skin-diseases  is  disap- 
pointing, and  that  it  is  inferior  as  a  local  application  to  the  usual  oils 
and  fats  employed  in  this  way. 

Glycerin  has  been  used  as  a  dressing  for  wounds  and  ulcerated 


818  TOPICAL   REMEDIES. 

surfaces,  with  more  or  less  advantage.  It  is  largely  prescribed  by 
gynecologists  as  a  topical  application  to  erosions  and  ulcerations  of 
the  cervix  uteri,  and  for  the  relief  of  vaginal  leucorrhoea. 

The  glycerite  of  starch  (plasma)  is  an  excellent  vehicle  for  the  ap- 
plication of  astringents  to  the  eye,  and  is  much  employed  by  ophthal- 
mologists for  this  purpose.  Glycerin  is  used  by  otologists  to  soften 
cerumen,  to  entangle  insects  which  have  entered  the  ear,  to  diminish 
the  secretion  of  pus,  and  to  relieve  the  morbid  state  of  the  auditory 
canal  in  cases  of  otorrhcea. 

Collodium. — Collodion.  Is  a  slightly  opalescent  liquid,  of  a  sirupy 
consistence.  By  long  standing  it  deposits  a  layer  of  fibrous  matter, 
and  becomes  more  transparent.  This  layer  should  be  reincorporated, 
by  agitation,  before  the  collodion  is  used.  When  applied,  it  should 
form  a  colorless,  transparent,  flexible,  and  strongly  contractile  film. 

Collodium  Flexile. — Flexible  collodion.  (Collodion,  920  grm.; 
Canada  turpentine,  50  grm.;  castor-oil,  30  grm.) 

Liquor  Gutta-Perchae. — Solution  of  gutta-percha.  (Gutta-percha, 
nine  parts  ;  carbonate  of  lead,  ten  parts  ;  commercial  chloroform, 
ninety-one  parts.) 

ACTIONS  AND  USES. — These  solutions,  when  applied  to  the  integu- 
ment, evaporate,  leaving  a  transparent  film  or  coating  impervious  to 
air  and  moisture.  In  drying,  collodion  contracts  energetically,  and 
may  indeed  produce  such  a  degree  of  constriction  as  to  cause  pain,  » 
and  to  render  the  part  bloodless.  Flexible  collodion  contains  turpen- 
tine and  castor-oil,  which  confer  the  property  of  flexibility,  while  they 
do  not  impair  the  impermeability  of  the  film.  The  solution  of  gutta- 
percha  has  properties  similar  to  flexible  collodion. 

These  solutions  are  employed  to  protect  exposed  parts  from  the 
contact  of  air,  to  secure  primary  union  of  incised  wounds,  to  cause 
resolution  of  inflamed  parts  by  mechanical  pressure,  etc. 

Some  cases  of  chronic  tubercular  and  squamous  skin-diseases  are 
much  improved  by  coating  them  with  the  gutta-percha  solution.  Pre- 
vious to  the  application  of  the  solution  all  scales  should  be  removed. 
Excellent  results  have  been  obtained  in  herpes  zoster  by  a  thick  coating 
of  the  flexible  collodion  or  the  gutta-percha  solution  :  the  pain  is  re- 
lieved, the  vesicles  aborted,  and  the  duration  of  the  disease  shortened. 
As  this  is  a  self -limited  disease,  there  must  remain  a  suspicion  of  post 
hoc  rather  than  propter  hoc.  Erysipelas,  especially  of  the  traumatic 
variety,  is,  at  least,  much  relieved  as  regards  the  local  symptoms  by  a 
thick  coating  of  flexible  collodion,  but  there  is  no  evidence  that  it  actu- 
ally shortens  the  duration  of  the  disease.  Burns  to  the  first  degree 
are  gpeatly  benefited  by  the  same  application  ;  it  prevents  contact  of 
the  air,  and  allays  the  irritation  and  pain.  When,  however,  there  is 


DEMULCENTS.  819 

much  exudation,  or  sloughing  takes  place,  an  impermeable  coating 
adds  to  the  distress. 

Collodion  has  been  used  without  much  success  in  small-pox,  to  hin- 
der the  development  of  the  pustules.  Small  boils,  carbuncles,  ncevi, 
and  even  superficially  placed  aneurisms,  may  be  so  compressed  as  to 
arrest  the  local  inflammation  or  to  cause  coagulation  of  the  T^lood. 
Orchitis  may  be  treated  by  a  coating  of  collodion,  instead  of  strapping. 
When  the  mechanical  effects  of  the  collodion  are  to  be  obtained,  suc- 
cessive layers  must  be  applied. 

Fissures  of  the  nipples  are  best  treated  by  flexible  collodion  or  gutta- 
percha  solution.  The  fissures  are  carefully  wiped  dry,  well  approxi- 
mated, and  then  thoroughly  coated.  Nipples  that  are  retracted  may 
be  made  more  prominent  by  surrounding  them,  after  being  well  drawn 
out,  with  a  thick  layer  of  collodion  so  placed  that  on  contracting  it  will 
pucker  the  skin  of  the  areola. 

Collodion  has  been  used  with  success  as  a  means  of  compression  in 
umbilical  hernia,  spina-bifida,  varicocele,  etc. 

Chondrus. —  Chondrus  crispus.     Irish  moss. 

Cetraria. —  Cetraria  Islandica.     Iceland  moss. 

Decoctum  Cetrarice. — Decoction  of  Iceland  moss. 

COMPOSITION. — The  principal  constituent  of  chondrus  is  a  mucilage, 
which,  when  dry,  is  horny,  but  swells  up  in  water,  forming  a  jelly. 
Cetraria  contains  about  seventy  per  cent  of  a  starch  (lichen-starch),  a 
decoction  of  which  gelatinizes  on  cooling.  In  addition  to  this  starch 
cetraria  contains  a  bitter  principle  (cetrarin),  and  a  peculiar  acid  (lich- 
eno-stearic  acid). 

These  lichens  are  used  only  for  the  production  of  diets  for  the  sick. 
They  were  formerly  supposed  to  possess  some  peculiar  virtues  which 
rendered  them  serviceable  to  pulmonary  invalids.  As  articles  of  food, 
they  have  a  very  low  position  as  regards  nutritive  value.  The  decoc- 
tion of  cetraria  may  be  used  as  a  stomachic  tonic,  containing  as  it  does 
a  bitter  principle  ;  but  it  is  only  to  be  prescribed  when  the  more  effi- 
cient remedies  are  not  well  borne. 

Chondrus  may  be  made  into  jelly  or  blanc  mange,  in  the  same  way 
as  gelatin  is  now  prepared  for  this  purpose.  Neligan  gives  the  fol- 
lowing recipe  for  the  preparation  of  a  jelly  from  chondrus  :  Chondrus, 
washed  and  macerated,  thirty  grains  ;  spring-water,  a  pint  ;  boil  down 
to  one  half  and  strain  with  expression,  and  add  to  the  strained  liquor 
four  ounces  of  white  sugar,  one  ounce  of  gum-acacia,  and  thirty  grains 
of  powdered  orris-root  ;  heat  to  dryness  with  a  gentle  temperature, 
stirring  constantly  so  as  to  obtain  a  pulverulent  mass,  to  which  three 
ounces  of  arrow-root  are  to  be  added  by  trituration.  A  jelly  is  pre- 
pared with  this  powder  by  rubbing  up  a  teaspoonful  of  it  with  a  little 
cold  water,  and  then  pouring  a  cupful  of  boiling  water  on  it. 


820  TOPICAL   REMEDIES. 

Acacia. — Gum-arabic.  A  gummy  exudation  from  Acacia  vera,  and 
other  species  of  Acacia. 

Mucilago  Acacice. — Mucilage  of  gum-arabic. 

Syrupus  Acacice. — Sirup  of  gum-arabic.  (Mucilage  of  acacia,  25 
c.  c.;  sirup,  75  c.  c.) 

Tragacantha. — Tragacanth.     The  gummy  exudation  from  Astraga- 
lus gummifer,  and  from  other  species  of  Astragalus. 
Mucilago  Tragacanthce. — Mucilage  of  tragacanth. 

Sassafras  Medulla. — The  pith  of  the  stems  of  Sassafras  officinale. 

Mucilago  Sassafras  Medullce. — Mucilage  of  sassafras-pith. 

ACTIONS  AND  USES. — These  preparations  are  used  as  demulcent 
drinks,  in  cases  of  acute  inflammation  of  the  stomach  and  intestines. 
They  are  supposed  to  make  a  protective  coating  on  the  inflamed  part, 
and  thus  save  it  from  further  injury.  They  are  especially  indicated 
when  irritating  and  corrosive  substances  have  been  swallowed.  They 
are  also  frequently  prescribed  as  diet-drinks  in  fevers  and  in  acute  in- 
flammations, in  accordance  with  the  supposition  that  they  are  not  only 
soothing  to  the  alimentary  canal,  but  are,  in  a  limited  sense,  foods.  As 
nutrients  these  gums  and  mucilaginous  substances  rank  very  low,  and 
can  by  no  means  take  the  place  of  such  a  food  as  milk.  Furthermore, 
they  are  exceedingly  apt  to  undergo  fermentation,  and  to  produce  flatu- 
lent colic  and  diarrhoea. 

Mucilaginous  drinks  are  very  frequently  taken  in  catarrhal  affec- 
tions of  the  bronchial  tubes  and  of  the  kidneys,  with  the  view  to  mod- 
ify the  morbid  process  going  on  in  these  parts.  It  need  hardly  be 
stated  that  such  a  theory  of  the  utility  of  demulcents  is  erroneous. 
Cough  is  modified  by  an  influence  which  is  probably  reflex,  when  mu- 
cilages are  applied  to  the  fauces  ;  but  in  no  other  way  can  the  mucous 
membrane  of  the  air-passages  be  affected  by  such  remedies  taken  into 
the  stomach.  As  gums  undergo  digestion  in  the  alimentary  canal,  it 
is  obvious  that  they  can  not  act  as  demulcents  on  any  part  of  the 
urinary  tract. 

The  chief  use  of  these  remedies  is  in  extemporaneous  prescriptions, 
to  hold  insoluble  medicines  in  suspension,  and  to  cover  the  taste  of  dis- 
agreeable ingredients. 

Linum. — Flaxseed.     The  seed  of  Linum  usitatissimum. 
Lini  Farina. — Flaxseed-meal. 

Infusum  Lini  Compositum.  —  Compound  infusion  of  flaxseed. 
(Flaxseed,  §  ss  ;  licorice-root,  3  ij  5  boiling  water,  Oj.)  (Not  official.) 

Ulmus. — Slippery-elm  bark.     The  inner  bark  of  Ulmusfulva. 
Mucilago  Ulmi. — Mucilage  of  slippery-elm  bark. 


POULTICES.  821 

Glycyrrhiza. — Licorice-root.     The  root  of  Glycyrrhiza  glabra. 

Glycyrrhizinum  Arnmoniatum. — Ammoniated  glycerin. 

Extractum  Glycyrrhizce  Purum. — Pure  extract  of  glycyrrhiza. 

Extractum  Glycyrrhiza  Fluidum. — Fluid  extract  of  glycyrrhiza. 

Mistura  Glycyrrhiza  Composita.  —  Compound  licorice-mixture 
(brown  mixture).  A  simple  expectorant  containing  paregoric,  wine  of 
antimony,  and  spirits  of  nitrous  ether.  Dose,  3  j —  §  ss. 

ACTIONS  AND  USES. — The  remedies  of  this  group  contain  mucilagi- 
nous constituents  on  which  their  properties  depend.  They  are  fre- 
quently prescribed  as  protectives  in  gastro-intestinal  disorders,  and  as 
expectorants  in  bronchial  affections. 

Poultices. — Flaxseed-meal,  powdered  slippery-elm  bark,  and  Indian 
or  corn  meal,  are  most  frequently  used  for  the  preparation  of  poultices. 
Wheat-bread  and  milk  are  also  occasionally  employed  for  the  same 
purpose. 

In  the  preparation  of  a  poultice,  the  meal  is  slowly  incorporated 
with  hot  water,  until  a  mass  of  the  proper  consistency  is  made.  The 
mixture  itself  should  not  be  applied  immediately  to  the  part,  for  it 
dries  and  adheres  with  considerable  tenacity.  A  piece  of  washed  mus- 
lin of  quadrangular  shape,  and  of  sufficient  size,  is  selected  ;  the  hot 
mass  is  spread  on  one  end  of  the  muslin,  leaving  a  margin  of  one  inch 
on  three  sides  ;  the  long  end  of  the  muslin  is  then  folded  over  the 
mass,  and  the  free  margins  are  stitched  or  pinned  together.  If  the 
poultice  is  not  frequently  renewed,  to  prevent  drying,  some  glycerin 
should  be  added  to  the  surface  which  is  to  remain  in  contact  with  the 
tissues.  Laudanum,  or  other  narcotics,  may  be  stirred  in  with  the 
meal  if  the  relief  of  pain  be  desirable. 

A  yeast-poultice  consists  of  brewers'  yeast,  to  which  sufficient  flax- 
•seed  is  added  to  give  the  proper  consistence. 

A  charcoal-poultice  differs  from  an  ordinary  poultice  in  having 
powdered  charcoal  incorporated  with  the  mass.  In  order  that  a  char- 
coal-poultice shall  have  the  proper  consistence,  the  mass  should  be 
thin  enough  to  take  up  a  sufficient  quantity  of  charcoal. 

ACTIONS  AND  USES. — A  poultice  is  a  means  of  applying  continu- 
ous heat  with  moisture,  and  of  softening  the  tissues.  An  afflux  of 
blood  takes  place  to  the  part,  the  vessels  dilate,  the  tissues,  softened 
by  the  combined  influence  of  heat  and  moisture,  permit  the  easy  diffu- 
sion of  the  fluids.  If  the  process  of  inflammation  has  begun,  or  is  in 
progress,  the  stasis  is  relieved,  the  tension  of  the  inflamed  part  is  less- 
ened, and  resolution  is  thus  favored  ;  or,  if  the  stage  of  exudation  is 
reached,  the  migration  and  multiplication  of  the  white  corpuscles  are 
promoted,  and  the  extrusion  of  purulent  elements  facilitated.  The 
accumulation  of  blood  in  the  neighborhood  of  the  poultice  seems  to 
•diminish  the  pressure  elsewhere,  and  thus  poultices  of  large  size  lower 


822  TOPICAL   REMEDIES. 

the  arterial  tension  and  lessen  stasis  in  internal  parts.  Poultices  re- 
lieve the  pain  of  inflamed  parts  by  relaxing  the  tissues,  and  thus  re- 
moving pressure  from  the  sensory  nerve-filaments.  The  impression 
thus  made  on  the  peripheral  nerve-endings  is  transmitted  to  the  center 
and  reflected  over  internal  organs.  It  is  within  the  range  of  every- 
body's personal  experience  that  warm,  moist  applications  relieve  pain 
in  internal  and  distant  parts,  which  have  no  anatomical  connection 
with  the  integument  to  which  the  applications  are  made. 

Poultices  have,  therefore,  a  local  and  a  systemic  effect.  Their 
therapeutical  uses  are  based  on  this  conception  of  their  physiological 
actions.  They  are  prescribed  to  relieve  the  tension  and  to  promote 
resolution  or  suppuration  in  boils,  carbuncles,  and  other  superficial  in- 
flammations, to  hasten  the  healing  of  irritable  ulcers,  to  favor  the  sep- 
aration of  gangrenous  sloughs,  etc.  Foul-smelling  wounds  requiring 
the  use  of  poultices  are  best  treated  with  the  yeast  or  charcoal  poul- 
tice. 

Unquestionable  benefit  is  derived  from  the  application  of  hot 
poultices  externally  in  acute  faucial  inflammations,  in  pneumonia,, 
pleuritis,  pericarditis,  hepatitis,  peritonitis,  etc. 

The  application  of  poultices  sometimes  degenerates  into  abuse.  If 
too  long  continued,  the  skin  becomes  white,  wrinkled,  and  sodden  ; 
small  abscesses  or  boils  form,  and  the  vessels  of  the  parts  very  slowly 
regain  their  tone.  If  kept  too  long  in  contact  with  wounds  or  ulcer- 
ated surfaces,  the  granulations  become  pale  and  flabby,  and  the  heal- 
ing process  is  retarded.  Applied  indiscreetly  to  inflamed  joints,  they 
may  promote  suppuration,  and  thus  permanently  injure  these  struc- 
tures. If  kept  long  in  contact  with  a  large  extent  of  surface,  they 
will  lower  the  general  tone  and  vigor  of  the  system,  depress  the  sys- 
temic circulation,  exhaust  the  irritability  of  the  vaso-motor  nerves, 
and  thus  seriously  embarrass  the  reparative  process,  if  not  wholly 
prevent  repair. 


APPENDIX. 


Equivalents  of  Weights  and  Measures. 

From  1  Troy  Ounce  down. 


METRIC 

METRIC 

WEIGHT 

WEIGHT 

Grains. 

AND 

MEASURE. 

Minims. 

Grains. 

AND 

MEASURE. 

Minims. 

Gm.]      [Cc. 

Gm.]      [Cc. 

480        [1  I 

31-103 

504-8 

240           [4  3 

15-551 

252-4 

478-4 

31 

503-1 

231-5 

15 

243-4 

475-4 

30-805 

500 

228-2 

14-786 

240 

463 

30 

486-9 

218-75    [Aav.  oz. 

14-175 

230-1 

456-4 

29-573 

480 

216-1 

14 

227-2 

450 

29-159 

473-3 

210 

13-607 

220-9 

447-5 

29 

470-7 

200-6 

13 

211 

437-5     [1  av.  oz. 

28-350 

460-1 

199-7 

12-938 

210 

432-1 

28 

454-4 

185-2 

12 

194-8 

427-9 

27-724 

450 

420        [7  3 

27-214 

441-7 

180         [3  3 

11-663 

189-3 

416-7 

27 

438-2 

171-1 

11-090 

180 

401-2 

26 

422 

169-8 

11 

178-5 

399-3 

25-876 

420 

154-3 

10 

162-3 

390 

25-271 

410-2 

150 

9-719 

157-8 

385-8 

25 

405-7 

142-6 

9-241 

150 

380-3 

24-644 

400 

138-9 

9 

146-1 

370-8 

24-028 

390 

123-5 

8 

129-8 

370-4 

24 

389-5 

360        [6  3 

23-327 

378-6 

120         [2  3 

7-775 

126-2 

354-9 

23 

373-3 

114-1 

7-393 

120 

342-3 

22-180 

360 

109-37    [iav.  oz. 

7-088 

115-9 

339-5 

22 

357-1 

108 

7 

113-6 

330 

21-383 

347-1 

100 

6-480 

105-2 

324-1 

21 

340-8 

95-1 

6-161 

100 

313-8 

20-331 

330 

92-6 

6 

97-4 

308-6 

20 

324-6 

80 

5-184 

84-1 

77-2 

5 

81-1 

76-1 

4-928 

80 

61-7 

4 

64-9 

300        [5  3 

19-440 

315-5 

60         [1  3 

3-888 

63-1 

293-2 

19 

308-4 

57 

3-696 

60 

285-2 

18-483 

300 

54         [i  av.  oz. 

3-544 

57-5 

277-8 

18 

292-1 

47-5 

3-080 

50 

270 

17-495 

284 

50 

3-240 

52-6 

262-3 

17 

275-9 

46-3 

3 

48-7 

256-7 

16-635 

270 

42-8 

2-772 

45 

246-9 

16 

259-7 

40 

2-592 

42-1 

38 

2-464 

40 

33-3 

2-156 

35 

30-9 

2 

32-5 

824 


APPENDIX. 


Equivalents  of  Weights  and  Measures. — (Continued.) 


Continuation  of  Table  of  Equivalents, 
from  1  Troy  Ounce  down. 


Equivalents  of  Weights  from 
5  Grains  down. 


Grains. 

METRIC 
WEIGHT 

AND 

MEASURE. 
Gm.]         [Cc. 

Minims. 

GRAMMES. 

GRAINS. 

In  decimal 
fractions. 

In  common 
fractions 
(approxi- 
mate). 

30        [i  3         1-944 

31-6 

0-324 

5 

5 

28-5 

1-848 

30 

0-291 

4-5 

4* 

23-8 

1-540 

25 

0-259 

4 

4 

20 

1-296 

21 

0-226 

3-5 

3* 

19 

1-232 

20 

0-194 

3 

3 

15-4324 

1 

16-23 

0-162 

2-5 

24 

0-130 

2 

2 

0-097 

1-5 

H 

15 

0-972 

15-9 

0-065 

1 

i 

14-3 

0-924 

15 

14 

0-907 

14-7 

13-3 

0-862 

14 

0-061 

0-94 

H 

13 

0-842 

13-7 

0-060 

0-93 

•& 

12-4 

0-801 

13 

0-057 

0-88 

I 

12 

0-775 

12-6 

0-053 

0-82 

ft 

11-4 

0-739 

12 

0-050 

0-77 

11 

0-713 

11-6 

0-049 

0-76 

1 

10-5 

0-678 

11 

0-045 

0-69 

ft 

0-040 

0-62 

T& 

0-036 

0-56 

A 

10 

0-648 

10-5 

0-032 

0-5 

i 

9-5 

0-616 

10 

9 

0-583 

9-5 

8-6 

0-554 

9 

0-028 

0-43 

iV 

8 

0-518 

8-4 

0-025 

0-39 

I 

7-7 

0-5 

8-1 

0-024 

0-37 

i 

7-6 

0-493 

8 

0-020 

0-31 

A 

7 

0-454 

7-4 

0-016 

0-24 

i 

6-7 

0-431 

7 

0-012 

0-18 

TV 

6 

0-389 

6-3 

0-008 

0-12 

i 

5-7 

0-370 

6 

0-004 

0-06 

iV 

0-0032 

0-05 

^ff 

0-0027 

0-04 

•jo 

5 

0-324 

5-3 

0-0022 

0-033 

% 

4-8 
4 

0-308 
0-259 

5 

4-2 

0-0018 
0-0016 

0-028 
0-025 

I 

3-8 

0-246 

4 

0-0013 

0-029 

* 

3 
2-9 

0-194 
0-185 

3-2 
3 

o-oon 

0-0010 

0-017 
0-015 

ft 

2 

0-130 

2-1 

0-0006 

0-010 

TO  15 

1-9 

0-123 

2 

0-0005 

0-008 

db 

1 
0-9508 

0-065 
0-06161 

1-0517 
1 

0-0004 
0-0003 
0-0002 

0-007 
0-005 
0-003 

TTO" 
TOO" 
TOO" 

0-0001 

0-0015 

T07T 

INDEX   OF   EEMEDIES. 


Acacia 820 

ACETA  : 

Acetum  Lobelias 696 

Opii 624 

Sanguinariae 359 

Scillse 792 

Acetanilid 424 

Acetyl-hydroxy-phenyl-urethan 588 

ACIDA  : 

Acidum  Aceticum 243 

Arseniosum 165 

Benzoicum 421 

—  Boricum 419 

—  Camphoricum 548 

Carbolicum 375 

Chromicum 815 

Citricum 243 

Gallicum 349 

Hydrobromicum  Dilutum 657 

Hydrochloricum 112 

Hydrocyanicum  Dilutum 698 

lodicum 265 

Lacticum 110 

Nitricum 113 

Nitromuriaticum 113 

Oxalicum 245 

—  Phosphoricum 113 

Pyrogallicum 347 

Salicylicum 390 

—  Sulphuricum 112 

—  Sulphurosum 246 

Tannicum , 339 

—  Tartaricum 243 

Aconitine 711 

Aconitum  Napellus  and  its  preparations. . .  711 

Acupuncture 808 

Adeps 121 

Benzoiuatus 121 

Lanae  Hydrosus 121 

Adonidin 519 

.Ether 591 

Aceticus 592 

—  Fortior 599 

Agaricin 726 

Ailanthus 725 

Air 93 

—  Compressed 96 

Airol 278 

Alcohol...  ..  568 


PAGE 

Ale 583 

Aliment 33,    74 

Animal 35 

in  Cachexiae 66 

in  Digestive  Disorders 65 

in  Inflammation 63 

Vegetable 47 

Alimentation,  Forced 72 

Rectal 71 

Alkalies 211 

Alkaline  Mineral  Springs 227 

Alnus  Serrulata 341 

Aloes  and  its  preparations 756 

Aloin 757 

Alum 334 

Alumen 334,  734 

Alumen  Exsiccatum 334 

Alumnol 338 

Ammonia 234 

Ammoniacum  and  its  preparations 552 

Ammonii  Benzoas 421 

Ammonii  Valerianas 553 

Ammonium  and  its  preparations 234 

Amygdalae  Oleum  Expressum 121 

Amylen  Hydrate 622 

Amyl  Nitrite 704 

Anaesthesia 599 

Infiltration 24,  611 

Local 610 

Anaesthetics 505,  599 

Animal  Aliment 35 

Animal  Diet 53 

Animal  Extracts 432 

Anemonine 721 

Anthelmintics 770 

Antif ebrin 424 

Antimony  and  its  preparations 321 

Antipyrin 410 

Antiseptics 365 

Antiseptic  Oils 427 

Antitoxins 436 

Apiol 794 

Apocodeine 735 

Apomorphine 735 

Aqua 77 

AQU.E  : 

Aqua  Acidi  Carbolici 375 

Ammonias 235 

Camphorae 545 

Chlori 370 


826 


INDEX   OF   REMEDIES. 


PAGE 

Aqua  Creosoti 374 

—  Hydrogenii   Dioxidi 368 

Aquapuncture 809 

Arbutin 790 

Argentum  and  its  preparations 298 

Aristol 277 

Arnica  and  its  preparations 676 

Arnicine 676 

Aromatic  Bitters , 182 

Arsenic  and  its  preparations 165 

Arterial  Transfusion 30 

Artificial  Digestion 69 

Asafoetida  and  its  preparations 549 

Asaprol    416 

Aspidium 774 

Aspidospermine 730 

Atomization  of  Liquids 9 

Atropine 523 

Aurum  and  its  preparations 296 

B 

Bantingism 53 

Baptisia 764 

Baptism 764 

Barii  Chloridum 240 

Barium 240 

Baths 79 

Baunscheidtismus 808 

Beef  Fluid 33 

Juice 33 

Beer 583 

Belladonna  and  its  preparations 523 

Benzoates 421 

Benzoic  Acid 421 

Benzoin 421 

Benzoyl-Guaiacol 388 

Benzosol 388 

Berberina 180 

Berberine 180 

Beta-Naphtol 416 

Beverages 74 

Bismuth  and  its  preparations 161 

Bitters,  Aromatic 182 

Bitters,  Simple 179 

Blisters 805 

Bloodletting 812 

Boral 338 

Boric  Acid 419 

Borocitrates 420 

Borotartrates 421 

Brandy 569 

Brayera  and  its  preparations 775 

Bromal 661 

—  Hydrate 661 

Bromalin 661 

Bromamide 661 

BROMIDES : 

Ammonium 647 

Calcium 647 

—  Lithium 647 

—  Potassium 648 

Sodium 648 

Bromine 871 

Bromof orm 658 

Broom...  790 


•  PA<MB 

Broths,  Animal,  Formulae  for 65 

Brown  Mixture 321,  804 

Brown-Sequard's  Spermine 433 

Brucine 476 

Buchu  and  its  preparations 790 

Burgundy  Pitch 804 

Buttermilk-Cure 60 

C 

Cacao  Butter 121 

Cadmium  and  its  preparations 325 

Caffeine  and  its  preparations 564 

Cajuputol 427 

Calabar  Bean 686 

Calcii  Hypophosphis 137 

Calcii  Phosphis  Praecipitatus 137 

Calcium  and  its  preparations 221 

Calendula 179 

Calomel 752 

Calumba  and  its  preparations 179 

Calx 221 

Chlorata 370 

Sulphurata 248 

Cambogia 764 

Camphor  and  its  preparations 545 

Camphor  Monobromate 645 

Cannabinum  Tannicum 554 

Cannabis  Americana 554 

Cannabis  Indica 554 

Canella 182 

Canquoin's  Paste 320 

Cantharidal  Collodion 805 

Cantharidin 797 

Cantharis  and  its  preparations 797 

Capsicum  and  its  preparations 787 

Carbolic  Acid 375^, 

Carica  Papaya 107 

Carlsbad 232 

Carota 791 

Carpaine 108 

Caryophyllin 427 

Cascara  Sagrada 747 

Cascarilla 182 

Castanea  vesca 342 

Castor-oil 747 

Cataphoresis 472 

Catechu  and  its  preparations 339 

Cathartics 744 

CERATA : 

Ceratum  Cantharidis 805 

Extract!  Cantharidis 805 

—  Plumbi  Subacetatis 310 

Zinci  Carbonatis 316 

Cerebral  Excitants 544 

—  Sedatives 561 

Cerium  and  its  preparations 328 

Cetraria 819 

Cetrarin 819 

Chalk 221 

Chalybeate  Mineral  Springs 159 

Champagne 575 

CHART  x : 

Charta  Cantharidis 805 

Sinapis 803 

Chenopodium  and  its  preparations 773- 


INDEX   OF   REMEDIES. 


827 


PAGE 

Chimaphila  and  its  preparations 790 

Chinoidine 185 

Chinoline 404 

Chloralamide 620 

Chloral  Hydrate 613 

Croton 619 

Urethan 588 

Chloralose 622 

Chlorinated  Lime 370 

Chloride  of  Methyl 586 

Chlorine 369 

Chlorodyne 598 

Chloroform 595 

Chondrus 819 

Chromic  Acid 815 

Chrysophanic  Acid 755 

Cimicifuga  and  its  preparations 520 

Cimicifugine 521 

Cinchona  and  its  preparations 191 

Cinchonidine 192 

Cinchonine 192 

Citric  Acid 243 

Citrine  Ointment 280 

Coca 557 

Cocaine 557 

Cocculus 488 

Cocoa 74 

Codeine 625 

Cod-liver  oil .121 

Coffee 74 

Colchicine  351 

Colchicum  and  its  preparations 357 

Collargolum 307 

Collodion 818 

Collodium  cum  Cantharide 805 

Collodium  Flexile 818 

Stypticum 339 

Colocynth  and  its  preparations 760 

CONFECTIONES  : 

Confectio  Rosre 341 

Sennse 753 

Conine 662 

Conium  and  its  preparations 662 

Convallaria 514  j 

Convallarin 515 

Copaiba  and  its  preparations 783 

Copper,  preparations  of 308  j 

—  in  Metallotherapy 333 

Coptis 179 

Cornus  Florida 179 

Corrosive  Sublimate 279 

Cotarnine 633 

Counter-irritants 801 

Crede's  Silver  Preparations 807 

Collargolum 307 

Creosotal 388 

Creosote 387 

Creta 221 

Croton-Chloral 619 

Croton-oil 765 

Cryptopine 634 

Cubeb  and  its  preparations 785 

Cuca 557 

Cuprum  Sulphas 306,  733 

Cuprum  and  its  preparations 308 


PAGE 

Curara 667 

Curarine 667 

Cutol 338 

Cyanide  of  Potassium 702 

D 

Dandelion 791 

Daturine 535 

Debove's  Powder 72 

DECOCTA : 

Decoctum  Cetrariae 819 

Chimaphilse 790 

Cornus  Floridae 179 

Haematoxyli .'  340 

Quercus  Albee 340 

Sarsaparillae  Compositum 354 

Demulcents 819 

Denutrition 51 

Dermatol 164 

Diet,  Animal 56 

Dry 54 

Milk 57 

Plansof 51 

Vegetable 55 

Diet-Drinks 64 

Formulae  for 64,    68 

Digestion,  Artificial 69 

Digestion-Ferments 104 

Digitaline 507 

Digitalis  and  its  preparations 506 

Digitoxin 507 

Diuretin 567 

Douche 81 

Nasal 7 

Dover's  Powder 737 

Dry  Diet 54 

Duboisia 541 

Duboisine 541 

E 

Effervescing  Powders 220 

Elaterin 767 

Elaterium 767 

Electric  Baths 455 

Electricity 440 

Electro-Diagnosis 459 

Physiology 455 

Therapy 462 

Electrolysis 471 

Electro-Magnetism 450 

Emetics 733 

Emetine 735 

Emollients 816 

EMPLASTRA  : 

Emplastrum  Ammoniac! 552 

Ammoniaci  cum  Hydrargyro. . .  278,  552 

Arnicas 804 

Asafcetidae 549 

Belladonnas 523 

Ferri 141 

Hydrargyri 278 

Opii 624 

Picis  Burgundicse 804 

Picis  Canadensis —        804 


828 


INDEX   OF   REMEDIES. 


PAGE 

Emplastrum  Picis  cum  Cantharide 804 

Plumbi 310 

Ems 228 

Emulsum  Ammoniaci 552 

—  Asaf cetidae 549 

—  Chloroform! 595 

Endermatic  Method 6 

Enemata 768 

Forms  of 769 

Nutrient 70 

Enepidermatic  Method 5 

Enteroclysis 14 

Epidermatic  Method 6 

Epispastics 805 

Epsom  Salts 749 

Ergot  and  its  preparations 492 

Ergotin 492 

Ergotinine 493 

Erigeron 184 

Erythroxylon 557 

Escharotics 113,  815 

Eserine 687 

Ether 591 

. Aceticus 592 

Hydriodicus 266 

Ethyl  Bromide 592,  608 

. Iodide 266 

Ethyl-chloral-urethan 588 

Eucaine 612 

Eucalyptol 185 

Eucalyptus  and  its  preparations 185 

Euonymin 763 

Euonymus 763 

Euphorin 588 

Europhen 276 

Evacuants 692 

Exalgine 427 

EXTRACTA  I 

Extractum  Aconiti 711 

Arnicas  Radicis 676 

—  Belladonnas 523 

Belladonnas  Alcoholicum 523 

Cannabis  Indices 554 

Cinchonas 192 

Colchici  Radicis 351 

—  Colocynthidis 760 

Colocynthidis  Compositum 760 

Conii  Alcoholicum 662 

—  Digitalis 1,  506 

Duboisise 541 

Eucalypti 185 

Gentianae 178 

Glycyrrhizse 821 

Haematoxyli 340 

Hyoscyami  Alcoholicum 536 

Kramerise 340 

Nucis  Vomicas 475 

—  Opii 624 

—  Pancreas 436 

Physostigmatis 686 

—  Podophylli 761 

Quassias 178 

Renali 434 

Rhei 755 

Stramonii. . .  . .  535 


PAGE 

Extractum  Taraxaci 791 

Testicular 433 

—  Thyroid 434 

EXTRACTA  FLUIDA  : 

Extractum  Aconiti  Fluidum 711 

Ailanthi  Fluidum 725 

Belladonna'  Fluidum 523 

—  Buchu  Fluidum 790 

Calumbas  Fluidum 179 

Cannabis  Indices  Fluidum 554 

Chimaphilae  Fluidum 790 

Cimicifuga  Fluidum 520 

Cinchonas  Fluidum 192 

Cocas  Fluidum 557 

Colchici  Radicis  Fluidum 351 

"       Seminis  Fluidum 351 

Conii  Fluidum 662 

Convallarias  Fluidum 515 

Cornus  Floridas  Fluidum 179 

Cubebas'  Fluidum 785 

Digitalis  Fluidum 506 

Ergotas  Fluidum 492 

Erythroxylon  Fluidum 557 

Eucalypti  Fluidum 185 

—  Gelsemii  Fluidum 672 

Gentianas  Fluidum 178 

Grindelise  Fluidum 722 

Guaranas  Fluidum 566 

Hydrastis  Fluidum 188 

Hyosciami  Fluidum 536 

Ipecacuanhas  Fluidum 737 

Kramerias  Fluidum 340 

Lobelias  Fluidum 696 

Lupulini  Fluidum 646 

Nucis  Vomicas  Fluidum 476 

Pareiras  Fluidum 790 

Phytolaccae  Fluidum 724 

Pilocarpi  Fluidum 679 

Pruni  Virginianas  Fluidum 179 

Quassias  Fluidum 178 

Rhei  Fluidum 754 

Sabinas  Fluidum 796 

Sanguinariae  Fluidum 359 

Sarsaparillas  Fluidum 354 

"  Compositum  Fluidum  .  354 

Sennas  Fluidum 753 

Serpentarias  Fluidum 182 

Spigeliae  Fluidum 773 

Stillingise  Fluidum 357 

Stramonii  Fluidum 535 

Taraxaci  Fluidum 791 

—  Testicular 21,  433 

Uva  Ursi  Fluidum 790 

Ustilaginis  Maidis  Fluidum 505 

Valerianae  Fluidum 552 

Veratri  Viridis  Fluidum 716 

Viburni  Opuli  Fluidum 364 

"        Prunifolii  Fluidum 364 

Xanthoxyli  Fluidum 362 

F 

Faradism 450 

Faradic  Electricity 450 

Fats  and  Oils 121 

FelBovis ..  746 


INDEX   OF   REMEDIES. 


PAGE 

Ferments 104 

Ferratin 153 

Ferrum  and  its  preparations 141 

Ferrum  Dialysatum 143 

Filix  Mas 774 

Firing 808 

Flax-seed 820 

Flexible  Collodion 818 

Fluid  Extracts  (see  "  Extracta  Fluida  "). 

Forced  Alimentation 72 

Formanilide 661 

Fowler's  Solution 165 

Fraxinus  Americana 363 

Friedrichshall 233 

Fumigations 8 

G 

Galazyme 44 

Galla 339 

Gallic  Acid 339 

Galls 339 

Galvanism 443 

Galvano-cautery 473 

Faradization 454 

Therapy 464 

Gamboge 764 

Gargles 345 

Gaseous  Enemata 372 

Inhalations 372 

Gaultheria 427 

Gelsemine 672 

Gelsemium  and  its  preparations 671 

Gentian 178 

Catesby's 178 

Geranium 340 

Glycerin 816 

GLYCERITA  : 

Glyceritum  Acidi  Carbolic! 375 

Amyli 816 

—  Hydrastis 188 

Vitelli 816 

Glycyrrhiza 821 

Gold  and  its  preparations 296 

Gold  in  Metallotherapy 333 

Goldthread 179 

Goulard's  Extract 310 

Ointment 310 

Granatum 774 

Grape-Cure 55 

Grindelia 722 

Guaiacol 387 

Guaiacum  and  its  preparations 356 

Guarana 566 

H 

Haematoxylon  and  its  preparations 340 

Haemogalol 154 

Hsemol 154 

Hamamelis  Virginica 341 

Heat 90 

Hemlock 662 

Heuchera 341 

Hip-Bath 81 

Homatropine 534 

Homburg  Springs 233 


PAGK 

Hope's  Mixture 116- 

Hops 646 

Humulus  and  its  preparations 646 

Hydragogue  Cathartics 744 

Hydrargyrum  and  its  preparations 278 

Hydrastine 188 

Hydrastinine 188 

Hydrastis  and  its  preparations, 188 

Hydrate  of  Chloral 613 

Hydrochloric  Acid 112 

Hydrocyanic  Acid 69& 

Hydrogen  dioxide 368 

Hydroquinone 404 

Hydrotherapy 79 

Hyoscine 539 

Hyoscyamine 536 

Hyoscyamus  and  its  preparations 536 

Hypnal 590 

Hypnone 590 

Hypodermatic  Method 16 

Remedies 19 

Hypodermatoclysis 'J& 


Ichthyol 349 

Igasuric  Acid 475 

Ignatia 48& 

INFUSA : 

Inf usum  Brayerse 775 

Cinchonas 191 

Convallariae 515 

Digitalis 506 

Pilocarpi 679 

Pruni  Virginianae 182 

Sennae  Compositum 753 

Infant-Feeding 60 

Infiltration  Anaesthesia 24 

Ingluvin 104 

Inhalations 8 

In  jections— Intravenous 25 

Organic  Liquids 21 

Insufflation 6 

Inunction  Method 123,  291 

lodates 265 

lodicAcid 265 

Iodides 255 

Iodine  and  its  preparations 253 

lodoform 263,  267 

lodo-tannin 264 

lodol 273 

Ipecacuanha  and  its  preparations 737 

Iridin 763 

Iris  Versicolor 763 

Iron  and  its  preparations 141 


Jaborandi  and  its  preparations 679 

Jalap  and  its  preparations 759 

Jequirety 810 

Jervia 716 

Juniper  and  its  preparations 788 

K 

Kairine 404 

Kairoline 404 


830 


INDEX   OF   REMEDIES. 


PAGE 

Kamala 775 

Kefyr 44 

Kino  and  its  preparations 340 

Kissingen 233 

Koumiss 43,  59 

Koussine 775 

Kousso 775 

Krameria  and  ks  preparations 340 


Lactic  Acid 110 

Lactucarine 647 

Lactucarium 647 

Lard 121 

Laxatives 744 

Lead  and  its  preparations 310 

Leptandra 762 

Leptandrin 763 

Licorice 821 

Lime  and  its  preparations 221 

Lini  Farina 820 

Linum  and  its  preparations 820 

LlNIMENTA  : 

Linimentum  Ammonite 235,  804 

Camphorae 545 

Cantharidis 804 

Chloroformi 804 

Saponis 545 

Terebinthinse 776 

LIQUORES : 

Liquor  Ammonias  Acetatis 235 

Arsenii  Chloridi 165 

Arsenii  et  Hydrargyri  lodidi 165 

Calcis 222 

Calcis  Saccharatus 222 

Ferri  Chloridi 142 

"     Citratis 142 

"     Nitratis 142 

"     Subsulphatis 141 

"     Tersulphatis 142 

Gutta-Perchae 818 

Hydrargyri  Nitratis 280 

lodi  Compositus 253 

Magnesii  Citratis 749 

Morphine  Sulphatis 626 

"         Bimeconatis 626 

Pancreaticus 105 

Pepsinae 104 

Plumbi  Subacetatis 310 

Potassse 212 

Potassii  Arsenitis 165 

"       Citratis 212 

Sodae 219 

Sodae  Chlorinatae 370 

Sodii  Arseniatis 165 

Zinci  Chloridi 316 

Lithium  and  its  preparations 223 

Lobelia  and  its  preparations 696 

Lobeline 696 

Loretin 275 

Lupuli 646 

M 

Magnesia  and  its  preparations 745 

Magnesii  Carbonas 745 


PAGE 

Magnesii  Citras 749 

—  Sulphas 749 

Magnetism , 442 

Magneto-Therapy 464 

Malt  Liquors 583 

Manganum  and  its  preparations 154 

Manna 744 

100 
341 
430 
291 
291 
752 
278 
331 
585 
586 
609 
413 
33 
76 
62 
,59 
61 


Massage 

Mel  Rosae 

Menthol 

Mercurial  Inunction 

Fumigation 

Purgatives 

Mercury  and  its  preparations 

Metallotherapy 

Methylal 

Methyl  Chloride 

Methylene  Bichloride 

Methylene  Blue 

Metric  System 

Milk  as  a  Beverage 

Milk  as  a  Poison 

Milk-Diet 40,  45 

Milk  Jelly 

MISTCRJE  : 

Mistura  Ammoniac! 552 

Asaf cetidae 549 

Crete 215 

Ferri  Aromatic! 143 

Ferri  Composite 141 

"      Laxans 143 

Gentianee  Alkaline 178 

•'        etSennae 178 

Glycyrrhizae  Composite 321,  821 

Magnesias  et  Asaf  oetidae 746 

Mongers  Solution 141 

Morphine  and  its  Salts 626 

MUCILAGINES  : 

Mucilago  Acacise 820 

Sassafras  Medullas 820 

Tragacanthas 820 

Ulmi 820 

Mucuna 771 

Muriatic  Acid 112 

Muscarine 726 

Mustard 735 

Myrica  Cerifera 341 

Myrtol 429 

N 

Napelline 716 

Naphtalin  415 

Naphtol 416 

Narceine 625,  634 

Narcotine 626-633 

Nasal  Douche 7 

Neurodin 588 

Nicotianine 692 

Nicotine 692 

Nitre...  ..  211 


Nitric  Acid 113 

Nitrite  of  Amyl 704 

Nitro-glycerin 707 

Nitro-Hydrochloric  Acid 113 

Nitrous  Oxide ...  . .  611 


INDEX   OF   REMEDIES. 


831 


Nosophen 276 

Nutrient  Enemata ~0 

Nux  Vomica  and  its  preparations 475 

Nymphaea  Odorata 342 


Oils  and  fats 121 

OLKA  DKSTILLATA  : 
Oleum  Cajuputi 427 

—  Caryophylli 427 

Chenopodii 773 

—  Copaibse 783 

—  Cubebae 785 

—  Erichthites 183 

Erigerontis  Canadense 183 

Eucalypti 185 

Gaultherise 427 

Juniperi 788 

Ricini 747 

Rutae 795 

Sabinae 796 

Tabaci 692 

Terebinthini 776 

Thymi 427 

Oleate  of  Mercury 279 

Oleatum  Hydrargyri 279 

Veratrinae 716 

OLKORKSIN^  : 

Oleoresina  Capsici 787 

Aspidii 774 

Cubebae 785 

Lupulini 646 

Piperis 786 

Oleum  Amygdalae  Expressum 121 

Gaultherise 427 

Gossypii  Seminis 121 

Lini 121 

Morrhuae 121 

Olivae 121 

Phosphoratum 128 

Ricini 747 

Theobromae 121 

Thymi 437 

Tiglii 765 

Valerianae 553 

Opium  and  its  preparations 624 

Orexine 210 

Oxalic  Acid 245 

Ox-gall 746 

Oxygen 366 

Ozone . .  368 


Pancreatin 105 

Papaine 107 

Papaverine 625 

Papayotin 107 

Paraldehyde 584 

Paregoric 624 

Pareira 790 

Parilline 355 

Parrish's  Chemical  Food 137 

Parsley 794 

Pelleterine 774 

Pepo 775 

55 


PAGE 

Pepsin 104 

Peptones 106 

Peptonized  Milk 105 

—  Gruel 105 

Perkins's  Tractors 331 

Petrolatum 121 

Petroselinum 794 

Phenacetin ." 418 

Phenoresorcin 404 

Phenosalyl 388 

Phenyl-urethan 588 

Phosphates  and  Phosphites 137 

Phosphoric  Acid 113 

Phosphorus  and  its  preparations 128 

Physostigma  and  its  preparations 686 

Phytolacca 724 

Picrotoxin 489 

Pictet  Liquid 373 

Pilocarpine  Hydrochlorate 679 

Pilocarpus 679 

PILULB  : 

Pilulae  AloSs 756 

"  et  Asafo3tidae 550,  756 

"  et  Mastiches 756 

"  et  Myrrhae 756 

Antimonii  Composites 321 

—  Asafostidae 549 

Catharticae  Compositae 760 

Copaibas 783 

Ferri  Carbonatis  (Massa) 141 

"      Compositae 141 

"      lodidi 141 

Galbani  Compositae 550 

Hydrargyri  (Massa) 279 

Opii 624 

—  Phosphori 128 

Quininae  Sulphatis. 192 

Rhei .' 754 

"    Compositae 754 

Pink-root 773 

Piper 786 

Piperin 786 

Pipsissewa  and  its  preparations 790 

Plumbism 311 

Plumbum  and  its  preparations 310 

Podophyllum  and  its  preparations 761 

Polygonum  Hydropiperoides 795 

Pomegranate 774 

Porter 583 

Potassii  Cyanidum 702 

Permanganas 155 

et  Sodii  Tartras 212 

Potassium  and  its  preparations 211 

Poultices 821 

Prescription  Writing 33 

Proplylamine 677 

Prunus  Virginiana 182 

Prussic  A  cid 698 

Ptomaines 432 

Pulsatilla 721 

PULVERBS : 

Pulveres  Effervescentes 220 

Pulvis  AloSs  et  Canellae 757 

Effervescens  Compositus 220 

Glycyrrhizaa  Compositus 745 


832 


INDEX   OF   REMEDIES. 


PAGE 

Pulvis  Ipecacuanhas  et  Opii 634,  737 

Jalapaa  Coinpositus 759 

—  Morphinae  Coinpositus 626 

Pulverization 9 

Pumpkin-seed 775 

Purgatives 774 

Pyoktanin 413 

Pyridine 8,  417 

Pyrocatechin 404 

Pyrogallol 347 

Q 

Quassia  and  its  preparations 178 

Quebrachine 730 

Quebracho 730 

Quercus  and  its  preparations 340 

Quinia  Carbamidata 209 

Quinine  and  its  Salts 192 

Quinine  and  Urethan 211 

R 

Raspail's  Eau  Sedatif 237 

Reichenhall 234 

Renal  Extract 434 

RESINS  : 
Resina  Guaiaci 356 

—  Jalapae 759 

—  Podophylli 761 

Scamraonii 760 

Resorcin 401 

Rhamnus  Purshiana 747 

Rhatany  and  its  preparations 340 

Rheum  and  its  preparations 754 

Rhubarb 754 

Rosa  Gallica  and  its  preparations 341 

Rubefacients 803 

Rubus 341 

Rue 795 

Russian  Baths 79 

Ruta...  ..  795 


Sabina 796 

Saccharin 418 

Sal  Ammoniac 234 

Salicetol 407 

Salicin 389 

Salicylate  of  Soda 390 

Salicylic  Acid 390 

Saline  Mineral  Waters 230 

Saline  Purgatives 749 

Salix 389 

Salol 407 

Salophen 407 

Sanguinaria  and  its  preparations 359 

Sanguinarine 359 

Sanguinarinic  Acid 359 

Santonica 771 

Santonin 771 

Saratoga  Springs,  Waters  of 230 

Sarsaparilla  and  its  preparations 354 

Sassafras  Medulla 820 

Savin 796 

Scammony  and  its  preparations 760 

Scilla  and  its  preparations 792 


PAGE: 

Scoparius 790- 

Scopolamine 543 

Seidlitz  Powders 220 

Senna  and  its  preparations 753 

Serpentaria  and  its  preparations .' 182 

Sevum 121 

Silver  and  its  preparations 298 

Sinapis  Alba 735,  803 

Nigra 735,  803 

Sitz-Bath 81 

Smilacine 355- 

Sodii  Hypophosphis 137 

—  Phosphas 137 

Pyrophosphas 137 

Salicylas 390- 

—  Sulphas 219 

Sodium  and  its  preparations 219- 

Somnal 588,  621 

Sozoiodol 277 

Sparteine 518,  791 

Spigelia  and  its  preparations 773- 

SPIRITI  : 

Spiritus  Athens  Compositus 591 

Athens  Nitrosi 591 

Ammoniae  235. 

Ammoniae  Aroinat  icus 235 

Camphorae 545 

Chloroformi 595. 

—  Frumenti 569 

Gaultheriae 427 

Juniperi  Compositus 788 

Vini  Gallici 569 

Squill 792 

Static  Electricity 474 

Statice  Limonium 341 

Steam  Bath 87 

Stillingia  and  its  preparations 357 

Stillingin 357 

Stramonium  and  its  preparations 535 

Strontium  and  its  Salts 326 

Strophanthine 517 

Strophanthus 517 

Strychnine  and  its  Salts 476 

Styptic  Colloid 339 

Sulphides 248 

Sulphites 246, 

Sulphocarbolates 385 

Sulphonal 621 

Sulphur  and  its  preparations 745 

Sulphuric  Acid 112 

Sulphurous  Acid 246 

Sulphurous  Mineral  Waters 250 

SUPPOSITORIA  : 

Suppositoria  Acidi  Tannici 339 

SYKUPI  : 

Syrupus  Acaciae 820 

Acidi  Citrici 243 

—  Calcii  Lacto-phosphatis 137 

—  Calcis 222 

Ferri  lodidi 142 

"     et  Mangani  lodidi 14  j 

Hypophosphitum 137 

"  cum  Ferro '. .  137 

Ipecacuanhas  737 

Lactucarii 647 


INDEX   OF   REMEDIES. 


833 


PAGE 

Syrupus  Mangani  lodidi 155 

Pruni  Virginianae 182 

Rhei 755 

Rubi 341 

—  Sarsaparillae  Compositus 354 

—  Scillse 792 

"     Compositus 321,  792 


Tabacum  and  its  preparations : 692 

Tannie  Acid 339 

Tannigen 349 

Tar 789 

Taraxacum 791 

Tartar  Emetic 743 

Tartaric  Acid 243 

Tea 74 

Terebene 781 

Terebinthina 776 

Terpine 781 

Terpinol 782 

Tetronal 622 

Teucrin 431 

Thallin 406 

Thebaine 634 

Theobromine 567 

Thymacetin 429 

Thymol 428 

TINCTORE  : 

Tinctura  Aconiti  Radicis 711 

Alogs 756 

"    et  Myrrhas 756 

Arnicas 676 

—  Asaf cetidae 549 

Belladonnas 523 

Benzoini 421 

"       Composite 421 

Calumba1 179 

Cannabis  Indicae 554 

Cantharidis 797 

—  Capsici 787 

Catechu 339 

Cimicifugae 520 

—  Cinchonas 192 

"       Composite 192 

—  Colchici 351 

Conii 662 

Cubebae 785 

Digitalis 506 

Eucalypti 185 

Ferri  Acetatis  Liberia 143 

"     Chloridi 142 

Gallas 339 

Gelsemii 672 

Gentianae  Compositae 178 

Guaiaci 356 

•       "       Ammoniata 356 

'    Humuli 646 

Hydrastis 188 

Hyoscyami 536 

Ignatiae 488 

lodi 253 

Ipecacuanhas  et  Opii 737 

Jaborandi 679 

Kino . .  340 


PAGE 

Tinctura  Krameriae 340 

—  Lactucarii 647 

—  Lobelise 696 

—  Lupulinae 646 

Nucis  Vomicae 475 

—  Opii 624 

-  "    Acetata 624 

-  "    Camphorata 624 

"    Deodorata 624 

—  Phosphor! 128 

"        jEtherialis 128 

—  Physostigmatis 686 

Phytolaccae 724 

Pilocarpi 679 

—  Pulsatillae 721 

Quassias 178 

Rhei 755 

"    Aromaticus 755 

"    Dulcis 755 

Sanguinariae 359 

Scillae 792 

Serpentariae 182 

Stramonii 535 

Strophanti 517 

—  Valerianas 552 

"        Ammoniatae 552 

Veratri  Viridis 716 

Tobacco 692 

Tolu,  Balsam  of 789 

Topical  Remedies 799 

Toxalbumin ' 436 

Toxins  and  Antitoxins 436 

Toxoglobulin 437 

Tragacanth 820 

Transfusion 27 

of  Milk 30 

—  Peritoneal 31 

Trichlorphenol 386 

Trimethylamine 677 

Trional 622 

TROCHISCI  : 

Trochisci  Acidi  Tannici 339 

Ammonii  Chloridi 234 

Cubebae 785 

Catechu 340 

—  Ferri  Subcarbonatis 141 

Glycyrrhizae  et  Opii 624 

Ipecacuanhas 787 

Morphines  et  Ipecacuanhas 626,  737 

—  Potassii  Chloratis 212 

Santonin! 772 

Tropacocaine • 564 

Troy  System 33 

Tuberculin 437 

Tully  Powder 626 

Turkish  Bath 82 

Turpentine 776 

Turpeth  Mineral 279 

Tyrotoxicon 621 

U 

Ulmus 820 

UNGUENTA : 

Unguentum  Acidi  Carbolic! 375 

Acidi  Tonnici ...  . .  339 


834 


INDEX   OF   REMEDIES. 


PAGE 

Unguentum  Benzoini 421 

—  Galla; 339 

—  Hydrargyri 279 

"          Ammoniata 280 

lodidiRubri 279 

"          Nitratis 280 

"      Rubri 279 

OxidiFlavi 279 

"      Rubri 280 

lodi 253 

lodoformi 267 

Plumbi  Carbonatis 310 

"       lodidi 310 

Potassii  lodidi 253 

—  Stramonii 535 

—  Tabaci 692 

Veratrinae 716 

—  Zinc  Oxidi 316 

Ural 588 

Uralia 564 

Uranii  Nitras 329 

Uranium 329 

Urethan 586 

Urino-Genital  Remedies 211,  776 

Uropherin 507 

Urotropin 800 

Ustilago  Maidis 505 

Uva  Ursi...  ..  790 


Valerian  and  its  preparations 552 

Vapor-Bath 91 

Vaseline 121 

Vegetable  Acids 243 

Vegetable  Diet 47,  55 

Venesection 812 

Veratrine 716 

Veratroidia 716 

Veratrum  Viride 716 

Viburnum  Opulus 364 

Prunifolium  ...  364 


PAGK 

Vichy 228 

Vienna  Paste 211 

Villate's  Solution 319 

Vinegar 243 

VINA  : 

Vinum 578 

Album .-.578 

"       Fortius 578 

—  Alo6s 756 

Antimonii  321 

—  Colchici  Radicis 351 

"         Seminis 351 

—  Ergotee 492 

Ferri  Amarum 143 

"     Citratis 143 

Ipecacuanhas 737 

—  Opii 624 

Rhei 755 

Rubrum 578 

Tabaci 692 

W 

Water 77 

Wet  Pack 80 

Whey-Cure 59 

Whisky 569 

Wine 578 

Woorara 667 

Worm-seed 773 


Xanthoxylin 362 

Xanthoxylum 362 


Yellow  Root 188 


Zinc  and  its  preparations 316 

Zinci  Phosphidum 128 

Zinci  Sulphas 316,  734 


ADDENDA. 


Acidum  Hypophosphorosum 113 

Argeiitamine 306 

Argonin 306 

Atmosphere,  The 93 

Cacodylates 21 

Carbolic  Acid,  Subcutaneous  Injection  of. .  386 

Chloretone 623 

Cusso 775 

Dormiol 624 

Infusion  of  Salt  Solution 32 

Oleum  Eucalypti 185 


Oxycamphor 732 

Protargol 306 

Roentgen  Rays 474 

Salipyrin 413 

Salt  Solution 14,    32 

Infusion  of 32 

Thiol 349 

Thyroid  Extract. 434 

X-Rays 474 

Xerof  orm 162 

Yohimbin  ...  . .  732 


CLINICAL  INDEX. 


ABDOMINAL  PLETHORA  : 

Aliment,  water-free  food,  54  ;  laxative  diet, 
66  ;  grape-cure,  55. 

Cathartics,  saline,  749  ;  resin-bearing,  753  ; 
and  hydragogue  purgatives,  764. 

Saline  Mineral  Waters,  229,  233  ;  especially 
Saratoga,  Vichy,  and  the  purgative  saline 
generally. 
ABORTION  : 

Aurum,  297.  The  chloride,  to  avert  the  tend-  ! 
ency  to  habitual  abortion. 

Cornutine,  500.  To  increase  uterine  action 
when  required. 

Opium,  641.  To  check  uterine  action,  and 
Ergot,  500,  Hydrastinine,  191,  and  Vibur- 
num, 365,  to  restrain  haemorrhage. 

Abortifacients,  ergot,  savine,  rue,  aloes,  pi- 
crotoxine,  apiol,  pilocarpus,  colocynth,  the 
hydragogue  cathartics,  etc.,  all  dangerous 
to  life  when  used  in  sufficient  quantity  to 
produce  abortion. 
ABSCESS : 

Belladonna  plaster,  523.    Emplastrum  am- 
moniaci  cum   hydrargyro,  278.      Leeches, 
814.    Silver  Nitrate  in  nitrous  ether  ap- 
plied  over   inflamed   area   and   adjacent  ! 
region  to  abort  inflammation,  304,  and  oint- 
ments or  powder  of  lodol,  274,  and  lodo- 
form,  271,  and  iodoform  substitutes,  Lore- 
tin,   275,    Nosophen,    276,   Europhen,    276, 
Aristol,    277.      Tincture    of  Iodine    as   a 
counter-irritant,  and  as  an  antiseptic  in- 
jected into  the  sac  of  an  abscess,  262.    Car-  , 
bolic  Acid,  383,  Salicylic  Acid,  400,  Resor- 
cin   and   Boric  Acid,  420,  for   antiseptic 
dressing.    Sulphides,  249,  gr.  $  every  few 
hours  to  abort  abscess,  or  hasten  the  for-  . 
mation  and  extrusion  of  pus.    Potass,  per- 
mangan.,  157,  as  a  deodorant  and  germi- 
cide.   Also  Methylene  blue,  414,  Naphtalin, 
415,  for  local  use. 
ACIDITY  : 

Mineral  Acids,  115,  before  meals.  Acid  fer- 
mentation, with  vomiting  of  pasty  matter, 
sulphurous  acid,  247.  During  meals  an 
acid  wine  (Rhine).  For  immediate  relief, 
alkalies  after  meals,  221.  The  frequent 
use  of  alkalies  enhances  the  mischief. 
Lime-water,  223.  Ammonium  Carbonate, 
237.  Alkaline  Mineral-waters,  229.  Tan- 


nic  Acid,  343,  in  pill-form— ui  j  glycerin  to 
gr.  iv  of  tannin.  Carbolic  Acid,  383,  stops 
fermentation  and  eructations.  Bismuth, 
163,  with  carbolic  acid,  gives  excellent  re- 
sults. The  purified  black  Mangani  Diox- 
idum,  156,  and  Silver  Oxide,  301,  are  serv- 
iceable, acting  as  local  sedatives  and  pre- 
venting acid  fermentation.  Lead  Acetate, 
313,  Kino,  343,  and  Nux  Vomica  Tincture, 
482,  act  in  the  same  way,  and  rather  re- 
move the  causes  than  affect  the  acidity  di- 
rectly. 

ACNE: 

Phosphorus,  136.  Even  more  effective  and 
safer  are  the  hypophosphites  and  phos- 
phates. Arsenic,  174 ;  sometimes  bene- 
ficial, but  on  the  whole  disappointing. 
Bismuth,  164,  is  an  excellent  topical  ap- 
plication when  there  are  heat  and  redness. 
Sublimed  Sulphur,  249,  applied  as  a  pow- 
der to  the  eruption  is  one  of  the  best  appli- 
cations. Sulphides,  250,  in  solution,  Ich- 
thyol,  350,  a  sulphur  compound  useful  both 
internally  and  externally  ;  also  iodoform 
substitutes,  Nosophen,  276,  Aristol,  277, 
and  others.  Alkaline  lotions,  when  the 
skin  is  greasy  and  the  sebaceous  follicles 
full,  are  useful ;  for  example,  liquor  po- 
tassce  in  rose-water,  225.  Lotions  of  cor- 
rosive sublimate,  294.  Glycerin,  817,  in- 
ternally. 

ADYNAMIA  : 

Alcohol,  576,  is  serviceable  when  it  improves 
the  appetite  and  digestion,  when  the  tongue 
becomes  moist,  and  when  delirium  sub- 
sides under  its  use.  Brandy  is  the  best 
form  when  bowels  are  relaxed  ;  whisky 
when  there  is  constipation.  A  wine  of 
good  body  and  high  bouquet  in  the  weak- 
ness of  sedentary  occupations.  Aliment, 
68,  73,  beef,  milk,  cod-liver  oil.  Bitters, 
especially  calumba  and  hydrastine,  190,  as 
a  substitute  for  quinine.  Eucalyptus,  187, 
for  malarial  adynamia,  but  especially  the 
alkaloids  of  cinchona,  notably  quinine, 
201,  gr.  ij — gr.  v.  ter  in  die.  Iron,  147,  to 
stimulate  digestion  and  promote  blood 
formation,  with  manganese.  Chalybeate 
springs,  161.  Ferratin,  153,  an  albuminous 
compound  of  iron.  Nux  Vomica  Tincture, 


886 


CLINICAL   INDEX. 


482,  with  capsicum  in  the  case  of  inebri- 
ates. Coca,  fluid  extract,  561,  prevents 
waste,  and  favors  constructive  metamor- 
phosis. 

AFTER-PAINS  : 

Chloral,  617,  one  of  the  most  efficient  reme- 
dies, but  considerable  doses  necessary. 
Camphor,  548,  effective,  with  or  without 
morphine.  Gelsemium,  675,  also  stops 
after-pains,  but  as  large  doses  are  neces- 
sary, safer  remedies  are  preferable.  Mor- 
phine and  atropine,  533,  subcutaneously  or 
by  the  stomach,  very  certain  to  relieve. 
Cimicifuga,  522,  affords  some  relief. 

ALBUMIN  URIA  : 

Milk  cure.  58;  especially  buttermilk,  60.  Iron, 
152.  Basham's  Mistura  Ferri  et  Ammonii 
Acetatis,  152,  and  the  purgative  chalybeate 
waters,  161,  for  the  anaemia.  Arsenic,  175, 
for  the  interstitial  changes  in  kidneys. 
Alkaline  diuretics,  219.  Gallic  acid,  344, 
especially  Aitken's  formula  to  restrain  loss 
of  albumen.  Oxygen,  367.  Gold  and  So- 
dium Chloride,  297,  in  the  chronic  forms. 
Nitro-glycerin  and  Nitrites,  711,  for  high 
vascular  tension.  Pilocarpine,  683.  Digi- 
talis, 513,  when  quantity  of  urine  much 
lessens.  Oxalic  Acid,  245,  is  suggested  by 
its  selective  action.  Lactate  of  Strontium, 
327,  Salts  of  Uranium,  329,  in  chronic 
forms  ;  also  Oil  of  Erigeron,  184,  Terpin 
Hydrate,  782,  renal  stimulants. 

ALCOHOLISM  : 

Bromides,  652,  especially  for  the  "horrors," 
in  drachm  doses.  Capsicum,  788,  for  its 
stomachic  tonic  and  hypnotic  qualities. 
Chloral,  617,  very  efficient  in  the  acute 
form,  but  caution  is  required  in  cases  with 
weak  heart  and  in  old  drunkards.  Opium, 
640,  cautiously,  and  especially  with  bella- 
donna, 644.  Zinc  Oxide,  319,  for  the  chronic 
Btate,  with  piperine  or  capsicum.  Cin- 
chona, 207,  especially  the  C.  Rubra,  fluid 
extract.  Lupulin,  646,  fluid  extract  with 
capsicum  ;  good  substitute  for  alcoholic 
stimulants.  Picrotoxin,  491,  for  the  mus- 
cular tremors.  Nux  Vomica,  484,  nerve 
and  stomachic  tonic.  Pilocarpine,  683, 
very  effective  in  acute  attacks  to  induce 
sleep. 

AMAUROSIS  : 

Strychnine,  484,  hypodermatically,  curative  in 
functional  disease  caused  by  tobacco,  alco- 
holic excess,  etc.  Pilocarpine,  683,  and 
also  Picrotoxin,  491. 

AMENORRHCEA  : 

Aconite,  715,  for  sudden  depression  due  to 
cold.  Aloes,  758,  when  due  to  anaemia  and 
torpor.  Iron,  151,  when  anaemia  is  the 
cause  ;  may  be  given  with  nerve-stimu- 
lants, as  nux  vomica,  chalybeate  waters, 
161.  Apiol,  794,  and  Hydropiper,  795,  when 
there  is  functional  inactivity  of  ovaries, 
preceded  by  a  chalybeate  course,  by  aloes, 
apiol  being  given  just  before  the  period 
for  several  days.  Arsenic,  175,  as  a  recon- 


stituent,  combined  with  iron.  Gold  and 
Sodium  Chloride,  297,  a  stimulant  of  the 
menstrual  function  ;  also,  Oxalic  Acid, 
245.  Asafcetida,  551,  for  the  nervous  dis- 
turbance and  as  an  ovarian  stimulant. 
Electricity,  470,  faradic  and  static ;  very 
efficient  to  start  the  flow  when  suitable 
preparation  has  been  made.  Ergot,  501,  is 
useful  when  plethora  exists.  Rue,  796,  and 
Savin,  797,  are  active  stimulants,  to  be 
given  with  great  caution.  Pulsatilla,  722, 
used  under  the  same  circumstances  as 
aconite  in  sudden  arrest  of  flow.  Perman- 
ganate of  Potassium  and  Saltt  of  Man- 
ganese are  the  most  effective  stimulants  of 
the  menstrual  flow,  158. 
ANEMIA: 

Compressed  Air,  99.  Oxygen,  348.  Iron,  146. 
Ferratin,  153,  Homogalol,  154,  Hamol,  154, 
mild  preparations  as  substitutes  for  iron 
salts.  Arsenic,  175,  an  adjunct  of  iron,  or 
when  the  latter  can  not  be  borne.  Pepsin 
and  Pancreatin,  106,  to  aid  the  primary 
assimilation.  Lacto-phosphate  of  Lime, 
134,  a  material  needed  in  the  anaemia  of 
lactation  and  of  suppuration.  Manganese, 
156,  of  use  when  associated  with  iron, 
Galvanization,  469,  central,  and  general 
faradization,  to  stimulate  the  functions  of 
organic  life.  Wines,  581,  especially  wines 
with  good  body.  Red  Marrow  of  bone,  436. 
ANAESTHESIA  : 

Magnetism,  464,  and  Metallotherapy,  331,  for 
the  hysterical  state,  and  for  other  forms, 
the  electric  brush,  468,  and  Strychnine,  483. 
ANESTHETICS  : 

Rules  for  administration,  603.  Morphine, 
subcutaneously  by  the  method  of  Bernard, 
602 ;  facilitates  the  inhalation,  lessens  the 
dangers,  and  prolongs  the  anaesthetic  stage 
with  a  less  quantity  of  the  anaesthetic. 
Whisky,  602,  administered  before  inhala- 
tion, sustains  the  heart  and  prolongs  the 
narcosis.  Means  of  restoration,  604,  de- 
pressing head,  drawing  out  tongue,  artifi- 
cial respiration,  inhalation  of  ammonia,  or 
intravenous  injection  of  the  same,  faradiza- 
tion of  chest-muscles,  electro-puncture  of 
the  heart,  etc. 
ANEURISM  : 

Aliment ,  54,  denutrition-cure.  Tuf nell's  plan, 
56.  Barium  Chloride,  242,  acts  by  raising 
the  arterial  tension,  and  has  been  used  suc- 
cessfully. Iodides,  258,  in  full  doses,  relieve 
pain,  and  promote  coagulation  of  blood  hi 
the  sac.  Acetate  of  Lead,  301,  depresses 
the  heart  and  raises  the  arterial  tension. 
Veratrum  Viride,  719,  slows  the  circula- 
tion, and  thus  facilitates  coagulation  in 
the  sac.  Aconite  and  other  arterial  seda- 
tives act  similarly,  but  their  action  must 
be  aided  by  a  proper  diet  and  absolute  re- 
cumbency. Ergot,  499,  especially  ergotin 
subcutaneously,  has  been  very  effective. 
Galvano-puncture,  471,  has  but  rarely  suc- 
ceeded. 


CLINICAL   INDEX. 


837 


ANGINA  PECTORIS  : 

Amyl  Kitrite,  706,  by  inhalation,  affords 
prompt  relief  in  cases  characterized  by 
elevated  arterial  tension,  but  must  be  used 
with  caution  when  arteries  are  atheroma- 
tous  and  heart  is  fatty.  Nitro-glycerin, 
709,  acts  similarly  but  more  slowly,  and  is 
more  manageable.  Arsenic,  173,  in  full 
doses,  is  very  efficient  as  a  means  of  pre- 
vention. Ether,  593,  in  small  quantity  by 
inhalation,  may  abort  a  mild  attack,  hypo- 
dermatically,  in  the  worst  cases. 
ANTIDOTES  : 

Far  the  Mineral  Acids,  112.  Alkalies,  soda, 
lime-water,  soap,  and  protectives,  as  oil, 
mucilage,  etc.  For  the  systemic  depres- 
sion, alcohol,  opium,  and  especially  car- 
bonate of  ammonia. 

For  Phosphorus,  128.  Emetic  of  sulphate  of 
copper,  French  turpentine,  or  old,  unrecti- 
fied  turpentine,  hydrated  magnesia,  laxa- 
tives, transfusion,  and  especially  solution 
of  Permanganate  Potassium,  130.  Oils  and 
fats  aid  the  absorption  of  phosphorus,  but 
mucilaginous  protectives  are  useful. 

For  Arsenic,  166.  Hydrated  sesquioxide  of 
iron,  dialyzed  iron,  hydrated  magnesia, 
emetics,  the  stomach-pump ;  opium  and 
alcoholic  stimulants  for  the  systemic  de- 
pression. 

For  the  Caustic  Alkalies,  212.  Diluted  acetic 
acid,  vinegar,  soap,  oil ;  opium  and  stimu- 
lants for  the  systemic  depression. 

For  Barium,  241.  Emetics,  protectives,  hy- 
drated magnesia,  tannin,  especially  diluted 
sulphuric  acid  ;  nitrite  of  amyl  and  nitro- 
glycerin  to  counteract  the  elevated  arterial 
tension. 

For  Sulphurous  Acid  and  Sulphites,  246,  and 
the  Sulphides,  248.  Weak  acids,  chlorine- 
water,  sulphate  of  iron,  common  salt,  etc. 

For  Iodine  and  its  poisonous  compounds, 
254.  Starch  is  the  antidote  for  iodine  ;  but, 
as  the  iodide  of  starch  is  not  without  power, 
emetics  should  also  be  given.  Albumen, 
starch,  lime-water,  tannin,  soap,  etc., 
should  be  used  in  poisoning  by  iodides, 
and  free  emesis  should  be  induced. 

For  lodoform,  269. 

For  Mercury  and  its  compounds,  281.  Albu- 
men, the  carbonated  alkalies,  tannin,  lime- 
water,  should  be  administered  freely. 
Emetics  should  be  given.  For  the  usual 
systemic  symptoms,  opium,  alcoholic  stim- 
ulants, etc. 

For  Gold  and  its  Chlorides,  296.  Same  as 
for  mercury. 

For  Silver,  298.  Common  salt  freely,  albu- 
men, tannin,  and  emetics. 

For  Copper,  306,  and  Zinc,  317.  Albumen, 
tannin,  lime-water,  soap,  oil,  and  mucilage  ; 
and  the  usual  systemic  remedies. 

For  Lead,  31 1 .  Diluted  sulphuric  acid,  alum , 
Epsom  salts,  milk ;  emetics  and  purga- 
tives ;  iodides  and  bromides  to  secure 
elimination. 


For  Antimony,  322.  The  vegetable  astrin- 
gents, tannin,  albumen,  oil,  mucilage,  and 
opium  and  stimulants  to  counteract  the 
depression. 

For  Nux  Vomica  and  its  Alkaloids,  476. 
Chloral,  ether  and  chloroform,  gelsemium, 
bromide  of  potassium,  are  the  physiologi- 
cal antagonists  ;  tannin  is  a  chemical  anti- 
dote. 

For  Picrotoxin,  489.  The  physiological  an- 
tagonists and  the  antidotes  are  the  same 
as  for  strychnine. 

For  Ergot,  492.  The  caustic  alkalies,  aconite, 
but  especially  amyl  nitrite. 

For  Digitalis,  507.  Aconite,  saponaria,  amyl 
nitrite,  and  nitro-glycerin,  are  the  physio- 
logical antagonists  ;  tannin,  sulphate  and 
chloride  of  iron,  are  chemical  antidotes. 

For  Belladonna  and  its  alkaloid  Atropine, 
523.  Opium  or  morphine,  physostigma  or 
eserine,  and  pilocarpine,  are  the  most  effi- 
cient antagonists.  The  caustic  alkalies  de- 
stroy the  active  principle,  but  the  avail- 
able chemical  antidotes  are  tannin,  com- 
pound solution  of  iodine,  charcoal,  etc. 

For  Stramonium,  Hyoscyamus,  and  DM- 
boisia.  The  antagonists  and  chemical 
antidotes  are  the  same  as  for  belladonna. 

For  Camphor,  545.  Caffeine,  the  arterial 
sedatives,  etc. 

For  Cannabis  Indica,  555.  Caustic  alkalies, 
strychnine,  faradic  electricity. 

For  Chloroform.  By  the  stomach,  595.  The 
stomach-pump,  oil  and  mucilage,  atropine, 
faradism,  artificial  respiration,  and  cold 
affusion.  By  inhalation,  604.  Nelaton's 
method  (inversion  of  the  body),  drawing 
out  the  tongue,  artificial  respiration,  fara- 
dism, ammonia  by  inhalation  and  intra- 
venous injection,  amyl  nitrite  by  inhala- 
tion, subcutaneous  injection  of  tincture  of 
digitalis,  and  oxygen,  348,  by  inhalation. 

For  Chloral,  613.  Ammonia,  atropine,  gal- 
vanism, and  heat,  to  overcome  the  cardiac 
depression.  Strychnine  is  the  antagonist 
of  Liebreich,  but  its  range  is  limited. 
Eserine,  to  a  slight  extent,  is  physiologic- 
ally opposed. 

For  Opium,  627.  The  stomach-pump,  or 
emetics  (bicarbonate  of  sodium,  followed 
by  tartaric  acid,  has  acted  favorably) ; 
cold  affusion,  faradization,  and  artificial 
respiration,  when  the  respiration  flags ; 
belladonna,  or  atropine  subcutaneously, 
has  acted  favorably  in  numerous  cases ; 
caffeine  injected,  or  black  coffee. 

For  Conium,  663.  Chemically  the  caustic 
alkalies  and  tannic  acid  are  antidotes ; 
emetics  or  the  stomach-pump,  cold  affu- 
sion, artificial  respiration.  Atropine  and 
strychnine,  subcutaneously,  to  counteract 
the  respiratory  depression. 

For  Curara  or  Woorara,  667.  Caustic  alka- 
lies and  tannin  act  chemically ;  artificial 
respiration  is  of  the  highest  importance  ; 
atropine  and  strychnine  counteract  the 


838 


CLINICAL   INDEX. 


respiratory  failure.  Cold  affusion  and 
emetics,  or  the  stomach-pump,  are  neces- 
sary. 

For  Gelsemium,  672.  Chemically  caustic 
alkalies  and  tannic  acid.  Emetics,  warmth, 
ammonia,  faradization  of  chest-muscles, 
artificial  respiration,  and  morphine,  sub- 
cutaneously,  are  the  important  measures. 

For  Pilocarpus,  679.  The  persalts  of  iron 
and  the  salts  of  metals  are  chemically  anti- 
dotal. Atropine  is,  in  a  very  complete  de- 
gree, the  physiological  antagonist ;  cardiac 
stimulants,  as  ammonia  and  alcohol,  an- 
tagonize the  cardiac  depression. 

For  Physostigma,  687.  The  vegetable  astrin- 
gents and  tannin,  chemical  antidotes. 
Physiological  antagonists  are,  atropine  to 
considerable  extent— chloral,  apparently, 
more  completely.  Faradization  of  chest- 
muscles  and  artificial  respiration  are  im- 
portant measures.  Emetics  should  not  be 
omitted. 

For  Tobacco  or  Nicotine,  692.  Emetics  or 
Btomach-pump.  Tannin,  compound  solu- 
tion of  iodine,  potassium  permanganate, 
157,  chemical  antidotes.  Ammonia,  bran- 
dy, atropine,  and  strychnine  to  overcome 
failure  of  respiration  ;  also,  artificial  res- 
piration, cold  affusion. 

For  Hydrocyanic  Acid  and  Cyanide  of  Po- 
tassium, 698,  702.  Cold  affusion  to  the 
spine,  artificial  respiration,  and  the  injec- 
tion of  atropine,  are  the  best  expedients. 
Emetics  should  be  given  if  there  is  time. 

For  Amyl  Nitrite  and  Nitro-glycerin,  704, 
707.  Ammonia,  cold  affusion,  and  artificial 
respiration,  strychnine  and  atropine  sub- 
cutaneously,  also  ergot,  a  true  physio- 
logical antagonist. 

For  Aconite  and  Veratrum  Viride,  711,  716. 
Ammonia,  alcohol,  artificial  respiration, 
heat,  atropine,  or  morphine,  subcutaneous- 
ly ;  also  digitalis. 

For  Agaricin  and  Muscarine,  726.  A  com- 
plete antagonism  exists  between  atropine 
and  muscarine  ;  also,  digitaline  and  eserine 
are  antagonists.  Potassium  permanga- 
nate, 157,  antidotal  to  organic  alkaloids. 

For  Chlorine,  370.  Ammonia  for  the  gas, 
and  albumen  for  the  solution. 

For  Carbolic  Acid,  375.  Saccharate  of  lime, 
or  lime,  is  a  chemical  antidote.  Oils  and 
glycerin  must  not  be  given,  but  vegetable 
demulcents  used  freely.  Atropine  is  a 
physiological  antagonist  of  great  value. 
Emetics  should  be  used,  and  diluents. 

For  Salicylic  Acid  and  Resorcin,  3SO,  401. 
Arterial  and  respiratory  stimulants  pre- 
vent the  cardiac  depression,  especially 
atropine. 

For  the  Hydragogue  Cathartics,  764.  Demul- 
cents, opium,  and  stimulants. 

For  Turpentine,  776.  Emetics,  diluents,  and 
demulcents.  Opium  is  the  most  important 
remedy  to  counteract  the  local  irritation 
and  the  cerebral  effects. 


For  Savin  and  Cantharides,  796.  Emetics 
and  demulcents.  Opium  to  counteract  the 
depression  and  local  inflammation  ;  also, 
stimulants  and  atropine  for  the  cardiac 
depression. 

ANTIPYRETICS  : 

Quinine,  204,  first  in  importance,  but  must  be 
given  in  full  doses.  Eucalyptus,  186,  use- 
ful in  chronic  malarial  poisoning.  Digita- 
lis, 511,  chiefly  useful  as  an  adjunct  to 
quinine.  Salicylic  Acid,  or  salicylates,  396, 
active  and  certain  antipyretics.  Antipyrin, 
412,  Salol,  408,  Acetanilid,  425,  Resorcin, 
404,  Thallin,  406,  Naphtol,  416,  Asaprol,  417, 
Phenacetin,  418.  Benzoates,  422,  are  the 
more  important  of  the  antiseptic  antipy- 
retics. Cold  Baths,  83,  84,  the  most  power- 
ful means  of  lowering  temperature.  Pilo- 
carpine,  683,  reduces  fever  after  a  prelimi- 
nary stimulation.  Of  lesser  importance 
are  Aconite,  713,  Gelsemium,  674,  and  Phy- 
tolacca,  725. 

ANTISEPTICS  : 

Carbolic  Acid,  375,  and  the  other  members 
of  the  group  in  the  same  division,  including 
those  mentioned  above,  and  classed  to- 
gether as  Antiseptics,  365  et  seq. 

APHONIA  : 

Atropine,  527,  is  curative  in  hysterical  cases, 
if  given  to  induce  some  obvious  constitu- 
tional symptoms.  Nitric  Acid,  118,  is  very 
effective  in  the  hoarseness  of  singers,  when 
the  aphonia  is  reflex  (cold,  indigestion, 
etc.),  and  in  fatigue  of  vocal  cords,  Elec- 
tricity, 467,  by  an  intra-laryngeal  elec- 
trode, usually  cures  paresis  of  the  vocal 
cords. 

APHTHA  : 

Bismuth,  162,  in  powder  directly  to  the  ulcers. 
Coptis,  180,  the  infusion  as  a  topical  appli- 
cation. Potassium  Chlorate,  217,  224,  prob- 
ably the  most  effective  remedy,  locally, 
and  by  the  stomach  ;  full  doses  are  neces- 
sary, lodoform,  263,  with  or  without  Tan- 
nin, 264,  and  lodol,  274.  Naphtalin,  417, 
an  excellent  topical  application.  Quinine, 
200,  highly  useful  as  a  tonic.  Muriatic 
Acid,  114,  a  local  application,  to  ulcers, 
formerly  more  employed  than  at  present. 
Sulphurous  Acid,  246,  well  diluted,  in  the 
form  of  spray.  Carbolic  Acid,  377,  pure, 
applied  to  ulcers,  an  anaesthetic  and  al- 
terant. Resorcin,  404,  dusted  over  affected 
surface. 

APOPLEXY.    (See  HEMORRHAGE,  CEREBRAL.) 

ARTHRITIS,  CHRONIC  RHEUMATIC  : 
Alkalies,  217,  especially  lithium.  Potassium 
Iodide,  260.  Cimicifuga,  522.  Salicylates, 
399 ;  especially  in  debilitated  subjects, 
Salicylate  of  Cinchonidine,  397.  Salicin, 
389.  Salol,  408.  Acetanilid,  426.  Anti- 
pyrin, 412.  Phenacetin,  418.  Carbolic  Acid, 
382,  by  parenchymatous  injection.  Arse- 
nic, 173,  persistently  used  in  small  doses. 
Cod-liver  Oil,  126,  with  or  without  the 
phosphates. 


CLINICAL   INDEX. 


839 


ASCARIDES  : 

Quassia,  181,  also  Eucalyptus,  186,  an  infu- 
sion as  a  rectal  injection,  or  by  irrigation 
of  the  bowel.  Carbolic  Acid,  382,  is  an 
efficient  but  unsafe  parasiticide  when  in- 
jected in  the  rectum.  Iron,  147,  the  sirup 
of  the  iodide,  by  the  stomach  to  prevent 
reproduction,  and  the  tincture  by  rectal 
injection.  Santonin,  772,  at  night,  with  or 
without  calomel,  and  a  laxative  in  the 
morning.  Enema  Aloes,  769.  Hydrocyanic 
Acid,  701,  for  lumbricoides.  Salicylic  Acid, 
395,  by  enema  and  by  stomach.  Myrtol,  429, 
and  Cajeput  Oil,  430. 

ASCITKS  : 

Copaiba  Resin,  784,  has  proved  very  efficient 
as  a  diuretic.  Pilocarpine,  683,  very  serv- 
iceable when  given  to  produce  free  dia- 
phoresis. Jalap,  759,  in  the  form  of  the 
compound  powder,  most  useful  as  a  hydra- 
gogue  cathartic.  Elaterium,  767,  also  a 
hydragogue  of  great  power  ;  must  be  given 
cautiously,  and  not  at  all  when  gastro- 
intestinal irritation  exists.  Remedies  are 
more  active  when  aided  by  a  milk-diet,  59, 
or  by  dry  diet,  54. 

ASTHMA : 

Air,  compressed,  99.  Oxygen,  367,  pure  or  di- 
luted, by  inhalation.  Amyl  Nitrite,  706,  by 
inhalation,  or  Nitro-glycerin,  710,  by  the 
stomach.  Arsenic,  173,  by  the  stomach,  as 
a  prophylactic,  or  by  smoking  in  cigarettes. 
Bromides,  656,  relieve  in  purely  spasmodic 
asthma,  but  soon  lose  their  effect ;  also 
Bromoform,  660.  Chloral,  617,  may  arrest 
the  paroxysms,  but  danger  of  chloral 
habit.  Chloroform,  605,  by  inhalation, 
dropped  on  warm  water,  relieves,  but  a 
habit  is  quickly  formed.  Last  two  reme- 
dies are  dangerous  in  weak  heart.  Ether, 
605,  is  safer  and  equally  efficient  by  inhala- 
tion. Paraldehyde,  585.  Quebracho,  732,  a 
valuable  remedy  in  most  forms  of  dyspnoea. 
Hyoscine,  540.  Belladonna,  527,  in  pastilles 
with  stramonium  and  other  narcotics,  gives 
temporary  relief,  but  Atropine,  hypoder- 

•  matically,  is  more  efficient.  Morphine,  644, 
and  atropine  subcutaneously,  give  more 
decided  and  lasting  relief  than  any  other 
remedies.  Grindelia,  723,  is  a  most  useful 
remedy,  next  in  value  as  a  means  of  imme- 
diate relief  to  morphine  and  atropine.  Io- 
dide of  Potassium,  259,  in  full  doses,  suc- 
ceeds remarkably  in  some  cases.  Ethyl 
Iodide,  267,  and  Ethyl  Bromide,  by  inhala- 
tion. Quinine,  207,  as  a  tonic  after  the 
acute  symptoms  and  as  a  prophylactic  in 
the  interval.  Strychnine,  484,  is  indicated 
when  there  is  weakness  of  respiratory 
muscles.  Pyridine,  417,  a  new  and  effect- 
ive remedy,  by  inhalation.  Oalvaniza- 
tion,  409,  of  the  pneumogastric  and  cervical 
sympathetic  relieves  the  spasmodic  diffi- 
culty of  breathing,  and  sometimes  effects 
a  cure,  and  faradization  of  the  chest- 
muscles  has  lately  been  reported  success- 


ful in  effecting  a  cure.  Tartar  Emetic,  324, 
and  Lobelia,  697,  carried  to  slight  nausea 
in  cases  of  deficient  secretion  of  bronchial 
mucus.  Pilocarpus,  683,  subcutaneously 
in  spasmodic  asthma. 

ASTIGMATISM  : 

Atropine,  531,  a  weak  solution  to  facilitate 
examination.  Hyoscine,  540,  Duboisine, 
542,  a  substitute.  Eserine,  691,  in  some 
cases. 

ATHEROMA  or  THE  VESSELS  : 
Arsenic,  173,  indicated  when  eyes  are  puffy, 
breathing  short,  and  ankles  swollen.  Phos- 
phorus, 135,  in  minute  doses  for  the  weak- 
ness and  mental  failure  associated  there- 
with, with  or  without  Cod-liver  Oil,  126, 
which  may  also  be  advantageously  com- 
bined with  phosphates  and  hypophos- 
phites.  Ammonium  Carbonate,  238.  to 
dissolve  thrombi.  Quinine,  207,  is  of  great 
service  administered  in  a  full  dose  daily  for 
a  time.  The  Iodides,  258,  persistently  ad- 
ministered, in  a  high  degree  effective. 

BED-SORES  : 

Alcohol,  577,  a  wash  to  skin.  Alum,  337,  with 
tincture  of  camphor  and  whites  of  eggs,  a 
good  topical  application  Bismuth  Sali- 
cylate,  164.  Resorcin,  404,  in  form  of 
powder.  Copaiba,  784,  and  Castor-Oil, 
equal  parts,  but  Naphtol,  416,  Methylene 
Blue,  413,  Tannigen,  349,  Dermatol,  164, 
local  applications,  astringent  and  antisep- 
tic. A  galvanic  couplet,  zinc  and  silver, 
connected  with  a  copper  wire,  has  been 
used  with  success,  470. 

BILIARY  CALCULI.    (See  CALCULI.) 

BILIOUSNESS  : 

Acids,  Mineral,  115,  before  meals  in  acid  in- 
digestion. Hydrochloric  acid  and  pepsin 
after  meals  in  atonic  dyspepsia.  Alkalies, 
and  their  laxative  salts,  216,  and  Alkaline 
Mineral  Waters,  229,  234,  when  the  uric 
acid  is  in  excess.  Sodium  Phosphate,  139, 
especially  useful.  Aloes  and  the  resin-bear- 
ing cathartics,  756,  Cholagogues,  so  called, 
Euonymin,  721,  Iridin,  763,  Baptisin,  764, 
etc.,  to  promote  biliary  evacuations.  Cal- 
omel and  blue-pill,  284,  in  small  quantity 
as  laxatives  merely.  Ammonium  Chloride, 
237.  Manganese,  156.  in  gouty  subjects. 
Ammonium  Iodide,  or  iodine,  257,  in  the 
biliousness  of  the  malarial  cachexia.  Hy- 
drastis,  190,  Stillingia,  357,  and  the  bitters, 
also  Tincture  of  Nux  Vomica,  482,  after 
the  action  of  saline  or  resinous  cathartics. 
Milk-Diet,  59,  65,  Whey-Cure,  59,  Koumiss, 
59,  of  high  importance. 

BITES  OF  VENOMOUS  SNAKES  : 
Ammonia,  240,  Bromine,  372,  locally  to  the 
wound.  Intravenous  Injection  of  Am- 
monia, 26.  Potassium  Permanganate,  157, 
Alcoholic  Stimulants,  576.  Chlorinated 
Lime,  370. 

BLADDER,  CATARRH  OF  : 
Alkalies,  218,  after  meals,  when  urine  is  acid. 
Ammonium  Benzoate,  422,  when  urine  is  al- 


CLINICAL   IXDEX. 


kaline.  Copaiba,  784,  Cubebs,  786,  Juniper, 
789,  and  other  urine-genitals,  are  useful, 
but  liable  to  damage  kidneys.  Cantharides 
Tincture,  790,  very  efficient  in  small  doses. 
Magnesium  Borotartrateand  Borocitrate, 
421,  have  proved  highly  useful.  Eucalyp- 
tus. 187.  and  Turpentine,  781.  Quinine,  207, 
very  beneficial  when  there  is  septicaemic 
fever.  Salicylic  Acid,  394,  Salol,  409,  Sac- 
charin, 418,  and  other  members  of  the 
series,  have  proved  effective. 

BLADDER,  IRRITABILITY  OP  : 
Belladonna,  530,  of  special  utility  in  noctur- 
nal incontinence,  but  must  be  carried  to 
the  production  of  physiological  effects. 
Cantharides  Tincture,  799,  sometimes  suc- 
ceeds remarkably  in  irritable  bladder  of 
women.  Aquapuncture,  809,  often  cura- 
tive. When  urine  is  acid,  Alkalies,  218 ; 
when  alkaline,  Ammonium  Benzoate,  422. 

BOILS  : 

Arsenic,  174,  long  continued  for  a  succession 
of  boils.  Silver  Nitrate,  305,  dissolved  in 
nitrous  ether,  and  painted  on  early,  will 
abort.  Sulphides,  249,  in  small  doses  fre- 
quently, either  stop  formation  or  push  to 
maturation  and  discharge  of  pus.  Sulphur- 
ous Waters,  253,  act  in  same  way.  Phos- 
phates, 140,  suitable  tonics. 

BONE  DISEASES  ;  SOFTENING  OF  BONE  : 
Lime  Carbonate  and  Phosphate,  139,  are 
materials  necessary.  Phosphorus,  135,  pro- 
motes formation  of  bony  tissue.  Phos- 
phates, 139,  improve  tissue  formation  in 
general.  Cod-liver  Oil,  124,  in  combina- 
tion. Calcium  Chloride,  223,  in  strumous 
subjects.  (See  also  CARIES,  RICKETS.) 

BEEATH,  FOUL : 

Chlorine-Water,  370,  properly  diluted.  Car- 
bolic Acid,  383,  in  dilute  solution,  as  a 
mouth-wash,  and  by  the  stomach.  Potas- 
sium Permanganate,  159,  in  rose-water  as  a 
mouth-wash.  Benzoic  Acid  and  Tincture 
of  Benzoin,  422,  topically  and  internally. 

BKIGHT'S  DISEASE  : 

Milk-Cure,  Koumiss,  Whey,  59,  61,  have  been 
very  successful,  especially  an  exclusive 
skim-milk  diet,  or  a  diet  composed  largely 
of  milk.  Water,  82,  and  large  draughts  of 
weak  alkaline  waters.  Potassium  Bitar- 
trate,  218,  as  lemonade,  drunk  freely  as  a 
diuretic.  Digitalis,  513,  the  infusion  for 
dropsy.  Iodide  of  Potassium,  258,  in  cases 
of  chronic  kind  (especially  if  there  is  a 
syphilitic  taint),  and  in  arterio-sclerosis. 
Iron,  152,  the  tincture  of  the  chloride  well 
diluted,  or  in  BashanVs  mixture,  to  stimu- 
late the  kidneys  and  to  relieve  the  accom- 
panying anaemia.  Pilocarpus,  683,  highly 
useful  in  many  cases  of  uraemia.  Aurum, 
297,  in  chronic  interstitial  nephritis  and 
amyloid  kidney.  Cantharides,  799.  Euca- 
lyptus, 187,  and  other  urino-genitals,  but 
are  doubtful.  Nitro-glycerin,  709,  has 
proved  highly  useful  when  there  is  In- 
creased vascular  tension. 


BRONCHITIS,  ACUTE  : 

Muscarine,  729,  at  the  onset  of  the  disease 
may  arrest.  Aconite,  714,  in  small  dose 
frequently.  Tartar  Emetic,  324,  in  mod- 
erate quantity,  with  or  without  morphine. 
Nitric  Acid  dilute,  118,  Cimicifuga,  521,  an 
expectorant,  may  be  combined  with  opium 
and  aconite.  Ammonium  Carbonate,  239, 
if  secretion  is  viscid  and  there  is  depression. 
Sanguinaria,  359,  and  Lobelia,  698,  nauseat- 
ing expectoration,  best  given  with  opium. 
Terebene  for  cough,  781,  a  valuable  remedy. 
Morphine,  or  Dover's  Powder,  with  quinine, 
642,  may  abort  if  given  early  enough.  Pilo- 
carpus, 683,  often  highly  useful  at  the  be- 
ginning. For  mild  cases,  Sirup  of  Squills, 
793,  or  the  compound  sirup,  with  Pare- 
goric, makes  a  useful  combination.  Ipecac, 
740,  as  expectorant'.  Apomorphine  and 
Apocodeine,  736. 

BRONCHITIS,  CAPILLARY  : 
Iodides,  258,  diminish  the  viscidity  of  the 
secretion,  and  thus  lessen  one  of  the  chief 
dangers.  Ammonia  Carbonate,  239,  acts 
similarly,  and  is  indicated  when  depression 
comes  on.  Ethyl  Iodide,  by  inhalation, 
267,  and  Terebene.  Serpentaria,  183,  a 
stimulating  expectorant,  may  be  given 
with  ammonia.  Turpentine,  779,  when  the 
capillary  circulation  languishes.  Terebene, 
for  cough,  781.  Camphor,  647,  also  under  the 
same  circumstances.  Emetics  are  highly 
useful,  the  Mercury  Subsulphate,  734,  ^Uwm, 
734,  and  Apomorphine,  736,  being  the  prin- 
cipal. Pilocarpus,  683,  when  there  is  much 
secretion.  Pyridine  Vapor,  417. 

BRONCHITIS,  CHRONIC  : 

Koumiss,  59,  71,  a  valuable  nutrient.  Cod- 
liver  Oil,  124.  Iron,  150,  especially  the  mis- 
tura  ferri  composita.  Ammonium  Chloride, 
239,  combined  with  stimulating  expecto- 
rants, as  Eucalyptus,  186,  or  Serpentaria, 
183,  or  Sanguinaria,  361.  The  Iodides,  258, 
especially  the  iodide  of  ammonium,  is  serv- 
iceable in  combination  with  the  expecto- 
rants just  named.  Morphine,  638,  espe- 
cially morphine  and  atropine,  644,  or  some 
preparation  of  opium,  is  indispensable  to 
quiet  cough.  Strychnine,  484,  and  the  sirup 
of  the  phosphate  of  iron,  quinine,  and 
strychnine,  is  a  valuable  respiratory  stimu- 
lant. Strychnine  is  the  best  remedy  to 
check  the  reflex  vomiting.  Inhalations  of 
Sulphurous  Acid,  in  spray  or  gas,  247,  es- 
pecially Pictet  liquid,  374,  Ethyl  Iodide, 
267,  and  gaseous  enemata  of  Carbolic  Acid 
and  Creosote,  379.  Benzoates,  also,  422, 
are  very  useful.  Grindelia,  723,  a  valuable 
expectorant,  especially  when  the  cough  is 
troublesome.  Copaiba,  784,  and  Cubeb, 
786,  useful  stimulating  expectorants. 

BRONCHORRHCEA  : 

Eucalyptus,  186,  Turpentine,  779,  its  deriva- 
tives and  the  stimulating  expectorants 
mentioned  under  chronic  bronchitis.  Car- 
bolic Acid,  379,  internally  and  by  spray. 


CLINICAL   INDEX. 


841 


Grindelia,  723,  Ammonium  Carbonate  and 
Chloride,  239.  Cubed,  786,  Copaiba,  784. 
Sulphurous  Acid,  spray,  247,  and  as  Pictet 
liquid,  374.  Benzoin,  inhalation,  422.  Tere- 
bene,  781,  antiseptic  ;  eliminated  by  the 
lungs.  Oxygen  by  inhalation  and  gas  ene- 
mata,  379.  Iodides,  258.  Phosphates  as 
restoratives,  140. 

BURNS  AND  SCALDS  : 

Sodium  Carbonate,  225,  in  saturated  solution 
to  relieve  pain.  Boric  Acid,  420,  most  use- 
ful in  Mr.  Lister's  hands.  Lead  Carbonate, 
315,  painted  on.  Turpentine,  780,  mixed 
with  basilicon-ointment.  Salicylic  Acid, 
400.  Carbolic  Acid,  382,  one-per-cent  solu- 
tion relieves  pain  and  prevents  suppuration. 
Collodion,  819,  the  flexile  for  slight  burns. 

OACHEXIA: 

Aliment,  67,  of  first  importance.  Air,  99. 
Massage,  102.  Oils  and  Fats,  124,  and  oil 
inunctions.  Iron,  148,  and  Chalybeate  Wa- 
ters, 161.  Manganese,  157,  especially  Sirup 
of  the  Iodide  of  Iron  and  Manganese.  Ar- 
senic, 175.  Phosphates,  140.  The  Simple 
Bitters,  181.  Eucalyptus,  186.  Hydrastis, 
191.  Quinine,  204.  Nitro-glycerin  to  im- 
prove nutrition  by  dilating  arterioles. 

•CALCULI,  BILIARY  : 

Aliment,  66.  Starches,  sweets,  and  especially 
fats,  should  be  avoided.  Alkaline  Mineral 
Waters,  229,  highly  useful.  Sodium  Phos- 
phate, 139,  persistently  used.  Turpentine 
and  Ether,  778,  remedy  of  Durand.  For  the 
paroxysms,  see  COLIC. 

<?ALCUU,  RENAL  : 

Alkalies,  218,  224,  when  the  calculi  are  com- 
pounds of  uric  acid  with  potash,  and  not 
soda  salts.  Also,  Alkaline  Mineral  Waters, 
229,  230,  Vichy,  Bethesda,  etc.  Ammonium 
Benzoate,  422,  for  the  solution  of  phos- 
phatic  calculi.  Very  long  continued  use  of 
the  solvent  necessary.  Magnesia  Boro- 
citrate,  420.  solvent  for  uric-acid  calculi. 
Magnesia  Tartroborate,  421,  probably  still 
more  efficient. 

CANCER : 

^Arsenic,  176,  relieves  the  pain  and  retards  the 
growth  of  carcinoma  of  the  stomach,  and 
also  of  epithelioma.  Bismuth,  163,  relieves 
the  vomiting  in  cancer  of  the  stomach  ; 
also,  Carbolic  Acid,  362,  especially  by  the 
method  of  parenchymatous  injection.  Po- 
tassa  Chlorate,  225,  Salol,  410,  lodol,  274, 
Naphtol,  416,  and  Terebene,  781,  applied 
in  powder  alters  the  ulcerated  surface. 
lodoform  and  Salicylic  Acid,  400,  also  in 
powder  to  the  surface  of  the  cancer.  Zinc 
Chloride  and  Sulphate  dried,  320,  are  effi- 
cient caustics.  Potassa  Fusa,  225,  Chromic 
Acid,  815,  and  Bromine,  372,  also  active 
escharotics  for  the  destruction  of  morbid 
growths. 

CARIES  : 

Cod-liver  Oil,  124,  to  promote  constructive 
metamorphosis.  Phosphates,  139,  and  Lime 
Carbonate,  223,  furnish  needed  materials. 


Calcium  Chloride,  223,  is  useful  in  the 
strumous  cachexia.  Phosphorus,  134,  pro- 
motes bone  formation.  Villatte's  solution 
used  to  dissolve  carious  bone. 

CATARRH,  ACUTE ;  COMMON  COLD : 
Aconite,  714,  for  the  preliminary  fever,  with 
Belladonna,  527,  when  secretion  is  excess- 
ive. Quinine  and  Morphine,  207,  642,  may, 
at  the  outset,  abort  an  attack.  Ipecac,  es- 
pecially the  fluid  extract,  743,  alone  or  in 
combination  with  opium  and  aconite.  Tar- 
tar Emetic,  324,  in  minute  doses  with  mor- 
phine, is  very  useful.  Dover'*  Powder,  642, 
at  the  inception  may  arrest  the  attack. 
Iodides,  258,  a  small  dose  very  frequently, 
and  Inhalations  of  Iodine,  262,  and  of 
Ethyl  Iodide,  266.  Ammonia,  240,  carefully 
inhaled  at  the  outset  of  the  disease.  Pul- 
tat  ilia,  722,  acts  similarly  to  aconite,  but  is 
contraindicated  if  gastrointestinal  irrita- 
tion exist. 

CATARRH,  BRONCHO-PULMONARY  : 
Air,  compressed,  98.  Alum,  320,  by  insuffla- 
tion. Aconite,  714,  when  attack  is  recent ; 
Belladonna,  527,  when  secretion  is  profuse. 
Eucalyptus,  186,  Hydrastis,  190,  Sanguina- 
ria,  341,  and  Prunus  Virginiana,  183,  after 
the  acute  symptoms  have  subsided.  Also, 
Cubeb,  786,  Copaiba,  784,  Turpentine,  781, 
Terebene,  781,  and  Carbolic  Acid,  379,  of 
great  value  by  inhalation  of  vapor  and 
spray  ;  also,  Arseniate  of  Sodium,  172,  by 
fumigation. 

CATARRH,  CHRONIC  NASAL: 
Alum.  320,  in  powder  by  insufflation.  7odo- 
form  and  Tannin,  271,  also  applied  hi  pow- 
der by  insufflation.  Iodine,  259,  hi  vapor 
inhaled  ;  also  Bromine,  371,  but  it  must  be 
inhaled  very  cautiously.  Ethyl  Iodide,  by 
inhalation,  267.  lodic  Acid  and  lodates,  265, 
effective  remedies  by  injection  and  spray. 
Sanguinaria,  361,  the  tincture  internally 
and  the  powder  locally.  Cubeb,  784,  in 
powder  by  insufflation  and  troches.  Also, 
Pyridine,  417,  and  Hydrogen  dioxide,  368. 

CATARRH,  GASTRIC.    (See  GASTRIC  CATARRH.) 

CATARRH,  INTESTINAL.  (See  DYSENTERY  and 
DIARRHCEA.) 

CATARRH,  GENITO-URINARY.  (See  BLADDER, 
CATARRH  OF,  CYSTITIS,  GONORRHCEA,  LEUCOR- 
RHCEA,  PROSTORRHCEA,  ENDOMETRITIS,  etc.) 

CEREBRAL  ANAEMIA  : 

Iron,  148,  and  Chalybeate  Mineral  Waters, 
161.  Galvanism,  465,  by  transverse  appli- 
cations. Phosphorus,  135,  and  Phosphates, 
140,  Quinine,  207,  Strychnine,  482,  and  the 
cerebral  excitants.  Caffeine,  566,  Guarana, 
567,  etc.  Arsenic,  173,  is  highly  efficient  in 
some  hypochondriacal cases  ;  also,  .4Mrttm, 
297,  Amyl  Nitrite,  705,  Nitro-glycerin,  709, 
and  Ammonia,  239,  afford  relief  in  sudden 
attacks  by  dilating  vessels. 

CEREBRAL  CONGESTION  : 

Aconite,  714,  Cold  Douche,  85,  alternate  hot 
and  cold  applications.  Bromides,  653, 
highly  useful.  Ergot,  501,  Gelsemium,  674, 


842 


CLINICAL   INDEX. 


Hydrocyanic  Acid,  701.  and  the  arterial 
sedatives,  Veratrum  Viride,  719,  Digitalis, 
513,  etc.  Galvanization  of  the  cervical 
sympathetic,  465.  Venesection,  814,  is  a 
suitable  remedy  in  cases  threatening  rup- 
ture of  vessels.  Arsenic,  173,  when  due  to 
atheroma  of  vessels.  Active  Cathartics, 
766.  Colchicum,  354,  lessen  blood-pressure 
and  act  by  derivation. 

CEREBRO-SPINAL  MENINGITIS  : 
Aconite  Tincture,  714,  carried  to  arterial  de- 
pression before  exudations.  Ergot,  501, 
also  for  first  stage  or  period  of  congestion 
and  irritation.  Gelsemium,  Fluid  Extract, 
674,  for  same  period.  Opium,  638,  is  the 
most  effective  remedy.  Quinine,  203,  full 
cinchonism  at  the  onset  of  the  disease. 
Cold  Paths,  83,  84,  for  hyperpyrexia. 

CHANCRE.  (See  SYPHILIS.) 
Bromine,  372,  Chromic  Acid,  815,  Nitric  Acid, 
119,  and  Acid  Nitrate  of  Mercury,  293,  effi- 
cient escharotics  for  the  destruction  of 
chancre.  lodoform,  271,  and  lodol,  273, 
with  or  without  Thymol,  428,  are  excellent 
applications  dusted  over  sore.  Carbolic 
Acid,  382,  applied  pure  in  mild  cases.  Iron 
Iodide,  152,  internally  in  cases  of  systemic 
depression,  or  sloughing  phagedaena.  Po- 
tassa  Chlorate,  225,  in  powder,  is  also  an 
excellent  local  application.  Aristol,  277, 
an  iodine  compound  useful  in  soft  chancre. 
Sozoidol,  277,  Loretin,  275,  in  same. 

CHILBLAINS  : 

Turpentine,  781,  and  still  more  efficient  Tere- 
bene,  782,  Tincture  of  Iodine,  262,  Carbolic 
Acid,  382,  with  iodine  and  tannin.  Sulphur- 
ous Acid,  diluted  with  glycerin,  247,  is  an 
excellent  application.  Benzoin  Tincture, 
422,  the  first  in  value. 

CHLOROFORM  NARCOSIS.    (See  ANTIDOTES,  NAR- 
COSIS.) 

CHLOROSIS  : 

Arsenic,  175,  as  an  adjunct  to,  or  substitute 
for.  iron.  Oxygen,  367,  inhaled.  Iron,  148, 
with  or  without  Manganese,  156,  or  arsenic; 
with  aloes  if  constipation  exist.  Ferratin, 
153,  Haemol,  154.  mild  tonics.  Chalybeate 
Springs,  161.  Massage,  102,  oil  inunctions, 
124,  and  faradization.  Galvanization,  465, 
to  central  nervous  system.  Red-marrow  of 
Bones,  436,  and  in  some  cases  the  Thyroid 
Body,  435.  Nux  Vomica,  or  strychnine, 
438,  stimulates  the  blood-making  organs ; 
may  be  combined  with  iron.  Pepsin  and 
Pancreatin,  107,  improve  digestion. 

CHOLERA  ASIATICA  : 

Lead  Acetate,  313,  an  excellent  astringent, 
usually  given  with  opium  and  camphor. 
Camphor,  546,  the  saturated  tincture.  Car- 
bolic Acid,  379,  with  or  without  iodine. 
Chloral,  616.  is  highly  effective  by  subcu- 
taneous injection  ;  usually  combined  with 
morphine.  Chloroform,  596,  a  few  drops 
frequently  to  stop  vomiting,  and  Chloro- 
dyne,  598.  Opium,  636,  especially  useful  to 
arrest  preliminary  diarrhoea.  Calomel, 


289,  minute  doses  will  sometimes  stop  vom- 
iting. Alcohol,  575,  as  iced  brandy  or 
champagne  to  arrest  vomiting  and  stimu- 
late the  heart.  Sulphuric  Acid,  116,  with 
opium  tincture,  an  excellent  remedy  for 
cholera  diarrhoea.  Arsenic,  172,  Fowler's 
solution  with  opium,  sometimes  valuable. 
Strychnine,  482,  has  been  used  with  success 
in  some  epidemics.  Atropine,  527,  to  stimu- 
late the  heart  in  cholera  asphyxia.  Intra- 
venous Injection  of  Salines,  25,  in  the  algid 
stage,  and  of  Milk,  30.  Enteroclysis,  14, 
Hypodermatoclysis,  23. 

CHOLERA  INFANTUM  : 

Aliment,  66,  is  of  the  highest  importance. 
See  Poisonous  Milk  and  Cream,  62,  which 
should  be  read.  Buttermilk-  Cure,  60.  Car- 
bolic Acid,  379,  with  or  without  bismuth,  is 
very  effective.  Bismuth,  163,  is  frequently 
prescribed  in  an  emulsion.  Zinc  oxide,  318. 
Calomel,  287,  in  minute  doses,  arrests  vom- 
iting. Copper  Sulphate,  308,  is  an  effective 
remedy,  but  only  the  smallest  doses  are 
admissible.  Potassium  Bromide,  651,  and 
the  Cold  Bath,  84,  85,  are  highly  useful  in 
cases  characterized  by  nervous  irritabil- 
ity and  feverishness.  Ipecacuanha,  741,  is 
a  desirable  remedy  when  the  stools  assume 
a  dysenteric  character.  Brandy,  575,  ren- 
ders important  service  in  most  cases,  but 
full  doses  are  necessary.  Camphor,  546,  is 
indicated  when  depression  is  marked ;  it 
may  be  given  in  milk.  Silver  Nitrate,  291, 
beneficial  after  the  acute  symptoms. 
Opium,  636,  must  be  given  with  great 
caution. 

CHOLERA  MORBUS :  « 

Morphine  and  Atropine,  636,  hypodermatic- 
ally,  the  most  efficient  remedy.  Chloral, 
616,  with  morphine  if  cramps  occur.  Car- 
bolic Acid  and  Bismuth,  379,  in  an  emulsion 
together,  are  sufficient  in  mild  cases.  The 
remedies  for  CHOLERA  ASIATICA. 

CHORDEE : 

Camphor,  547,  successful  if  given  in  sufficient 
quantity  ;  may  be  administered  with  lactu- 
carium.  Bromides,  657,  occasionally  gire 
relief .  Cantharides  Tincture,  799,  in  small 
dose,  is  said  to  be  useful.  Morphine  and 
Atropine,  644,  subcutaneously,  is  the  most 
certain.  Colchicum,  354,  in  a  nightly  dose, 
will  succeed  by  inducing  some  nausea. 
Tartar  Emetic,  325,  will  relieve  if  carried 
to  nausea.  Tobacco,  Wine  of,  695,  a  few 
drops  at  bed-hour.  Lupuline,  646,  not 
powerful. 

CHOREA : 

Water,  86,  cold  effusion  and  cold  baths. 
Iron,  150,  especially  subcarbonate,  for  the 
condition  of  anaemia  and  amenorrhoaa. 
Cod-liver  Oil,  121,  when  the  nutrition  is 
poor.  Arsenic,  173,  one  of  the  most  cer- 
tain remedies,  but  large  doses  are  required, 
and  well  borne.  Strychnine,  484,  and  es- 
pecially Picrotoxin,  491,  in  full  doses  when 
the  nervous  element  is  predominant,  dm- 


CLINICAL   INDEX. 


843 


icifuga,  522,  useful  in  some  cases,  but  it  is 
uncertain,  and  must  be  pushed  to  get  the 
best  results.  Conium,  665,  especially  succus 
conii,  has  been  strongly  urged  by  Harley. 
Morphine,  640,  in  the  large  doses  advised  by 
Trousseau,  and  Chloral,  617,  especially  at 
night,  are  highly  useful.  Static  Electricity, 
466,  has  lately  been  revived.  Magnets,  464. 
Calcium  Chloride,  223,  has  done  good  in 
strumous  subjects.  Cannabis  Indica,  556. 
Cocaine,  562,  highly  effective  in  some 
cases. 

CIRRHOSIS  : 

Iodides,  257,  with  or  without  arsenic,  are 
useful  in  the  first  stage.  Phosphate  of 
Soda,  140,  persistently  administered,  of 
real  value  if  commenced  early.  Gold  and 
Sodium  Chloride,  297,  has  seemed  to  have 
curative  power  if  given  hi  tune.  Arsenic, 
172,  also  retards  if  it  does  not  arrest  over- 
growth of  connective  tissue.  Stillingia, 
358,  and  Hydrastis,  190,  in  incipient  dis- 
ease, secondary  to  intestinal  catarrh. 

COLIC  : 

Asafaetida,  551,  in  the  flatulent  colic  of  in- 
fants. Chloroform,  596,  useful  in  flatulent 
colic  and  in  hepatic,  a  few  drops  fre- 
quently ;  also  Chlorodyne,  598.  Ether,  593, 
605,  internally  and  by  inhalation.  Cam- 
phor, 547,  a  few  drops  of  the  saturated 
tincture  frequently.  Infusum  Tabaci,  694, 
as  an  enema,  effective  but  dangerous. 
Morphine,  641,  and  Morphine  and  Atro- 
pine,  644,  hypodermatically,  the  most 
prompt  and  successful  remedy. 

COLICA  PICTONUM: 

Alum,  335,  overcomes  the  constipation  with 
success ;  may  be  given  with  dilute  sul- 
phuric acid.  Sulphuric  Acid,  118,  very 
dilute  in  "  lemonade,"  as  prophylactic  and 
as  a  curative  agent.  Morphine,  641,  and 
Morphine  and  Atropine,  644,  subcutane- 
ously,  relieves  pain  most  quickly.  Iodides, 
261,  and  Bromides,  652,  to  cause  excretion 
of  lead.  Magnesia  Sulphate,  750,  to  over- 
come constipation. 

COLIC,  HEPATIC  : 

For  the  pain— Morphine  and  Atropine,  644, 
subcutaneously.  Spirit  of  Chloroform,  596, 
Ether,  593,  internally  and  by  inhalation. 
Nitro-glycerin  and  Amyl  Nitrite,  705,  709. 
Tobacco,  694,  for  pain  by  relaxing  spasm. 
For  the  calculi— Aliment,  Sodium  Phos- 
phate, 140.  Remedy  of  Durande,  778.  Al- 
kaline Mineral  .Waters,  229.  (See  CALCULI, 
BILIARY.) 

CONDYLOMATA  : 

Calomel,  293,  also  lodol,  274,  dusted  over. 
lodofoi-m,  271,  powder  applied  freely.  Car- 
bolic Acid,  382,  a  mild  escharotic  for  sun- 
pie  cases.  Chromic  Acid,  815,  in  paste  co 
destroy  ;  solution  of  bichromate  of  potassa 
a  useful  lotion.  Nitric  Acid,  119,  a  dilute 
solution  as  a  wash. 

CONJUNCTIVITIS  : 
Calomel,  294,  dusted  over  membrane.    Yel- 


low Mercuric  Oxide,  294,  an  ointment  of, 
with  vaseline,  a  most  efficient  remedy  for 
granular  lids.  Tannin,  346,  and  Tannigen, 
349,  in  powder  dusted  over  membrane,  an 
excellent  application.  Bismuth,  164,  also 
applied  in  powder  directly.  Copper  Sul- 
phate, 309,  a  smooth  crystal  applied  direct- 
ly, an  approved  remedy.  Silver  Nitrate, 
303,  a  long-standing,  useful  agent.  Zinc 
Sulphate,  320,  a  weak  solution  in  rose- 
water,  one  of  the  best  remedies  for  simple 
conjunctivitis.  Cadmium,  326,  hi  solution, 
a  substitute  for  copper  and  zinc.  Fluid 
Extract  of  Ergot,  501,  applied  undiluted,  is 
said  to  be  very  efficient.  For  granular  lids, 
Jequirety,  811,  which  sets  up  substitutive 
inflammation. 

CONSTIPATION  : 

Aliment,  66,  highly  important  in  habitual : 
bread  of  unbolted  flour,  corn-meal  bread, 
fruits,  and  succulent  vegetables.  CaMiar- 
tics,  744.  Physiological  laxatives  :  Arsenic, 
172,  small  doses  of  Fowler's  solution  in- 
crease action.  Nux  Vomica,  482,  Physos- 
tigma,  688,  Belladonna,  526,  Tabaci  Vinum, 
694,  a  few  drops  at  bed-time,  Muscarine,  729, 
all  act  by  either  increasing  secretion  or 
muscular  action,  or  both.  Faradization, 
466,  of  intestines.  Saline  Mineral  Waters, 
229,  233,  and  the  purgative  Sulphurous 
Waters,  253.  Enemata,  769. 

CONVALESCENCE  : 

Koumiss,  43,  Galazyme  and  Kefyr,  44,  valu- 
able reconstituent  stimulants.  Bitters,  181 , 
the  simple,  especially  calumba  and  gentian. 
Eucalyptus,  186,  a  tonic  of  special  utility 
after  malarial  diseases.  Hydrastis,  190, 
tonic,  and  useful  substitute  for  quinine. 
Coca,  560,  a  tonic  and  stimulant  of  the 
nervous  system  ;  also  Cfuarana,  566,  be- 
longing to  the  same  class.  Iron,  148,  espe- 
cially sirup  of  the  iodide,  the  carbonate, 
sulphate,  and  tincture  of  the  chloride. 
Phosphates,  139,  and  Phosphites,  140,  Cod- 
liver  Oil,  126,  Pepsin,  107,  and  Pancreatin, 
109.  Wine,  582. 

CONVULSIONS  : 

Anaesthetics,  605,  in  uraemic  and  puerperal 
convulsions.  Bromides,  612,  in  epileptic  and 
epileptiform.  Chloral,  617,  in  puerperal, 
uraemic,  and  epileptiform.  Morphine,  640, 
hypodermatically,  in  full  doses,  in  uraemic 
convulsions.  Veratrum  Viride,  620,  hi 
puerperal.  Cold  Bath,  87,  especially  hi 
convulsions  of  infancy. 

COUGH : 

Asafo3tida,  551,  in  cough  by  habit,  bronchor- 
rhoea  and  chronic  bronchitis ;  also,  under 
the  same  conditions,  ammoniac,  cubeb,  co- 
paiba, turpentine,  etc.  Bromoform,  660, 
for  spasmodic  cough  and  whooping-cough. 
Chloral,  617,  in  spasmodic  cough,  cough  by 
habit,  whooping-cough,  etc.  Gelsemium, 
674,  useful  to  quiet  a  nervous  element  in 
cough.  Lobelia,  698,  a  nauseating  expec- 
torant of  great  utility  in  dry  cough,  bron- 


844 


CLINICAL   INDEX. 


chilis,  asthma,  etc.  Terebene,  781,  Paral- 
dehyde, 585,  Pyridine,  417,  Erigeron  Oil, 
185,  antispasmodic  and  stimulant  expecto- 
rants. Cerium,  328,  in  cough  associated 
with,  or  reflex  from,  stomach  derangement. 
Opium,  642,  in  some  form,  of  chief  utility 
as  a  means  of  quieting  cough.  Prunus 
Virginiana,  183,  anodyne  and  tonic  expec- 
torant. Hydrocyanic  Acid,  701,  indicated  in 
cough  of  irritation,  habit,  reflex,  and  stom- 
achal. Grindelia,  723,  especially  useful  in 
spasmodic  cough,  and  as  a  stimulant  ex- 
pectorant in  chronic  bronchitis.  Lactuca- 
rium,  647,  sirup,,  an  excellent  vehicle  for 
cough  mixtures.  Ipecacuanha,  740,  espe- 
cially the  fluid  extract,  an  excellent  nau- 
seating expectorant. 

GROUP.  (See  LARYNGISMUS  STRIDULUS.) 
Alum,  326,  not  depressing.  Mercury  subsul- 
phate,  693,  the  most  efficient  emetic  in 
croup.  Calomel,  288,  by  some  supposed  to 
be  sedative  and  aplastic,  allaying  laryn- 
geal  spasm  and  preventing  formation  of 
membrane.  Copper  Sulphate,  308,  Zinc 
Sulphate,  318,  as  emetics  inferior  to  tur- 
peth  mineral.  Tartar  Emetic,  324,  causes 
dangerous  depression  in  young  children. 
Apomorphine,  736,  effective  but  may  be 
dangerous.  Quinine,  201,  in  large  doses 
highly  useful.  Lactic  Acid,  110,  and 
Papain,  108,  solvents  of  false  membrane, 
applied  in  spray  or  directly.  Carbolic 
Acid,  379,  in  spray.  Lime-  Water,  223,  and 
steam  from  slaking  lime.  Ipecac,  740,  as 
an  emetic.  Ethyl  Iodide  Vapor,  362,  Py- 
ridine, 417,  Eucalyptol,  187,  and  Turpen- 
tine Vaporized,  781. 

CYSTS: 

Iodine,  264,  tincture  or  compound  tincture 
of,  injected,  is  effective.  Silver  Nitrate, 
305,  a  solution  injected  into  cysts  to  excite 
adhesive  inflammation.  Galvano- Punc- 
ture, 471,  will  usually  permanently  oc- 
clude. 

CYSTS,  HYDATID,  of  Liver,  or  elsewhere : 
Iodine  Injections,  263.     Galvano-puncture, 
471.    Simple  Acupuncture,  809,  and  escape 
of  some  fluid,  often  suffices. 

DELIRIUM  TREMENS  : 

Alcohol,  576,  of  great  utility  when  assimilation 
can  not  proceed  without  it.  Bromides,  652, 
may  cure  the  preliminary  "horrors,"  and 
succeed  in  mild  cases  of  delirium  tremens. 
Chloral,  617,  very  effective,  but  dangerous 
in  old  topers  and  cases  of  weak  heart. 
Paraldehyde,  585,  Hypnone,  590,  Urethan, 
588,  are  safer  and  probably  not  less  effi- 
cient. Pilocarpine,  683,  has  proved  highly 
useful.  Chloroform.  597.  by  the  stomach, 
lessens  delirium  and  procures  sleep.  Ar- 
nica Tincture,  676,  highly  serviceable 
when  there  is  much  depression.  Digitalis, 
512,  tincture  or  infusion,  especially  the 
former,  in  full  doses  in  cases  with  cardiac 
depression,  anaemia  of  brain,  due  to  low 
tension  and  lessened  vis-a-tergo.  Opium, 


640,  must  be  given  cautiously,  and  the  at- 
tempt to  overwhelm  the  brain  avoided. 
Quinine,  207,  to  restore  digestion  and  sup- 
port the  powers  of  life.  Cannabis  Indicar 
556,  sometimes  is  remarkably  quieting. 
Ammonium  Carbonate,  239,  required  in 
condition  of  depression.  Capsicum,  788, 
has  hypnotic  effects  of  great  value  in  mild 
cases. 

DEMENTIA  PARALYTICA  : 

Paraldehyde,  585,  as  a  calmative.  Physo- 
stigma,  690,  has  seemed  to  retard  the 
progress.  Gold  and  Sodium  Chloride, 
297. 

DIABETES : 

Aliment,  56,  67,  all  saccharine  and  starchy 
food  excluded.  Buttermilk,  GO.  The  Milk- 
Cure,  67,  has  succeeded  remarkably  in 
some  cases  ;  Buttermilk,  60,  may  be  better. 
Alkalies,%18,  and  Alkaline  Mineral  Waters. 
229,  of  great  value  in  the  glycosuria  of 
obese  subjects.  Arsenic,  175,  and  Clemens's 
solution  and  Opium,  combined  with  advan- 
tage in  thin  subjects.  Sodium  ArseniateT 
175,  with  phosphate  of  soda  and  the  Phos- 
phates, 140,  which  are  also  useful  of  them- 
selves. Lactic  Acid,  111,  has  sometimes 
done  good.  Oxygen,  367,  Hydrogen  Di- 
oxide, 368,  Salicylic  Acid,  399,  Opium,  642, 
especially  codeine,  restrains  the  waste  of 
sugar.  Gold  and  Sodium  Chloride,  297,  is 
a  promising  remedy.  Saccharin,  418,  as  a 
sweetener  of  foods,  and  as  an  antiseptic. 
Intravenous  Injection  of  Ammonia,  26, 
in  diabetic  coma. 

DIABETES  INSIPIDUS: 

Dry  Diet,  65,  Ergot.  501,  is  one  of  the  most 
efficient  remedies.  Pilocarpus,  684,  has 
done  good  in  some  cases.  Valerian,  554, 
restrains  the  flow  but  does  not  cure.  Mus- 
carine,  730,  has  been  used  with  apparent 
success.  Auri  et  Sodii  Chloridum,  298,  has 
been  of  benefit  when  sclerosis  is  develop- 
ing. Potassium  Iodide,  260,  has  cured 
cases  of  syphilitic  origin. 

DIARRHOEA  : 

Chalk,  223,  in  the  diarrhoea  of  children,  mis- 
tura  cretoe,  with  or  without  opium.  Calo- 
mel, 287,  in  minute  doses,  or  hydrarg.  cum 
creta,  when  the  stools  are  pasty  and  whitish. 
Bismuth,  163,  especially  combined  with 
creosote  and  glycerin,  is  useful,  but  large 
doses  are  necessary ;  also  Dermatol,  166. 
Zinc  Salts,  318,  especially  the  Oxide,  which 
may  be  given  with  bismuth,  or  the  sul- 
phate with  morphine  in  the  diarrhoea  of 
adults.  Copper  Sulphate,  308,  is  the  most 
efficient  of  the  mineral  astringents  in 
chronic  diarrhoea  ;  is  usually  combined 
with  opium.  Arsenic,  172,  Fowler's  solu- 
tion, with  tincture  of  opium  when  un- 
digested food  is  passed  soon  after  meal, 
and  in  chronic  diarrhoea.  Mineral  Acids, 
116,  especially  sulphuric,  in  profuse  watery 
stools,  or  Hope's  mixture.  Lead  Acetate, 
314,  one  of  the  most  generally  useful  as- 


CLINICAL   INDEX. 


tringents.  Camphor,  546,  with  or  without 
opium,  for  summer  diarrhoea.  Camphoric 
Acid,  549,  especially  in  tuberculous  diar- 
rhoea. Ergot,  499,  has  proved  very  suc- 
cessful in  some  epidemics.  The  newer 
remedies,  also  highly  efficient,  are  Salol, 
409,  and  Naphtalin,  416,  supposed  to  be 
decomposed  by  pancreatic  solution,  and 
therefore  act  locally  by  the  released  con- 
stituents. Tannic  Acid,  343,  aud  vegetable 
astringents  containing  it,  especially  rubus, 
kino,  catechu,  are  much  employed  in  sim- 
ple diarrhoea.  Aliment,  53,  55,  56,  59,  and 
66,  milk-cure,  raw-meat  pulp,  but  caution  is 
necessary  in  respect  to  the  latter,  because 
of  danger  of  tsenia. 

DIPHTHERIA  : 

Belladonna,  527,  useful  at  outset  to  check 
exudation,  and  later  to  support  weak  heart. 
Carbolic  Acid,  379,  locally  in  solution  and 
spray,  and  systemically,  and  Sulphocarbo- 
lates,  385.  Chlorine,  370,  aqua  chlori  and 
chlorinated  lime  and  soda  topically  to  cor- 
rect fetor  and  destroy  germs.  Hydrogen 
Dioxide,  368,  and  Pictet  Liquid,  373.  Lac- 
tic Acid,  110,  one  of  the  best  solvents. 
Sulphurous  Acid,  247,  an  antiseptic,  in 
spray  of  dilute  solution  to  fauces.  Quinine 
by  local  application  to  nares  and  fauces, 
207.  Potassa  Chlorate,  216,  218,  more 
largely  used  than  any  remedy,  topically, 
and  by  the  stomach,  iron,  149,  tincture  of 
the  cMoride  much  employed,  undiluted  to 
the  fauces,  and  by  the  stomach  in  full 
doses ;  also  largely  prescribed  with  potassa 
chlorate.  Acid  Muriatic,  117,  was  former- 
ly applied  to  exudation.  Acid  Salicylic, 
396,  and  the  salicylates,  the  former  also 
locally,  to  reduce  temperature  and  prevent 
systemic  infection.  Resorcin,  404,  acts 
similarly  to  carbolic  and  salicylic  acids. 
Alcohol,  576,  very  much  prescribed  for 
support,  and  to  prevent  diffusion  of  the 
poison.  Pilocarpus,  685,  supposed  to  act 
locally  in  detaching  false  membrane.  Eu- 
calyptus, 186,  Turpentine,  780,  and  Tere- 
bene,  782,  in  vapor.  Salol,  409,  Naphtol, 
414,  and  other  antiseptics  are  now  used 
with  varying  success  ;  but  especially  the 
Antitoxins,  438. 

PROPSY  : 

Digitalis,  510,  one  of  the  foremost  remedies, 
especially  in  cardiac  and  renal  dropsy,  less 
so  in  dropsy  of  cavities.  The  "  digitalis 
group  "  contains  some  of  the  mosn  effect- 
ive remedies,  as  Squill,  793,  Caffeine,  566, 
Strophantus,  518,  Adonidin,520.  and  others. 
They  have  effects  similar  to  digitalis,  and 
are  prescribed  under  the  same  conditions. 
Juniper,  789,  Scoparius,  791,  and  its  alka- 
loid, Sparteine,  519,  and  other  urino-geni- 
tals  having  diuretic  properties,  of  great 
value  in  cardiac  dropsy  ;  must  be  used 
cautiously  in  renal  dropsy  Copaiba,  784, 
especially  the  resin,  has  given  good  results 
in  ascites.  Potassa  Salts,  218,  especially 


bitartrate  and  acetate  largely  diluted, 
highly  useful  in  renal  dropsy.  Iron,  161, 
especially  tincture  of  the  chloride,  alone  or 
in  Basham's  mixture,  as  a  diuretic  and  to 
correct  anaemia.  Pilocarpus,  683,  very 
valuable  in  renal  dropsy  when  secretion  of 
urine  is  much  reduced  or  suppressed,  and 
when  convulsions  occur.  Hydragogue  Ca- 
thartics, 767,  especially  indicated  hi  as- 
cites.  Saline  Purgatives,  750,  in  general 
dropsy.  Dry  Diet,  54,  Milk-Cure,  59,  Whey,. 
59,  and  Koumiss  Cures,  59. 

DYSENTERY,  ACUTE  : 

Aliment,  66,  of  first  consequence.  Saline 
Purgatives,  751,  especially  Epsom  salts  hi 
acute  dysentery,  with  bloody  discharges 
and  high  fever.  Ipecacuanha,  741,  a 
remedy  of  highest  value  in  acute,  epidemic, 
and  puerperal ;  must  be  administered  hi 
large  doses  ;  milk  a  good  vehicle.  Silver 
Nitrate,  302,  Copper  Sulphate,  307,  Zinc 
Sulphate,  318,  are  excellent  astringents, 
after  the  more  acute  symptoms.  Lead 
Acetate,  314,  may  be  used  at  any  period, 
but  better  after  action  of  salines,  in  acute 
disease.  Opium,  630,  combined  with  some 
of  the  astringents,  but  given  after  the  ac- 
tion of  salines  in  the  acute  disease.  Tur- 
pentine, 778,  in  epidemic  dysentery  of  low 
type.  Ergot,  499,  has  been  used  with  suc- 
cess in  acute.  One  of  the  new  antiseptics, 
Naphtalin,  416,  has  proved  a  valuable 
remedy  in  diarrhoea,  and  it  also  entirely 
deodorizes  the  stools.  Salol,  409,  is  highly 
efficient  in  arresting  intestinal  fermenta- 
tion. 

DYSENTERY,  CHRONIC  : 

Aliment,  56,  60.  Grape-Cure,  55,  Arsenic,  172' 
—Fowler's  solution  with  opium.  Iron,  147, 
pernitrate,  a  powerful  astringent.  Tannic 
Acid,  343,  with  milk-diet,  and  the  vegetable 
astringents.  Silver,  copper,  and  zinc  salts 
(as  above),  with  opium.  Nux  Vomica, 
482.  Ergot,  499,  Ipecac,  741,  and  especially 
the  antiseptics  Naphtalin,  416,  and  Salol, 
409. 

DYSMENORRHCEA  : 

Aconite,  715,  and  Pulsatilla,  722,  for  the  con- 
gestive form  especially  succeeding  to  sup- 
pression. Ergot,  499,  under  the  same  con- 
ditions as  the  two  preceding  ;  also  Cimici- 
fuga,  522,  and  Potass.  Pemianganat.,  158, 
Camphor,  547,  Gelsemium,  675,  and  Apiol, 
794,  are  useful  in  the  neuralgic  form.  Amyt 
Nitrite,  706,  and  Spirit.  Glonoin,  709,  afford 
relief  quickly.  Chloroform,  5%,  Chloral, 
618.  Cannabis  Indica,  557,  Morphine,  641, 
especially  with  Atropine,  645,  all  give  re- 
lief in  painful  menstruation.  When  men- 
orrhagia  coexists,  or  there  is  plethora, 
Sodium  Bromide,  657.  Electricity,  469 ; 
galvanism  during  the  interval  is  highly 
useful.  Iron,  151,  in  anaemic  cases.  Vibur- 
num, 365.  Antipyrin,  413,  Methylal,  586, 
Urethan,  588,  and  other  members  of  the 
antiseptic  group. 


CLINICAL   INDEX. 


DYSPEPSIA  : 

Diet,  60,  62,  69,  the  most  important,  especially 
the  milk-cure.  Pepsin,  106,  Ingluvin,  106, 
and  Pancreatin,  106,  assist  digestion  in 
atonic  dyspepsia.  Mineral  Acids,  115,  mu- 
riatic acid  after  meals,  with  or  without 
pepsin,  in  atonic  dyspepsia.  In  case  of  an 
excess  of  acid  in  stomach-juice,  the  min- 
eral acid  before  meals.  In  excess  of  uric 
acid  as  well  as  of  stomach  acid,  Nitric 
Acid,  116,  is  the  most  efficient.  Alkalies, 
821,  to  relieve  excess  of  acid  ;  given  before 
meals,  alkalies  favor  the  production  of 
acid  gastric  juice  ;  after  meals,  neutralize 
acid.  Alkaline  Mineral  Waters,  229,  234, 
as  well  as  alkalies,  are  highly  useful  in 
dyspepsia  of  obese  subjects.  Antiseptics, 
375  et  seq.,  should  be  used  when  acid  fer- 
mentation occurs.  Bitters,  Simple,  181, 
especially  gentian  and  calumba,  stimulate 
digestion  ;  may  be  given  with  acids  or  al- 
kalies. Arsenic,  171,  drop  doses  of  Fowler's 
solution  relieve  irritative  dyspepsia.  Sil- 
ver, 301,  oxide  especially,  is  very  useful. 
Nux  Vomica,  482,  is  an  excellent  stomachic 
tonic,  and  removes  various  nervous  symp- 
toms. Hydrastis,  190,  Eucalyptus,  186, 
Wild  Cherry,  183,  Hop,  646,  are  useful 
stomachic  tonics. 
EARACHE : 

Opium,  642,  in  the  form  of  morphine  solu- 
tion, which  is  usefully  combined  with  atro- 
pine.  Cocaine,  5  to  10  per  cent  solution, 
the  most  effective  remedy,  561.  Heat, 
93. 
ECLAMPSIA  : 

Transfusion,  30,  has  been  successfully  em- 
ployed in  uraemic  convulsions.  Bloodlet- 
ting, 813,  when  there  is  much  cerebral  con- 
gestion. Morphine,  644,  hypodermatically 
in  ursemic.  Chloroform,  607,  by  inhalation. 
Chloral,  617.  Potassium  Bromide,  654,  Pil- 
ocarpine,  683,  in  uraemic  or  puerperal  con- 
vulsions. Veratrum  Viride,  720,  in  puer- 
peral . 
ECTHYMA : 

Cod-liver  Oil,  126,  both  internally  and  locally. 
Quinine,  208,  usually  effects  a  cure,  but 
must  be  given  in  full  doses.  Lead  Carbon- 
ate, Solutions  of  the  Acetate,  315,  Naphtol 
and  Naphtalin,  415,  lodoform,  263,  and 
lodol,  274,  are  the  most  useful  topical  ap- 
plications. 
ECZEMA  : 

Carbolic  Acid,  382,  internally  and  externally. 
Salicylic  Acid,  399,  applied  locally.  Boric 
Acid,  420,  one  of  the  most  efficient  reme- 
dies, locally.  Lead,  315,  liquor  plumbi  sub- 
acetatis  with  glycerin,  a  good  application 
when  there  is  abundant  secretion :  also 
lead-paint  —  carbonate  with  linseed-oil  — 
spread  on  thickly.  Bismuth,  subnitrate, 
164,  and  Salicylic  Acid,  400,  in  powder 
freely  to  the  eruption.  Tannin,  346,  in 
powder  dusted  over,  or  as  glycerite  of  tan- 
nin ;  also  Pyrogallic  Acid,  348,  with  cau- 


tion. Copper  Sulphate,  309,  Zinc  Sulphate, 
320,  Silver  Nitrate,  304,  are  useful  astrin- 
gent applications.  Mercury,  294,  the  brown 
citrine  ointment  to  eczema  of  eyelids.  Bel- 
ladonna, 531,  or  atropine,  internally,  is 
beneficial  in  the  acute  cases.  Arsenic,  174, 
is  curative  in  chronic  cases  ;  when  the  skin 
is  much  thickened  by  exudation  in  the 
chronic  cases,  Jequirety,  811.  Electricity, 
470,  by  central  galvanization  has  done  great 
good  in  chronic  cases.  An  exclusive  milk- 
diet,  56. 

EMPHYSEMA : 

Compressed  Air,  98,  affords  much  relief, 
sometimes  permanent.  Oxygen,  367,  Oxy- 
gen Dioxide  (Ozone),  368,  for  the  parox- 
ysms of  difficult  breathing.  Grindelia,  723, 
gives  great  relief  to  the  oppression.  Ar- 
senic, 173,  long  continued,  improves  the 
nutrition  of  the  lungs.  Iodides,  258,  lodo- 
form, 269,  Ethyl  Iodide,  264.  by  inhalation, 
act  both  by  contact  and  by  absorption. 
Cod-liver  Oil,  125,  improves  the  condition, 
Hypophosphites,  140,  also.  Strychnine, 
485,  is  a  valuable  respiratory  stimulant. 
For  the  element  of  spasm,  Pyridine,  417, 
Terebene,  781,  and  others. 

EMPTEMA  : 

Iodine,  263,  a  solution  of  iodine  and  iodide  of 
potassium  to  wash  out  the  cavity  and  pre- 
vent reaccumulation  of  pus.  Carbolic 
Acid,  882,  and  Carbolic  Acid  and  Iodine, 
388,  to  correct  fetor,  and  the  Antiseptics, 
366,  generally. 

ENDOCARDITIS  : 

Quinine,  201,  to  check  inflammation.  Chlo- 
ral, 616,  unless  heart  is  weak,  when  it  be- 
comes dangerous.  Salicylic  Acid,  398,  is 
useful  in  the  rheumatic  form  of  the  dis- 
ease ;  also  Salol,  409.  Morphine,  642,  as  a 
remedy  in  serous  inflammations.  Potash 
Salts,  217,  liquefy  exudation.  Pilocarpine, 
683,  to  cause  absorption  of  exudation. 

ENDOMETRITIS  : 

Carbolic  Acid,  382,  undiluted  on  cotton- 
wrapped  probe.  lodo-tannin,  263,  and 
iodoform  and  tannin  locally.  Chromic 
Acid,  815,  applied  in  solution  to  interior  of 
cavity.  Nitric  Acid  (fuming),  120,  highly 
efficient,  but  requires  caution. 

ENTERALGIA  : 

Milk-Cure,  58,  stops  the  troubles  of  digestion 
which  give  rise  to  the  pain.  Fermentable 
foods  to  be  avoided— starch  and  sugar,  65. 
Arsenic,  171,  is  remarkably  beneficial  in 
the  more  strictly  neuralgic  cases.  Bella- 
donna, 526,  is  useful  as  an  anodyne,  atro- 
pine especially.  Prussic  Acid,  701  (official 
solution),  gives  relief  promptly,  or  fails  en- 
tirely. Galvanization,  468,  central,  per- 
sistently applied,  is  curative  sometimes. 

ENTERITIS.    (See  DIARRHOEA,  DYSENTERY.) 
Diett  65,  66,  must  be  regulated,  an  essential 
point   in   treatment.     Arsenic,    171,    with 
opium,  usually  highly  effective  as  a  reme- 
dy.   Copper  Sulphate,  308,  Lead  Acetate, 


CLINICAL   INDEX. 


847 


314,  and   the    other  mineral   astringents, 
with  opium,  are  curative. 

EPILEPSY  : 

Amyl  Nitrite,  706,  inhaled  when  aura  is  felt 
may  prevent  seizure  ;  Nitro-glycerin,  710, 
also,  if  there  be  more  time.  Potassium 
Bromide,  654,  is  the  most  useful  remedy, 
but  is  adapted  to  the  cases  occurring  in  the 
daytime,  to  the  grand  mal,  and  to  reflex 
epilepsy,  and  to  the  condition  of  cerebral 
hypereemia  rather  than  anaemia.  Chloral, 
618,  is  the  most  suitable  remedy  for  the 
nocturnal  variety.  Cannabis  Indica  and 
Cnnnabinum  Tannicum,  556,  Atropine, 
529,  Strychnine,  484,  Picrotoxin,  491,  are 
suitable  for  petit  mal,  for  nocturnal  va- 
riety, for  cases  characterized  by  anaemia 
and  depression,  and  must  be  faithfully  per- 
sisted in  for  a  long  time.  The  last-named 
seems  most  promising.  Silver  Nitrate,  302, 
formerly  much  prescribed,  and  not  with- 
out utility,  but  the  danger  of  staining  is 
great.  Salts  of  Copper,  309,  especially 
Cuprum  Ammoniatum,  Zinc  Oxide,  319, 
so-called  nervine  tonics,  have  been  bene- 
ficial, but  are  not  curative.  Iron,  150,  espe- 
cially the  bromide,  with  potassium  bromide 
to  prevent  the  anaemia  and  depression 
caused  by  the  latter.  Iodides,  260,  when 
syphilitic  in  origin. 

EPISTAXIS  : 

Ergot,  503,  Barium  Chloride,  242,  Digitalis, 
509,  Ipecacuanha,  742,  restrain  haemor- 
rhage by  acting  on  the  vessels.  Turpen- 
tine, 779.  in  oozing  from  relaxation.  Lo- 
cally Tannin,  345,  in  solution  injected. 
Iron,  146,  subsulphate  in  spray,  or  weak 
solution  applied  by  irrigation  ;  also  lodic 
Acid,  266.  Alum,  337,  powder  insufflated, 
or  solution  injected.  Transfusion,  29, 
when  a  fatal  result  is  threatened  from  loss 
of  blood.  Intravenous  injection  of  Am- 
monia when  heart  fails,  237.  Subcutane- 
ous injection  of  Ether,  594. 

EPITHELIOMA  : 

Coptis,  181,  infusion  or  decoction  locally,  es- 
pecially in  epithelioma  of  the  tongue.  Ar- 
senic, 176,  persistently  used.  Potassium 
Chlorate,  225,  said  to  be  very  effectual  ap- 
plied in  powder.  Zinc  Chloride,  and  Sul- 
phate dried,  320,  useful  escharotics.  Car- 
bolic Acid,  382,  injected  beneath  tumor. 
Salicylic  Acid,  400,  and  Boric  Acid,  420, 
Pyoktanin,  414,  and  Bromine,  372,  applied 
topically.  Teucrin,  432,  injected. 

ERYSIPELAS  : 

Aconite,  714,  in  the  idiopathic  variety,  when 
there  is  much  fever.  Belladonna,  531,  a 
very  beneficial  remedy,  combined  with 
aconite  when  there  is  sthenic  reaction. 
Quinine,  208,  in  full  doses  in  the  more  Be- 
vere  cases,  to  sustain  the  powers  of  life 
and  prevent  cerebral  embolism.  Salicylic 
Acid  and  Salicylates,  396,  Sodium  Benzo- 
ate,  423,  Resorcin,  404,  and  Salol,  409,  to 
prevent  systemic  infection  in  traumatic 
5G 


variety.  Ammonium  Carbonate,  239,  when 
cardiac  depression  exists.  Iron,  149,  espe- 
cially tincture  of  the  chloride  in  large 
doses.  Locally,  Argenti  Nitras,  304,  ac- 
cording to  Higginbotham's  method,  Car- 
bolic Acid,  382,  Trichlor -phenol,  386,  and 
the  antiseptics  generally  to  the  inflamed 
area.  Oil  inunctions  are  very  grateful  in 
simple  erysipelas,  124.  Antitoxins,  438. 

ERYTHEMA : 

Quinine,  208,  is  very  effective  in  erythema 
nodosum  ;  Belladonna  in  the  simple  form, 
531,  Zinc,  320,  Alum,  327,  and  Lead,  315,  are 
suitable  local  applications,  as  lotions.  Bis- 
muth dusted  over  the  surface  allays  irrita- 
tion, 164.  When  the  disease  is  reflex  from 
gastro-intestinal  disorder,  Nitric  and  Mu- 
riatic Acids,  119,  are  beneficial. 

EXOPHTHALMIC  GOITRE  : 
Iron,  152,  and  Chalybeate  Waters,  159,  for 
the  anaemia.  Digitalis,  513,  Barium,  242, 
Ergot,  501,  and  in  some  cases  Sparteine, 
519,  raise  the  arterial  tension  and  slow  the 
heart.  Galvanism,  469,  in  uncomplicated 
cases,  is  decidedly  curative. 

FAVUS: 

Cod-liver  Oil,  126,  locally,  and  in  case  of  de- 
bility, by  the  stomach.  Carbolic  Acid, 
382,  an  efficient  parasiticide.  Naphtol, 
416,  still  more  useful.  Myrtol,  430,  Resor- 
cin, 404,  Salicylic  Acid,  400,  and  Boric 
Acid,  420,  are  efficient  local  applications. 

FEET,  FETOR  OF  : 

Potassa  Permanganate,  159,  in  solution,  will 
remove  fetor  temporarily.  Sodium  Bicar- 
bonate, 224,  a  saturated  solution,  is  service- 
able. Salicylic  Acid,  399,  in  powder  freely 
dusted  over  the  feet  and  stockings,  is  very 
effective.  Benzoin  Tincture,  422,  when 
"frost-bite"  is  the  cause,  but  useful  in 
all. 

FELON : 

Silver  Nitrate,  305,  a  strong  solution  in  nitric 
ether  applied  over  the  part  may  abort  the 
affection,  if  at  the  beginning.  Lead  Ni- 
trate, 315. 

FEVER: 

Aconite,  714,  highly  useful  in  simple  inflam- 
mation, and  in  the  eruptive  fevers.  Ali- 
ment, 63,  must  be  regulated.  Alcohol,  538, 
does  good  when  the  temperature  declines, 
the  pulse  falls,  the  skin  perspires,  and 
the  tongue  grows  moist.  Baths,  Cold,  83, 
certain  method  of  reducing  body-heat,  and 
especially  valuable  in  typhoid  and  pneu- 
monia. Digitalis,  510,  is  indicated  in  in- 
flammatory fever  and  in  the  eruptive 
fevers  during  the  first  stage,  and  as  an  aid 
to  quinine  when  employed  as  an  antipy- 
retic. Quinine,  204,  occupies  the  first  po- 
sition as  an  antipyretic,  and  is  more  gen- 
erally applicable  than  any  other.  Chloral, 
616,  reduces  fever,  and  is  highly  useful 
when  high  febrile  excitement  coincides 
with  delirium  and  wakefulness.  Salicylic 
Acid,  396,  Resorcin,  404,  Sodium  Benzoate, 


848 


CLINICAL   INDEX. 


422,  are  antipyretic  and  antiseptic.  Among 
the  newer  contributions  to  the  antipyret- 
ics, and  most  effective,  are  Antipyrin,  411, 
Acetanilid,  426,  Salol,  409,  Calomel,  289, 
and  compound  solution  of  Iodine,  261,  the 
former  administered  during  the  first  week, 
and  the  latter  during  the  whole  course  of 
typhoid  fever,  affect  the  course  and  dura- 
tion favorably  ;  "the  specific  treatment" 
of  the  Germans.  Carbolic  Acid,  381,  and 
Carbolate  of  Iodine,  380,  have  good  effects 
in  typhoid.  Turpentine,  779,  in  typhoid, 
puerperal,  and  yellow  fever,  when  there  is 
much  vaso-motor  depression,  haemorrhage, 
etc. 

FISSURE  OP  THE  ANUS  : 
Hydrastis,  191,  the  fluid  extract  applied  un- 
diluted, lodoform,  263,  dusted  well  over 
the  fissure,  and  lodo-tannin,  264,  applied 
in  the  same  way.  Trichlor phenol,  386. 
Carbolic  Acid,  382.  Cocaine,  to  allay  irri- 
tability, 561. 

FISSURE  OP  NIPPLES  : 

Iron,  153,  liquor  ferri  subsulpb.,  and  glycerin 
applied  with  a  brush.  Tannin,  346,  in 
powder  or  the  glycerite.  Tincture  of  Ben- 
zoin, 422,  with  glycerin.  Brandy,  577,  with 
or  without  glycerin.  Collodion,  819,  flexile 
collodion,  or  Liq.  Guttce  Perchoz,  819,  ap- 
plied to  close  fissure.  Lead  Nitrate,  315, 
with  simple  ointment  or  glycerin,  is  the 
most  efficient  application. 

FLATULENCE : 

Calumba,  181,  with  aromatics.  Camphor, 
511,  will  often  give  prompt  relief.  Chloro- 
form, 596,  especially  the  spirit.  Asafcet- 
ida,  551,  Valerian,  554,  and  Spirit  of 
Ether  Compound,  593,  are  adapted  to  nerv- 
ous and  hypochondriacal  cases.  Turpen- 
tine, 736,  is  indicated  in  the  flatulence  of 
fevers,  peritonitis,  etc.  Nux  Vomica,  482, 
Belladonna,  526,  Physostigma,  689,  and 
probably  Muscarine,  729,  give  relief  to 
those  cases  of  flatulence  dependent  on 
paresis  of  the  muscular  layer  of  the  bowel ; 
also  the  formula  of  Wood,  181.  Diet  is  of 
the  highest  importance,  in  cases  arising 
from  intestinal  indigestion. 

FRECKLES : 

Alkalies,  224,  in  form  of  a  lotion  composed 
of  potassa  carbonate  and  chloride  of  soda. 
Sodium  Biborate,  420,  a  saturated  solu- 
tion, is  a  safe  and  often  successful  lotion. 
Naphtol,  416,  Boric  Acid,  420,  and  Tincture 
of  Benzoin,  422,  are  newer  and  efficient 
remedies. 

GALL-STONES.    (See  CALCULI,  BILIARY.) 

GANGRENE : 

Bromine,  372,  one  of  the  best  escharotics  in 
hospital  gangrene  to  arrest  morbid  action. 
Chlorine,  371.  Chromic  Acid,  815,  is  a 
highly  efficient  caustic,  and  penetrates 
deeply  with  little  pain,  comparatively. 
Zinc  Chloride  and  dried  Sulphate,  320, 
powerful,  but  painful.  Potassa  Fusa,  225, 
an  active  escharotic.  Nitric  Acid,  119, 


next  to  bromine,  is  the  most  useful  caus- 
tic to  arrest  the  destruction  of  parts,  ex- 
ternal, by  gangrene.  The  Antiseptics  ap- 
plied to  the  affected  surface,  including 
Carbolic  Acid,  382,  Salicylic  Acid,  400,  Re- 
sorcin,  404,  Salol,  409,  lodoform,  271,  Myr- 
tol  and  Thymol,  430,  and  others  are  the 
most  effective  now  used.  To  these  Cam- 
phor, 548,  may  be  added.  Turpentine,  781, 
used  locally,  and  Eucalyptol,  186,  are  high- 
ly useful  in  gangrene  of  the  lungs  to  pre- 
vent extension  and  to  destroy  fetor. 

GASTRALGIA  : 

Aquapuncture,  809,  injections  under  the  skin 
of  water  over  the  epigastrium,  affords 
much  relief.  Alum,  336,  is  useful  in  the 
cases  with  acidity  and  pyrosis.  Arsenic, 
171,  one  or  two  drops  t.  d.  of  Fowler's  solu- 
tion, is  the  most  generally  effective  of  all 
remedies.  Ether,  593,  Chloroform,  596, 
Atropine,  526,  and  the  anodynes,  allay  the 
pain.  Bismuth,  163,  and  with  Creosote  and 
Glycerin,  379.  Silver,  301,  Zinc  Oxide,  318, 
and  Manganese  Oxides,  156,  make  a  per- 
manent impression  on  the  nerve-endings  in 
the  mucous  membrane,  and  hence  give 
permanent  results.  Hydrocyanic  Acid, 
701,  and  Cyanide  Potass.,  703,  if  success- 
ful, are  speedily  so.  Nitro-glycerin,  709, 
also  acts  quickly  and  often  effectively.  In 
cases  having  a  distinct  periodicity,  Qui- 
nine, 200,  and  Salicylic  Acid,  395,  have 
acted  well,  and  Resorcin,  404,  will  proba- 
bly be  found  beneficial.  Nux  Vomica,  482, 
may  remove  the  morbid  state  on  which  the 
pain  depends.  Morphine,  635,  subcutane- 
ously,  alone  or  combined  with  atropine, 
stops  the  pain  at  once.  Galvanism,  469, 
the  pneumogastric  and  sympathetic  acted 
on,  has  been  successful.  Diet,  62,  is  of  the 
utmost  consequence. 

GASTRIC  CATARRH  : 

Aliment,  65,  especially  the  milk-cure,  59. 
Arsenic,  171,  is  the  most  important  reme- 
dy ;  next  are  Oxides  of  Silver,  301,  Man- 
ganese, 156,  and  Zinc,  318,  Bismuth,  163, 
Alum,  335,  and  Lead.  Acetate,  313.  The 
Bitters,  180,  especially  Calumba,  180,  Nux- 
Vomica  Tincture,  482,  Cinchona  Infusion, 
Eucalyptus,  186,  and  Hydrastis,  190,  are 
beneficial,  if  not  continued  too  long  ;  also 
Wild  Cherry,  183.  To  these  may  be  added 
the  various  Antiseptics,  as  Creosote,  379 
et  seq.,  and  others  of  the  same  group. 

GASTRIC  ULCER  : 

Milk-Cure,  59,  65,  Rectal  Alimentation,  71, 
Nutrient  Enemata,  71,  Lead  Acetate,  313, 
sedative,  and  arrests  haemorrhage.  Bis- 
muth, 163,  allays  pain  and  arrests  vomit- 
ing. Arsenic,  171  ;  Fowler's  solution  in 
drop-doses  also  lessens  pain  and  vomiting 
remarkably.  Silver  Oxide  and  Nitrate, 
301,  promote  cicatrization  and  relieve  pain. 
Morphine  and  Atropine,  635,  645,  arrest 
pain  and  vomiting,  even  in  very  minute 
quantity. 


CLINICAL   INDEX. 


849 


GASTRITIS,  ACUTE  : 

Ice,  82,  Hydrocyanic  Acid,  701,  Morphine, 
635,  subcutaneously  or  endermically.  Cre- 
osote, 379.  Rectal  Alimentation,  71.  Pa- 
pain,  108,  in  the  apepsia  of  infants. 

GASTRITIS,  CHRONIC.    (The  same  as  for  GAS- 
TRIC CATARRH.) 

GLANDS,  LYMPHATIC,  AFFECTIONS  OF. 
Carbolic  Acid,  382,  properly  diluted,  injected 
into  the  substance  of  the  glands  ;  also  Io- 
dine. 259,  and  lodoform,  272,  solutions. 
Iron  and  Manganese  Iodides,  148,  156,  in- 
ternally, and  tincture  of  iodine  injected 
into  the  substance  of  glands,  262.  Sul- 
phides, 249,  are  said  to  mature  or  abort 
suppuration  in  glands.  Calcium  Chloride, 
223,  and  Phosphates,  140,  are  highly  useful 
in  strumous  inflammation  and  suppura- 
tion. Pilocarpus,  682,  684,  has  a  curative 
action  in  acute  affections  of  parotid  and 
submaxillary  glands.  Conium,  664,  local- 
ly and  systemically,  has  long  been  re- 
garded as  discutient.  Mercury,  293,  espe- 
cially bichloride,  in  acute  inflammatory 
diseases  of  tonsils,  parotid  and  submaxil- 
lary glands.  Lead  Iodide,  262,  and  lodo- 
form, 263,  268,  as  an  ointment  externally. 
Ointment  of  the  Red  Mercuric  Iodide,  294, 
has  remarkable  effects  in  goitre,  enlarged 
spleen,  etc. 

GLEET : 

Iron,  153,  tinct.  ferri  chloridi,  in  anaemic  sub- 
jects. Turpentine,  781,  is  beneficial  when 
the  local  condition  is  one  of  relaxation. 
Juniper,  789,  Cantharides  Tinct.,  799,  are 
useful  under  the  same  circumstances. 
lodoform,  263,  and  lodol,  274,  in  pencils. 
Corrosive  Chloride,  295,  in  solution.  Pyok- 
tanin,  412,  Creolin,  407,  Teucrin,  431,  and 
other  remedies  of  the  group.  Blisters,  807, 
to  the  perinfeum  are  very  beneficial. 

GOITRE  : 

Iodine.  259,  both  internally  and  locally,  ef- 
fective in  the  case  of  simple  hypertrophy. 
Ointment  of  the  Red  Mercuric  Iodide,  294, 
exceptionally  useful  in  same  state.  In- 
jections of  Tincture  of  Iodine,  259,  262,  263, 
very  effective  in  cystic  degeneration. 
Electrolysis,  471,  has  succeeded  in  simple 
hypertrophy  and  cystic  state  of  gland. 
Animal  Extracts,  432. 

iONORRHCEA  : 

Internal  Remedies.— Copaiba,  784,  Cubeb, 
786,  Buchu,  790,  and  other  urino-genital 
remedies,  more  useful  after  acute  symp- 
toms. Colchicum,  354,  Saline  Laxatives, 
750,  Aconite,  715,  and  Veratrum  Viride, 
720,  during  the  first  acute  symptoms,  Tur- 
pentine, 781,  and  Cantharides  Tincture, 
799,  for  the  chronic  stage. 

Injections. — Bismuth,  164,  with  or  without  Fl. 
Ex.  of  Hydrastis,  191,  is  one  of  the  best. 
Methylene  Blue,  414,  Creolin,  407,  and 
Naphtol,  416,  have  proved  very  efficient 
topical  applications.  Zinc  Sulphate,  320,  a 
very  weak  solution,  often  repeated,  can  be 


used  alone,  or  chloride  or  sulphate  of  zinc, 
and  Lead  Acetate,  315,  in  combination. 
After  the  acute  symptoms,  stronger  solu- 
tions and  pencils  of  above  and  Silver  Ni- 
trate, 305,  Copper  Sulphate,  309,  Iron  Sub- 
sulphate,  153,  Cadmium  Sulphate,  326, 
Alum,  336,  and  Tannin,  345. 

GOUT: 

Aliment,  59,  67,  of  first  importance.  Alka- 
lies, 224,  and  Alkaline  Mineral  Waters, 
229,  especially  potash  and  lithium  salts. 
Manganese  Salts,  156,  very  serviceable  in 
chronic  gouty  affections.  Salicylic  Acid, 
the  salicylates,  and  Salol,  409,  very  effect- 
ive in  the  acute  form.  Ouaiac,  357,  after 
acute  symptoms.  Colchicum,  353,  espe- 
cially colchicine,  the  most  celebrated 
remedy  for  the  paroxysms.  Arnica,  636, 
and  Trimethylamine,  637.  Sulphurous 
Waters,  253,  Sulphur-Baths,  250. 

G0MS,  AFFECTIONS  OF  : 

Alum,  337,  for  spongy  and  bleeding.  Tannin, 
345,  especially  Olycerite,  345,  for  same  con- 
dition. Carbolic  Acid,  382,  and  lodoform, 
263,  when  fetor  is  present.  Benzoin  Tinc- 
ture, 422,  with  or  without  glycerin.  Be- 
sorcin,  404. 

HEMATEMESIS  : 

Alum,  337,  especially  in  passive.  Lead  Ace- 
tate, 314,  may  oe  used  in  all  conditions. 
Iron,  146,  as  Monsel's  solution,  one  of  the 
most  effective  applications.  lodic  Acid, 
266,  a  safe  and  effective  haemostatic.  Tan- 
nin, 345,  and  the  vegetable  astringents, 
especially  Hamamelis,  341,  Rhatany,  341, 
and  Logwood,  340,  Turpentine,  781,  in  weak 
and  relaxed  state  of  vessels.  Ergotin,  503, 
subcutaneously. 
HJEMATURIA  : 

Ergot,  503,  by  the  stomach  or  subcutane- 
ously ;  may  be  combined  with  rhatany, 
ipecacuanha,  or  other  astringents.  Gallic 
Acid,  343,  one  of  the  most  useful  remedies. 
Rhatany,  341,  owes  its  utility  to  the  pres- 
ence of  tannic  and  gallic  acids.  Quinine, 
207,  is  highly  effective  in  the  intermittent 
or  malarial  form  ;  Turpentine,  781,  in  the 
heemorrhagic  diathesis,  and  in  the  passive 
form. 
HEMOPTYSIS  : 

Ergot,  503,  with  ipecac  and  a  little  opium  by 
the  stomach ;  ergotin  subcutaneously. 
Gallic  Acid  and  ergot,  343,  by  the  stomach. 
Ipecacuanha,  742.  Digitalis,  509.  Tinct. 
of  Verat.  Viride,  719.  Barium  Chloride, 
242.  Iron,  146,  subsulphate  solution  in 
spray,  a  highly  effective  application.  Lead 
Acetate,  315,  with  opium,  frequently  pre- 
scribed, but  not  so  effective  as  those  pre- 
viously named. 
HEMORRHAGE  AND  HBMORRHAGIC  DIATHESIS  : 

Arterial  Sedatives.— Digitalis,  503.  Verat. 
Viride,  719.  Aconite,  719,  Lead  Acetate, 
315,  Barium  Chloride,  242,  Venesection, 
813,  Ipecac,  742,  and  Ergot,  503,  act  by 
slowing  the  heart  and  diminishing  the 


850 


CLINICAL   INDEX. 


caliber  of  the  vessels,  and  are  therefore  1 
adapted  to  active  haemorrhage.  Turpen- 
tine, 781,  Ammonia,  238,  by  stomach  and 
by  intravenous  injection,  and  Alcohol,  576, 
relieve,  by  increasing  the  contractile  energy 
of  the  vessels,  and  are  therefore  indicated 
in  passive  hspmorrhage.  To  these  must  be 
added  Transfusion,  29,  when  death  is  immi- 
nent from  simple  loss  of  blood.  Astrin- 
gents are  employed  locally  and  systemic- 
ally,  and  include  Alum,  337,  Lead  Acetate, 
314,  Iron,  Subsulphate  and  Chloride,  151, 
153,  Sulphuric  Acid,  118,  Tannin,  343,  Gal- 
lic Acid,  343,  and  the  Vegetable  Astrin- 
gents, 341,  346. 

HEMORRHAGE,  CEREBRAL  I 

Venesection  or  Leeches,  814,  when  the  blood- 
pressure  is  high  and  haemorrhage  threat- 
ened or  proceeding.  Purgatives,  750,  under 
the  same  circumstances.  Ergotin,  503, 
Barium  Chloride,  242,  and  arterial  seda- 
tives, when  collateral  hyperaemia  comes 
on. 

HEMORRHAGE,  INTESTINAL  : 

Tannic  Acid,  345,  and  vegetable  astringents. 
Lead  Acetate,  314,  Sulphuric  Acid,  dilute, 

118.  lodic  Acid,  265,  an  active  haemostatic. 
Iron,    pernitrate,    141.      Turpentine,    781. 
Opium,  637,  to  quiet  intestinal  movements. 
Ice,  88,  to  abdomen.    Ergotin,  503,  hypoder- 
matically. 

HEMERRHAGE,  UTERINE  : 

Ergot,  503.  fluid  extract  in  full  doses.  Ipecac, 
742,  carried  to  nausea  merely,  is  highly 
effective.  Digitalis,  503,  Barium  Chloride, 
240,  Sulphuric  Acid,  dilute,  118,  small  doses 
frequently,  and  Epsom  Salts,  708.  Cold, 
88.  Hot  Water,  88.  Iron,  152;  Monsel's 
solution,  diluted,  injected. 
HEMORRHOIDS  : 

Aloes,  758,  in  recent  haemorrhoids,  as  after 
delivery,  highly  useful.  Ergot,  499,  in  di- 
lated haemorrhoidal  veins  without  new  tis- 
sue, by  the  stomach  and  topically.  Alka- 
line, 233,  Sulphurous,  253,  and  purgative 
Chalybeate  Waters,  especially  Bedford, 
232.  Saline  Purgatives,  750,  notably  Epsom 
salts,  in  bleeding  piles.  Senna,  754,  the 
confection  especially.  Sulphur,  745,  and 
Cream  of  Tartar,  751,  to  render  movements 
soft  and  easy  :  also  Cascara  Sagrada,  747, 
and  Pulv.  Glycyrrhiz.  Comp.,  745.  The 
Grape-Cure.  55.  Alum,  336.  Iron,  153; 
Monsd's  solution  to  arrest  bleeding. 
Leeches,  814,  to  inflamed  piles.  Nitric  Acid, 

119,  to  the  mulberry,  bleeding  pile.    lodic 
Acid,  265,   Ung.  Gallce,  347,  ointment  for 
haemorrhoids.     The  parenchymatous   in- 
jection of  Carbolic  Acid,  382,  one  of  the 
best  remedial  measures. 

HAY-FEVEB  : 

Arsenic,  173,  internally  and  in  cigarettes. 
Atropine,  527,  when  secretion  is  profuse. 
Carbolic  Acid,  379,  by  inhalation.  Bro- 
mine, if  cautiously  used,  highly  efficient, 
371.  Quinine,  205,  207,  is  useful  at  onset  in 


spray,  locally,  and  later  as  a  tonic.  Iodides, 
258,  carried  to  iodism,  afford  a  great  relief  ; 
may  be  combined  with  arsenic.  Also  Ethyl 
iodide,  267,  Pyridine,  417,  and  others,  by 
inhalation.  Grindelia,  723,  for  the  asth- 
matic symptoms.  Muscarine,  729,  will 
probably  prove  useful  in  the  asthmatic 
stage,  if  membrane  is  dry.  Morphine,  644, 
is  probably  beneficial  at  any  stage,  but 
great  danger  of  morphine-habit.  Pilocar- 
pine,  683.  Nitro-glycerin,  709,  for  the  asth- 
ma. Cocaine,  561,  to  the  nose  a  highly 
efficient  application,  but  liable  to  abuse. 

HEADACHE  : 

Ammonia,  237,  for  nervous  headache  ;  espe- 
cially aromatic  spirits,  and  the  Carbonate, 
239,  for  migraine.  Arsenic,  173,  for  cere- 
bral congestion  and  hemicrania.  Bro- 
mides, 616,  for  true  migraine.  Digitaline, 
512,  in  congestive  hemicrania,  from  venous 
hyperaemia.  Ergot,  501,  in  the  headache 
of  miliary  aneurisms  and  hi  arterial  hy- 
peraemia. Galvanism,  468,  applications  to 
cervical  sympathetic  during  intervals,  per- 
sistently, and  mild  transverse  applications 
during  seizure.  Amyl  Nitrite,  705.  by  in- 
halation in  cases  characterized  by  vaso- 
motor  spasm  (pallor  of  face).  Also  Nitro- 
glycerin,  709,  internally  under  same  condi- 
tions. Potassium  Cyanide,  703,  a  solution 
applied  on  compress  to  painful  region. 
Sodium  Phosphate,  140,  in  headache  due 
to  "biliousness."  Picrotoxin,  491,  in  neu- 
ralgic headache  ;  also  Strychnine,  482. 

HEABT,  DISEASES  OP  : 

Aconite,  714,  Veratrum  Viride,  719,  and  Bro- 
mides, 651,  for  overaction  and  simple  hy- 
pertrophy. Digitalis,  509,  in  rapid  action 
with  low  tension  and  valvular  lesions.  Also 
Convallaria,  516,  Sparteine,  519,  Strophan- 
thin,  518,  and  Adonidin,  520.  Cimicifuga, 
522,  under  the  same  conditions.  Ergot, 
499,  is  useful  in  dilated  heart.  Amyl  Nitrite, 
705,  in  angina  pectoris  :  also  Nitro-glycerin, 
709.  Iron,  151,  remarkably  beneficial  in  the 
irritable  heart  of  anaemia.  Morphine,  637, 
hypodermatically  in  dilated  heart  and  gen- 
eral dropsy  therefrom.  Quinine,  201,  in 
peri-  and  endocarditis  and  cardiac  weak- 
ness. Ammonia,  238,  inhaled,  intravenous, 
and  by  the  stomach  in  sudden  failure. 
Atropine,  527,  a  prompt  cardiac  excitant. 

HEHIPLEGIA  : 

Galvanism,  465,  cautiously  applied  to  the 
brain  ;  faradism  to  the  muscles,  if  they 
waste  or  degenerate.  Strychnine,  483,  486, 
hypodermatically  into  the  paralyzed  mus- 
cles, after  local  troubles  have  ceased.  Mas- 
sage, 102. 

HEPATIC  DISEASES  : 

Aconite,  672,  in  acute  inflammation.  Alka- 
line Mineral  Waters,  229  ;  also  Sulphurous, 
253,  in  portal  congestion.  Colchicum,  353, 
is  an  active  remedy  in  congestion  of  the 
liver.  Nitro- Muriatic  Acid,  115,  and  the 
acid  bath,  are  useful  in  torpor  of  liver. 


CLINICAL   INDEX. 


851 


The  resin-bearing  purgatives,  Rhubarb,  755, 
and  the  following :  Aloes,  757,  Podophyl- 
lum,  762,  Euonymin,  764,  and  especially 
Ipecacuanha,  740,  the  most  effective.  Am- 
monium Chloride,  237,  and  Iodides,  259,  in- 
cluding lodoform,  272,  are  useful  in  catarrh 
of  bile-ducts.  Salol,  409,  and  Salicylic 
Acid,  397,  have  decided  effects.  Sodium 
Phosphate,  140,  one  of  the  most  certain  and 
useful  cholagogues.  Gold  and  Sodium 
Chloride,  297,  is  effective  in  sclerosis.  Mer- 
curials, 287,  have  questionable  utility. 
Phosphorus,  135,  prevents  the  formation  or 
checks  the  growth  of  connective  tissue 
(sclerosis). 

HERPES  : 

Copper  Acetate,  309,  as  an  ointment ;  Calo- 
mel, 294,  also  as  an  ointment,  and  Zinc 
Ointment,  320,  are  curative.  Belladonna 
or  Atropine,  533,  internally,  is  useful.  The 
following  antiseptics:  Aristol,  277,  Alum- 
nol,  338,  Boral,  338,  Nosophen,  276,  Ichthyol, 
350,  Pyrogallol,  348,  Thymol,  429,  Boric 
Acid,  420,  Aristol,  277,  Naphtalin,  416, 
Resorcin,  404,  Salicylic  Acid,  400,  Trichlor- 
phenol,  386,  Carbolic  Acid,  382.  Galvan- 
ism, 470,  in  cases  having  a  neurotic  origin, 
as  H.  zoster. 

HOARSENESS  : 

Nitric  Acid,  118,  is  highly  effective  in  hoarse- 
ness of  singers  and  reflex  from  stomach 
troubles.  Atropine,  533,  affords  prompt 
relief  usually  in  hysterical  aphonia. 

HYDROCELE  : 

Carbolic  Acid,  382,  injected  into  the  sac  after 
the  withdrawal  of  the  fluid.  Iodine  Tinc- 
ture, 264,  injected  in  the  same  way.  Silver 
Nitrate,  305,  a  sufficiently  strong  solution 
thrown  into  the  sac  after  fluid  is  removed. 
Galvano-puncture,  471,  sometimes  succeeds 
admirably. 

HYDROPHOBIA  : 

Amyl  Nitrite,  705,  by  inhalation,  and  Nitro- 
glycerin,  706,  by  the  stomach,  should  be 
faithfully  tried.  Curara,  671,  has  appar- 
ently succeeded.  Morphine,  601,  Paralde- 
hyde,  585,  Methyl  Chloride,  586,  Hypnone, 
590,  Ethyl  Bromide,  592,  are  palliative,  and 
may  have  curative  effects.  Methylal,  586, 
Hypnol,  590,  and  Vrethan,  588,  and  its  con- 
geners, promise  utility. 

HYDRO-THORAX  : 

Iodine  Injections,  264,  to  prevent  reaccumu- 
lation  of  fluid.  Pilocarpus,  683,  to  cause 
absorption.  Resin  of  Copaiba,  784,  as  a 
diuretic.  Dry  Diet,  54. 

HYPERPYRKXIA  : 

Cold  Bath,  84,  Quinine,  201,  in  massive  doses, 
and  the  Antipyretics  of  the  antiseptic  group. 

HYPOCHONDRIA  : 

Arsenic,  173,  has  good  effects  in  the  hypo- 
chondria of  the  aged.  Colchicum,  353,  with 
colocynth,  to  deplete  the  portal  circulation. 
Caffeine,  566,  is  a  serviceable  cerebral 
stimulant  in  these  cases.  Asafcetida,  551, 
is  particularly  indicated  and  has  great 


value  in  cases  characterized  by  much  flatu- 
lence. Opium,  639 ;  in  some  cases  small 
doses  of  the  tincture  is  a  remedy  of  the 
first  importance.  Cocaine,  562,  but  danger 
of  cocaine  habit ;  Cannabis,  556.  Chloral, 
617,  may  be  required  to  procure  sleep. 
Gold  and  Sodium  Chloride,  298,  gives  ex- 
cellent results  in  the  hypochondria  of  the 
aged. 

HYSTERIA  : 

Ammonia,  239,  the  aromatic  spirits,  for  the 
hysterical  seizure.  Asafoetida,  551,  Vale- 
rian, 554,  Camphor,  547,  Eucalyptus,  186, 
Ether,  593,  are  useful  remedies  to  relieve 
the  vapors  and  accompanying  symptoms. 
Phosphates,  139,  Iron,  150,  Coca,  562,  Cod- 
liver  Oil,  124,  and  the  "rest-cure,"  are  the 
remedies  to  relieve  the  abnormal  mobility 
of  the  nervous  system. 

IMPETISO  : 

Glycerite  of  Tannin,  345,  an  excellent  appli- 
cation. Lead  Acetate,  315,  in  solution. 
Zinc  Oxide,  320,  dusted  over  or  ointment 
applied.  Quinine,  208,  usually  improves. 
The  Mineral  Acids,  119,  in  intestinal  indi- 
gestion. 

IMPOTENCE : 

Phosphorus,  or  Zinc  Phosphide,  134,  138,  are 
efficient  stimulants.  Cannabislndica,557, 
also  stimulates  the  function.  Nux  Vomica, 
483,  Sanguinaria,  361,  also  increase  sexual 
activity,  but  differ  in  degree.  Ergotin,  504, 
subcutaneously  about  the  dorsal  vein  of  the 
penis,  or  Fluid  Extract  of  Ergot,  501,  by 
the  stomach,  increase  the  vigor  of  the  erec- 
tions. Arsenic,  175,  in  functional  impo- 
tence, and  Iron  Arseniate,  175,  act  as  a 
tonic  to  the  organs.  Gold  and  Sodium 
Chloride,  297,  has  also  slowly  acting  aphro- 
disiac effects. 

INCONTINENCE,  NOCTURNAL  : 
Belladonna  or  Atropine,  530,  carried  to  the 
point  of  inducing  some  physiological  ac- 
tion. Ergot,  501,  in  cases  due  to  paresis  of 
the  muscular  layer  of  the  bladder.  Iron, 
152,  sirup  of  the  iodide,  in  weak,  anaemic 
subjects. 

INDIGESTION  : 

Aliment,  56, 60.  In  stomach  indigestion,  give 
foods  digested  chiefly  in  intestine,  and  in 
intestinal  indigestion,  food  digested  chiefly 
in  stomach.  Milk-Cure,  59.  Pepsin,  Pan- 
creatin,  Ingluvin,  and  Papdin,  109,  digest- 
ive ferments,  109,  increase  activity  and 
thoroughness  of  digestion.  Mineral  Acids, 
115,  and  Lactic  Acid,  111,  in  atonic  dyspep- 
sia and  indigestion.  Alkalies,  217,  and  Al- 
kaline Mineral  Waters,  229,  233,  for  the 
indigestion  of  the  obese,  gouty,  and  rheu- 
matic. Sulphurous  Acid,  247,  for  indiges- 
tion with  pasty  vomiting,  sarcina,  etc. 
Bismuth,  164,  and  Dermatol,  for  painful  in- 
digestion and  nausea  ;  also  Hydrocyanic 
Acid,  702.  Strychnine,  482,  or  tinct.  nucis 
vom.,  to  stimulate  organs ;  also  Ignatia, 
488,  and  Picrotoxin,  491.  Aloes,  757,  in  in- 


852 


CLINICAL    INDEX. 


digestion  with  torpor  of  large  intestine,  and 
pasty  motions.  Alcohol,  575,  an  excellent 
stomachic  tonic  in  moderate  quantity  for 
the  indigestion  of  the  old. 

INFLAMMATION  : 

Aliment,  63.  Water,  84,  the  methods  of  hy- 
drotherapy,  to  reduce  heat.  Alcohol,  575, 
in  condition  of  systemic  and  cardiac  de- 
pression, as  an  antipyretic,  etc.  Leeches, 
814,  very  useful  in  certain  local  inflamma- 
tions superficially  situated,  the  systemic 
condition  being  sthenic.  Aconite,  715,  use- 
ful in  inflammation  of  respiratory  organs 
and  parenchymatous  inflammations  in  gen- 
eral. Veratrum  Viride,  719,  Gelsemium, 
512,  Arnica,  677,  and  especially  Digitalis, 
675,  are  valuable  as  arterial  sedatives  to  di- 
minish blood-supply  to  inflamed  area,  and 
cease  to  be  beneficial  when  exudations  be- 
gin. Belladonna,  527,  in  some  catarrhal 
inflammations  is  highly  useful.  Alkalies, 
217,  especially  the  potash  salts  and  am- 
monia, are  very  valuable  in  the  exudation 
stage.  Saline  Cathartics,  750,  to  lower  the 
blood-pressure  and  to  cause  excretion  of 
products  of  waste.  To  the  remedies  acting 
on  the  circulation  may  be  added  Barium 
Chloride,  242,  and  Muscarine,  729,  and  un- 
der some  circumstances  Ergot,  501.  Qui- 
nine, 201,  in  full  quantity,  especially  when 
combined  with  opium,  may  abort  an  incip- 
ient inflammation.  Opium,  638,  is  the  most 
important  remedy  in  serous  inflammation. 
Tartar  Emetic,  324,  affords  undoubted 
good  results  in  some  forms,  notably  in 
acute  bronchitis.  Pilocarpus,  684,  has  very 
satisfactory  results  in  exudation  in  the  eye, 
pleura,  etc. 

INSOLATION.  (SUNSTROKE.) 
Cold  Bath,  86,  or  douche  or  wet  pack,  for  the 
state  of  high  fever.  Morphine,  640,  hypo- 
dermatically.  Turpentine  Enema,  780,  as  a 
derivative.  Brandy,  576,  and  Ammonia,  238, 
for  heat-exhaustion,  and  the  antipyretics, 
as  Salicylic  Acid,  396,  Acetanilid,  426,  Ex- 
algin,  427,  Thymol,  430,  Thymacetin,  530, 
Antipyrin,  411,  Thallin,  406,  Phenacetin, 
418,  and  other  synthetical  products  of  the 
same  series  in  heat  fever. 

INSOMNIA  : 

Alcohol,  576,  in  the  condition  of  cerebral  anse- 
mia,  or  in  quantity  to  induce  narcosis. 
Paraldehyde,  585,  Urethan,  588,  and  its 
congeners,  Phenyl-Urethan  and  Chloral- 
Urethan,  are  efficient  hypnotics.  Hypnone, 
590,  and  Hypnal,  590,  and  Methylal,  586, 
act  in  a  similar  manner.  Chloral,  616. 
the  most  direct  and  generally  useful  hyp- 
notic. Belladonna,  532,  in  some  morbid 
states  with  great  restlessness  and  delirium  ; 
but  Hyoscyamine,  538,  Hyoscine,  540,  and 
Duboisine,  542,  in  sufficient  quantity,  are 
more  frequently  successful,  especially  in 
the  insomnia  of  mania,  puerperal  mania, 
etc.  Bromides,  652,  a  direct  hypnotic,  but 
the  action  is  easily  prevented.  Morphine, 


640,  Morphine  and  Atropine,  644,  is  gener- 
ally the  best  sleep-producer  in  cases  of 
pain,  in  some  kinds  of  mania,  and  in  mel- 
ancholia. Humulus,  646,  a  hop-pillow,  has 
induced  sleep  ;  lupuline  is  more  effective. 
Phosphorus,  135,  under  some  circumstances 
acts  well.  Galvanization,  465,  of  cervical 
sympathetic,  causes  sleep  when  circum- 
stances are  favorable.  Water,  85,  a  tepid 
or  warm  bath  at  bed-hour,  often  succeeds. 
Massage,  102. 

INTERMITTENT  FEVKB  : 

Cinchona,  204.  Quinine  is  prophylactic ; 
rightly  used  prevents  malarial  infection, 
and  iu  proper  quantity  arrests  the  parox- 
ysms. In  severe  cases,  combination  with 
morphine  is  very  effective.  An  attack  im- 
pending may  be  arrested  by  Amyl  Nitrite, 
706,  or  Nitro-glycerin,  709,  and  Pilocarpine, 
684,  as  respects  the  chill :  Chloroform,  597, 
by  inhalation,  or  by  the  stomach  in  a  full 
dose,  may  prevent  a  chill.  Salicin,  389, 
Salicylic  Acid,  396,  and  Resorcin,  404,  es- 
pecially the  last  named,  have  decided  anti- 
periodic  qualities  only  inferior  to  quinine. 
Carbolic  Acid,  381,  hypodermatically, 
seems  to  be  quite  effective.  Apiol,  794, 
also  has  very  decided  antiperiodic  quali- 
ties. Cinchonidine  Salicylate,  396,  an  an- 
tiperiodic of  considerable  value.  Other 
substitutes  for  quinine  are  Nitric  Acid,  118, 
which  acts  quite  well  in  mild  cases :  Hy- 
drastine,  190,  has  some  antiperiodic  power, 
but  is  an  active  tetanizer  ;  Eucalyptus,  187, 
more  adapted  to  chronic  malarial  poison- 
ing, and  for  convalescence  after  attacks  of 
fever  ;  Oleoresin  of  Capsicum,  788,  and 
Nux  Vomica,  482,  adjuncts  to  other  and 
more  powerful  remedies.  Antipyrin,  411, 
Acetanilid,  426,  and  Salol,  409,  and  the  an- 
tipyretics of  the  antiseptic  group. 

INTERTRIOO  : 

Bismuth,  164,  dusted  over  the  surface.  Zinc- 
Ointment,  320.  Tannin,  in  powder,  346. 
Tannigen,  349,  Alumnol,  338,  mild  and  un- 
irritating  applications. 

INTESTINAL  CATARRH  : 

Ammonium  Chloride,  237.  Bismuth,  164,  is 
one  of  the  best  remedies.  Calomel,  294,  in 
minute  doses  frequently.  Silver  Kitrate, 
802,  Copper  Sulphate,  308,  Lead  Acetate, 
313,  Zinc  Oxide  and  Sulphate,  319,  are  ex- 
cellent remedies,  valuable  in  the  order 
named.  The  vegetable  tonic  astringents, 
Eucalyptus,  186,  Hydrastis,  190,  and  those 
containing  Tannic  Acid,  343,  are  also  use- 
ful. Salol,  408,  of  special  value  because  of 
the  action  of  the  pancreatic  secretion  and 
the  more  powerful  germicides  and  antisep- 
tics, 375  et  seq,  especially  Naphtalin  and 
Ichthyol. 

INTESTINAL  PARASITES  : 
Calomel,  288,  for  the  round  worm  ;  also  Hy- 
drocyanic Acid,  701.     Carbolic  Acid,  382, 
but  especially  Glycerin,  821,  for  intestinal 
trichina.      Remedies   against    the   round 


CLINICAL   INDEX. 


853 


worm,  771,  Santonin,  Spigelia,  The  Bit- 
ters, 181,  especially  Quassia  against  ascar- 
ides,  etc.  Papdin,  108,  a  solvent. 

INTUSSUSCEPTION  : 

Effervescent  Enemata,  770  ;  also  Irrigation, 
770,  acting  mechanically.  Tobacco  Enema, 
694,  to  relax  spasm.  Morphine,  638,  hypo- 
dermatically  of  first  importance.  Bella- 
donna, 526. 

IRITIS  : 

Atropine,  530,  to  prevent  adhesions,  and 
check  inflammation  by  emptying  vessels  of 
iris.  Eserine,  691,  now  much  employed  to 
break  up  adhesions  and  diminish  intra-ocu- 
lar  tension  ;  also  Homatropine,  534.  Pilo- 
carpine,  683,  to  cause  absorption  of  exu- 
dations and  effusions.  Mercury,  288,  of 
great  importance,  as  most  cases  are  spe- 
cific. Duboisine,  542,  is  much  employed  as 
a  substitute  for  atropine ;  also  Scopola- 
mine,  544. 

JAUNDICE  : 

Aliment ,  55,  59,  63,  especially  the  skim-milk 
cure,  avoidance  of  fats,  etc.  Alkalies,  217, 
and  the  Alkaline  Mineral  Waters,  229,  So- 
dium Phosphate,  140,  the  most  useful  rem- 
edy in  catarrh  of  bile-ducts,  and  in  incipi- 
ent sclerosis.  Ammonium  Chloride,  237, 
and  the  Iodide,  257,  and  lodoform,  271,  are 
beneficial  under  the  same  circumstances. 
Manganese,  156,  Permanganate  ofPotassa, 
157,  and  Arsenic,  172,  have  unquestionable 
cholagogue  effects,  and  stimulate  the  dis- 
charge of  bile  ;  are  adapted  to  the  catarrh- 
al  form,  and  to  the  jaundice  of  gouty 
subjects.  The  resin-bearing  cathartics, 
Rhubarb,  Aloes,  Podophyllum,  Iris,  and 
Euonymin,  752-765,  promote  the  excretion 
of  bile.  Nitro- Muriatic  Acid,  115,  internal- 
ly and  by  bath,  has  long  had  good  repute 
in  malarial  jaundice.  Benzoic  Acid,  422, 
and  Benzoates,  423,  remove  bile  from  sys- 
tem. Salol,  Pyridine,  and  Naphtalin  are 
useful  in  all  cases  of  catarrhal  jaundice. 
Mercurials,  287,  are  of  doubtful  utility,  but 
good  results  seem  to  be  obtained  from 
small  doses  of  calomel. 

JOINTS,  DISEASES  OP  : 

Carbolic  Acid,  382,  in  solution  injected  in 
synovitis,  with  reported  good  results.  Gal- 
vanism, 470,  highly  useful  in  chronic  affec- 
tions. Massage,  102,  produces  remarkable 
results  in  stiffness  and  deformity  of  joints 
from  inflammation  and  lack  of  use.  Ole- 
ate  of  Mercury  and  Morphine,  294,  is  of 
great  service  in  inflammatory  affections  of 
joints.  Silver  Nitrate  in  Nitrous  Ether, 
303,  an  efficient  application  to  check  in- 
flammation. Blisters,  807,  a  succession  of 
them  about  the  joints,  in  cases  of  synovitis. 

KERATITIS  : 

Atropine,  531,  to  check  inflammation  by  caus- 
ing contraction  of  the  vessels.  Eserine, 
691,  lowers  intra-ocular  tension  and  relieves 
pain.  Pilocarpine,  683,  is  of  great  service 
in  removing  exudation  and  stopping  in- 


flammation. Calomel,  294,  and  Yellow  Ox- 
ide, 295,  in  powder  locally,  very  effective. 
Zinc  Sulphate,  320,  in  solution,  is  an  ordi- 
nary lotion  in  these  cases,  and  is  often  pre- 
scribed with  atropine.  Lead  lotions  must 
be  used  with  caution.  Cocaine,  562,  to  re- 
lieve pain  and  check  inflammation,  alone 
or  in  combination  with  atropine. 

LABOR: 

Anaesthetics,  606  ;  Chloral,  618,  relieves  pain 
and  stops  irregular  action.  Ergot,  502,  is 
administered  to  hasten  labor  under  suit- 
able conditions,  to  cause  expulsion  of  pla- 
centa, and  to  arrest  haemorrhage.  Mor- 
phine, 645,  hypodermatically,  stops  "  false 
pains." 

LACTATION  : 

Belladonna,  533,  arrests  the  secretion  of 
milk ;  a  solution  of  atropine  may  be  ap- 
plied to  the  gland.  Pilocarpus,  684,  in- 
creases secretion  of  milk.  Phosphates, 
especially  Lime  Phosphate,  139,  and  the 
Calcium  Salts,  223,  are  highly  useful  in  the 
debility  of  lactation. 

LARYNGISMUS  STRIDULUS  : 
Quinine,  208,  administered  in  the  interval, 
may  prevent  attacks  that  recur  frequently. 
Nitro-glycerin,  709,  will  speedily  allay  the 
spasm.  An  Anaesthetic,  605,  will  at  once 
stop  an  attack ;  a  few  drops  of  ether  In- 
haled will  usually  suffice.  Bromides,  656, 
will  suspend  attacks  if  a  sufficient  quantity 
is  given,  and  prevent  recurrences ;  also 
Bromoform,  659.  Tartar  Emetic,  324,  a 
nauseant,  will  stop  the  spasms,  but  may  in- 
duce dangerous  depression  in  young  chil- 
dren. Mercuric  Subsulphate,  734,  is  as  ef- 
fective, and  safer.  Ipecac,  740,  will  also 
arrest  attacks.  Gold  and  Sodium  Chloride, 
297,  highly  useful  in  respiratory  neuroses. 

LARYNX,  DISEASES  OF  : 

Aconite,  713,  in  acute  catarrh,  small  dose  of 
the  tincture  often  administered.  Inhala- 
tions, 8,  of  various  astringent  and  anodyne 
substances ;  also  Insufflation,  7,  of  the 
same  in  powder  ;  Tannin,  lodo-Tannin, 
lodoform,  lodoform  and  Tannin,  263  et 
seq.,  Nitrate  of  Silver,  Copper  and  Zinc 
Salts,  Nitrate  of  Bismuth,  MonseVs  Iron, 
Alum,  Sulphurous  Acid,  247,  Bromine,  Io- 
dine, Oxygen,  Chlorine,  Quinine,  Benzoin, 
Benzoate  of  Soda,  Resorcin,  Salicylic  Acid, 
Carbolic  Acid,  and  the  Antiseptic  group. 


LEAD-POISONINO  : 

Sulphuric  Acid,  118,  forms  the  insoluble  sul- 
phate ;  Magnesium  Sulphate,  751,  for  the 
constipation,  and  for  the  cachexia  a  com- 
bination of  sulphates  of  quinine  and  iron, 
and  dilute  sulphuric  acid.  Sulphides,  250. 
Alum,  335,  is  an  effective  purgative  and  an- 
odyne in  lead-colic  ;  also  alum  whey.  Io- 
dides, 261,  and  Bromides,  652,  form  soluble 
combinations  and  cause  excretion  of  lead. 
For  the  paralysis,  Galvanism  and  Farad- 
ism,  465,  466,  and  Strychnine,  486. 


854 


CLINICAL  INDEX. 


LENTIGO  : 

Glycerite  of  Iodine,  263,  locally.  Tannin, 
346.  Alum,  337. 

LEPRA : 

Nitric  and  Nitro- Muriatic  Acid,  119,  for  the 
accompanying  indigestion.  Arsenic,  174, 
long  continued,  renders  important  service. 
Phosphorus,  136,  and  Phosphates,  139. 

LKUCOCYTHEMIA  : 

Oxygen  Inhalations,  367,  improve  the  quality 
of  the  blood.  Iron,  151,  is  of  little  value  in 
the  real,  but  highly  useful  in  the  pseudo- 
disease.  Chalybeate  Springs,  161,  are  more 
useful.  Phosphorus,  136,  and  Arsenic,  173, 
are  sometimes  beneficial.  Digitalis,  513, 
hi  young  subjects  does  good.  Also  Stro- 
phantus,  518,  and  Adonidin,  520.  Ergot, 
501,  in  the  splenic  form.  Electricity,  469, 
as  central  galvanization,  is  very  beneficial. 
Transfusion,  29.  Red  Marrow  of  Bone, 
436. 

LEUCORRHCEA  : 

Alum,  337,  is  a  cheap  and  useful  injection  ; 
may  be  combined  with  zinc  and  borax,  in 
a  lotion.  Bismuth,  164,  suspended  by 
mucilage  or  glycerin,  is  an  excellent  in- 
jection ;  may  be  advantageously  combined 
with  Fluid  Extract  of  Hydrastis,  191, 
which  is  one  of  the  best  astringent  appli- 
cations. Lead,  315,  the  acetate  of  Goulard's 
extract  properly  diluted,  is  an  excellent 
topical  application.  Zinc,  320.  lodo-Tan- 
nin,  262,  Tannic  Acid,  345,  and  lodoform 
and  Tannin,  263,  packed  about  the  cervix, 
is  a  highly  efficient  treatment.  Carbolic 
Acid,  382,  diluted  and  used  with  care,  is  an 
excellent  deodorizer  when  the  discharges 
are  foul ;  may  be  combined  with  the  pre- 
ceding lotions  ;  also  Trichlorphenol,  386. 
Boric  Acid  solutions,  420.  Naphtalin,  415. 
Resorcin,  404.  Monsel's  Solution,  153,  is 
a  good  application,  but  stains  clothing. 
Ichthyol,  350,  and  Alumnol,  338. 

LOCOHOTOR  ATAXIA  : 

Phosphorus,  135,  useful  to  relieve  pain  and 
retard  changes.  Silver  Nitrate,  302,  has 
done  more  good  than  any  other  remedy, 
but  Gold  and  Sodium  Chloride,  297,  de- 
serves careful  trial.  Hyoscyamine,  539,  es- 
pecially Acetanilid,  426.  and  Antipyrin,  413, 
relieve  the  pains.  Electricity,  467,  espe- 
cially static,  the  faradic  brush,  has  given 
great  relief . 

LUMBAGO : 

Acupuncture,  806,  and  Baunscheidtismus, 
808,  sometimes  afford  immediate  relief. 
Aquapuncture,  809,  is  also  very  promptly 
curative  in  some  cases,  and  usually  re- 
lieves. Chloroform,  597,  also  Ether,  594,  a 
few  drops  injected  deeply  in  old  cases  is 
remarkably  beneficial.  Cimicifuga,  522, 
brings  about  relief,  sometimes  completely, 
but  often  fails.  Galvanism,  470— descend- 
ing stabile  and  labile  currents — usually  ef- 
fects a  cure.  Iodides,  261,  are  curative 
•when  disease  is  due  to  mercurial,  plumbic, 


or  other  metallic  poisoning.  Morphine, 
641,  and  with  Atropine,  644,  in  minute 
quantity  injected  into  the  muscles  affords 
prompt  relief.  Salicylic  Acid,  399,  and 
Salol,  410,  are  appropriate  remedies  in 
rheumatismal  cases.  Hydrotlierapy,  80, 
86,  hot  douche  to  back.  Emplastra,  804, 
the  various  anodyne  and  healing  plasters. 
Massage,  102. 

LUPUS : 

Cod-liver  Oil,  126,  internally  and  locally. 
Iodine,  263,  and  lodoform,  269,  in  strumous 
and  syphilitic  cachexia,  and  iodoform,  etc., 
to  ulcer.  Arsenic,  174,  Fowler's  solution 
long  continued  exerts  a  curative  influence, 
and  arsenious  acid  locally.  Zinc  Sulphate, 
dried,  320,  a  manageable  and  efficient 
caustic.  Carbolic  Acid,  382,  undiluted,  to 
sore,  and  diluted  injected  beneath.  Cor- 
rosive Sublimate,  294,  the  first  of  germi- 
cides. Chromic  Acid,  815,  a  very  power- 
ful caustic,  causing  but  little  pain.  Potassa 
Chlorate,  225,  Bismuth,  164,  Bromides,  657, 
in  powder,  dusted  over  ulcer,  have  lately 
been  used  with  great  success.  Galvano- 
caustic,  474,  is  an  elegant  and  efficient 
topical  agent ;  also  the  method  of  Cata- 
phoresis,  472. 

LYMPHOMA  OR  LYMPHADENOMA  : 
Arsenic,  176,  especially  hypodermatically, 
has  good  effects.  Phosphorus,  134,  has 
seemed  to  cure,  but  has  only  benefited. 
Iron  and  Manganese  Iodide,  155  ;  the  sirup 
has  improved  the  general  state,  and  retard- 
ed the  progress  of  the  disease. 

MALARIAL  CACHEXCA  : 

Quinine,  204,  is  the  most  important  remedy. 
Cinchonidine  Salicylate,  206,  Cinchonine 
and  its  salts,  206,  and  Chinoidin,  207,  other 
alkaloids  of  cinchona,  valuable  substitutes 
for  quinine.  Benzoates,  423,  Antipyrin, 
412,  Resorcin,  404,  Salol,  409,  Pyridine,  417, 
and  other  antiseptics.  Carbolic  Acid,  380. 
Eucalyptus,  187,  is  an  excellent  remedy  for 
the  convalescence  and  for  the  cachexia. 
The  Bitters,  181,  are  also  highly  useful 
under  the  same  conditions.  For  the  anae- 
mia, Iron,  148,  is  invaluable  ;  it  acts  more 
efficiently  in  the  cachexia  when  combined 
with  Arsenic,  175,  which  is  also  an  impor- 
tant remedy  in  malarial  cachexia.  Iron 
and  Manganese  Iodide,  155,  is  also  a  valu- 
able restorative.  For  the  changes  in  the 
spleen  and  liver,  Compound  Solution  of 
Iodine,  261,  Ammonium  Iodide,  261,  and 
externally  to  the  splenic  region  Ointment 
of  the  Red  Mercuric  Iodide,  294,  are  ex- 
tremely effective. 

MANIA,  ACUTE  : 

Anaesthetics,  605,  Paraldehyde,  585,  Hyp- 
none,  590,  and  Urethan,  588,  are  safe  and 
useful  remedies  ;  Chloral,  617,  is  more  act- 
ive, but  not  without  danger.  Methylal.  586, 
a  useful  calmative.  Conine,  665,  especial- 
ly the  Hydrobromate,  without,  but  especial- 
ly with,  morphine  hypodermatically,  has 


CLINICAL    INDEX. 


855 


sometimes  succeeded  in  curing  acute  mania 
with  great  motor  excitement.  In  the  acute 
cases  with  great  restlessness,  Gelsemium, 
674,  Duboisine,  542,  and  Hyoscine,  540,  have 
induced  quiet  and  occasionally  effected  a 
cure.  Hyoscyamine,  538,  has  become  an 
important  remedy  as  a  calmative  and 
hypnotic.  Cocaine,  562,  especially  as  com- 
bined with  atropine,  when  there  is  great 
restlessness.  Digitalis,  512,  has  proved 
beneficial  in  paroxysmal  excitement  of 
general  paresis,  and  in  acute  epileptic 
mania.  Veratrum  Viride,  720,  has  acted 
well  under  the  same  circumstances.  Water- 
Cure,  86,  as  warm  bath  and  pack,  a  valu- 
able calmative. 

MANIA.  CHRONIC  : 

Ergot,  501,  is  highly  beneficial  in  chronic 
mania  with  lucid  intervals,  and  in  epileptic 
mania.  Bromides,  653,  are  occasionally 
useful,  but  not  sufficiently  active.  Mor- 
phine, 640,  is  the  most  important  remedy, 
but  Chloral,  617,  may  be  better  at  times. 
Iron,  150,  in  cases  of  an  anaemic  character, 
may  be  very  useful.  Digitalis,  512,  has 
good  effects  in  chronic  mania,  in  general 
paresis,  etc.  Physostigma,  690,  has  had 
unexpectedly  good  results  in  general  pa- 
ralysis. Hyoscyamine,  538,  and  Hyoscine, 
especially  for  the  trembling  and  as  a  hyp- 
notic. To  this  should  be  added  Pilocar- 
pine,  685,  which  has  been  very  useful  in 
delirium  tremens. 

MASTITIS  : 

Belladonna,  533,  stops  secretion  of  milk  and 
lessens  blood-supply  ;  a  solution  of  atro- 
pine brushed  over  the  mamma  is  the  best 
form.  Phytolacca,  725,  appears  to  arrest 
the  inflammation  ;  the  tincture  and  fluid 
extract  are  convenient  for  administration. 
Pilocarpine,  683,  should  be  tried  in  severe 
cases  with  much  induration. 

MELANCHOLIA  : 

Opium,  640,  small  and  frequent  doses  of  the 
tincture  give  best  results.  Bromides,  653, 
are  sometimes  highly  beneficial,  and  yet 
frequently  fail.  Cannabis  Indica,  556.  is  a 
useful  and  promising  remedy.  Caffeine, 
566,  has  also  done  good.  Arsenic,  173, 
especially  combined  with  minute  doses  of 
opium,  and  in  a  greater  degree  Aurum, 
297,  give  excellent  results.  Chloral  Hy- 
drate, 617,  does  good  as  a  hypnotic.  Col- 
chicum,  354,  Colocynth,  761,  and  other 
agents  which  unload  the  portal  circula- 
tion, render  important  service. 

MENINGITIS.     (See   CEREBRO-SPINAL   MENINGI- 
TIS.) 

For  the  acute  condition  before  exudation,  or 
during  the  stage  of  excitation,  Opium,  640, 
is  a  remedy  of  the  highest  importance ; 
Chloral,  617,  checks  exudation ;  Ergot, 
502,  Gelsemium,  674,  Pulsatilla,  722,  Aco- 
nite, 715,  for  their  effects  on  the  conges- 
tion. For  Hyperpyrexia,  Quinine,  203, 
Digitalis,  512,  Cold  Baths,  87.  and  the  anti- 
5G* 


pyretics,  as  Antipyrin,  412.  Pilocarpine, 
683.  During  the  exudation  stage,  or  stage 
of  depression,  Ammonium  Carbonate,  239, 
and  the  Iodides,  259. 

MENORRHAGIA  : 

Potassium  Bromide,  657,  often  arrests 
promptly,  and  is  best  adapted  to  cases  of 
ovarian  excitation.  Ergot,  501,  in  the 
menorrhagia  of  subinvolution.  Oil  of 
Erigeron,  184,  in  some  cases  and  in  metror- 
rhagia  ;  also  Canella,  183.  Cannabis  In- 
dica,  557,  sometimes  very  useful.  Digi- 
talis, 512,  in  cases  of  mitral  disease,  or 
when  arterial  tension  is  very  low.  Ipecacu- 
anha, 742,  is  remarkably  beneficial  in  puer- 
peral menorrhagia,  and  may  be  advantage- 
ously combined  with  ergot.  Gallic  Acid, 
343,  sometimes  succeeds  well.  Aloes,  758, 
is  indicated  in  cases  dependent  on  fecal 
accumulations,  in  relaxed  habits. 

MENTAQRA  : 

Copper  Sulphate,  309,  Zinc  Sulphate,  320, 
and  Silver  Nitrate,  303,  lotions,  and  the 
germicides,  Resorcin,  404,  Pyrogallol,  348, 
and  others. 

MERCURIALISMUS  : 

Iodides,  261,  combine  with  metal  and  cause 
its  excretion  by  kidneys,  chiefly.  Bro- 
mides, 653,  it  is  asserted,  have  the  same 
effects.  Belladonna,  526,  is  the  best  rem 
edy  for  the  ptyalism.  Tannin,  345,  Alum, 
337,  Alumnol,  338,  Potassa  Chlorate,  216, 
and  the  antiseptics,  are  efficient  topical 
applications.  Quinine,  200,  and  the  Min- 
eral Acids,  114,  for  the  systemic  depression. 
Hyoscyamine,  539,  is  a  good  remedy  for 
mercurial  trembling. 

METRITIS  : 

Water,  88,  hot  vaginal  douche,  has  good  ef- 
fects. Carbolic  Acid,  382,  undiluted  or  di- 
luted, applied  on  cotton-wrapped  probe  to 
the  lining  of  the  uterine  cavity.  Nitric 
Acid,  120,  the  fuming  acid,  is  also  applied 
directly  to  the  cervical  canal.  Potassa 
Fusa,  225,  to  the  uterine  neck  to  cure  indu- 
rations. Ergotin,  500,  persistently  used, 
has  great  value  in  chronic  interstitial  me- 
tritis.  Aurum,  297,  chloride,  very  effective 
in  chronic  induration  of  the  uterus.  Silver 
Nitrate,  pure  and  in  solution,  303,  is  much 
employed  topically  in  metritis.  Iodine, 
265,  lodoform,  272,  and  various  solutions, 
are  freely  used.  Leeches,  814,  to  the  cer- 
vix, give  good  results.  Saline  laxatives, 
750,  and  Saline  Mineral  Waters,  233,  are 
useful  in  plethoric  subjects. 

MIGRAINE  : 

Ammonium  Chloride,  239,  a  full  dose  may 
cut  short  an  attack.  Cannabis  Indica,  556, 
often  succeeds.  Guarana,  567,  Caffeine, 
Coca,  561,  will  usually  arrest  a  seizure. 
Ergot,  500,  cures  the  congestive  form,  and 
Amyl  Nitrite.  706,  or  Nitro-glycerin,  709, 
the  anaemic.  Belladonna,  529,  relieves 
those  cases  accompanied  by  vaso-motor 
spasm,  and  Digitalis,  512,  those  with  low 


856 


CLINICAL   INDEX. 


tension  of  the  vessels  and  weak  heart,  or 
those  dependent  on  a  mitral  lesion.  Bro- 
mides, 655,  if  sufficient  doses  are  given, 
will  arrest  impending  attacks.  When  re- 
flex from  stomach  disorder,  an  emetic  of 
Ipecac,  740,  will  stop  ;  if  a  symptom  of 
intestinal  indigestion,  Sodium  Phosphate, 
138.  Antipyrin,  413,  Acetanilid,  426,  and 
Phenacetin,  418,  are  efficient  analgesics. 
Diet,  65,  is  of  the  first  consequence  in  the 
cases  of  stomach  origin. 

MYALGIA  : 

Ammonium  Chloride,  239,  sometimes  affords 
relief.  The  Salicylates,  399,  Salol,  410,  and 
Acetanilid,  426,  are  more  efficient.  Elec- 
tricity, 468,  rarely  fails  to  cure  ;  galvanism 
and  static  electricity,  and  very  rapidly 
interrupted  faradic,  may  alike  succeed. 
Counter-irritation  by  Firing,  Aquapunc- 
ture,  809,  and  Acupuncture,  808,  will  usually 
relieve.  When  a  rheumatic  condition  is  the 
cause,  and  there  is  debility  from  malarial 
poisoning,  Cinchonidine  Salicylate,  399, 
will  cure ;  when  a  mineral  poison,  the 
Iodides,  261.  Massage,  102,  will  usually  do 
good. 

MYELITIS  : 

When  idiopathic,  Ergot,  500,  Barium  Chlo- 
ride, 242,  Galvanism,  465,  are  the  most 
appropriate  remedies  ;  when  specific.  Mer- 
cury, 288,  or  the  Iodides,  261.  Hydro- 
therapy,  86,  especially  the  tepid  rubbing 
wet  pack.  Massage,  102,  to  the  damaged 
muscles.  After  acute  symptoms,  or  in 
chronic  cases,  Strychnine,  483,  Picrotoxin, 
491,  and  similar  excitants  are  proper. 

N.EVI  : 

Chromic  Acid,  815,  readily  destroys  with  little 
pain.  Galvano-causty,  471,  is  a  good  means 
of  removing  them.  Nitric  Acid,  119,  is  also 
an  efficient  caustic.  Collodion,  818,  by  me- 
chanical compression  in  drying,  will  some- 
times cure. 

NARCOSIS.  (See  ANTIDOTES.) 
Ammonia,  238,  by  inhalation,  especially  by  in- 
travenous injection,  in  failure  of  the  heart's 
action.  Oxygen  inhalations,  367,  in  chloro- 
form narcosis.  Faradism,  467,  to  stimulate 
the  respiratory  center  by  reflex  irritation, 
and  the  respiratory  muscles  directly.  Amyl 
Nitrite,  706,  by  inhalation  in  cardiac  fail- 
ure. Water,  86,  the  cold  douche  and  cold 
affusion  in  cerebral  narcosis,  prussic-acid 
poisoning,  sunstroke,  etc.  Ether  injec- 
tions, 594,  Heat,  93,  in  alternation  with 
cold.  Emetics,  Apomorphine,  736,  Copper 
Sulphate,  308,  Zinc  Sulphate,  318,  etc. 

NEURALGIA  : 

Aconite,  715,  when  there  is  febrile  excite- 
ment ;  Aconit ine,  715,  is  particularly  effect- 
ive in  neuralgia  of  the  fifth  nerve.  Alcohol, 
576,  in  sufficient  quantity,  is  an  anodyne, 
but  the  alcoholic  habit  is  quickly  formed. 
Anaesthetics,  605,  promptly  relieve.  Cod- 
liver  Oil,  126,  is  of  great  value  as  a  nutrient. 
Chloroform,  by  deep  injection,  597,  is  very 


effective  in  old  neuralgise.  Croton  CJiloral, 
619,  is  useful  in  neuralgia  of  the  fifth.  The 
following  analgesic  antiseptics,  Cocaine, 
561,  and  with  atropine  Antipyrin,  413,  Ex- 
algin,  427,  Paraldehyde,  584,  Methylal,  586, 
Urethan,  588,  and  its  congeners,  Hypnone, 
590,  Acetanilid,  426,  are  efficient  analgesics 
for  the  relief  of  neuralgia,  and  to  stop  the 
pains  of  locomotor  ataxia.  Morphine,  641, 
subcutaneously,  is  the  most  efficient  rem- 
edy for  the  relief  of  pain.  Aquapuncture, 
809,  often  remarkably  beneficial.  Belladon- 
na, 529,  especially  atropine  subcutaneously, 
in  tic-douloureuxand  sciatica,  but  full  doses 
must  be  administered.  Arsenic,  173,  bene- 
fits by  improving  the  nutrition.  Bromides, 
653,  are  useful  in  some  cases  ;  Cimicifuga, 
522,  and  Gelsemium,  674,  do  good  in  simple 
neuralgia  of  the  fifth,  and  in  ovarian  neu- 
ralgia. Galvanism,  468,  is,  next  to  subcu- 
taneous injection  of  morphine,  the  most 
decidedly  curative  agent.  Massage,  102, 
gives  much  relief.  Copper,  Ammoniated, 
309,  in  neuralgia  of  the  fifth,  has  been  re- 
vived lately.  Iron,  151,  is  required  in 
anaemia,  the  usual  condition.  Phosphorus, 
135,  has  proved  curative  in  suitable  cases, 
if  pushed.  Amyl  Nitrite,  706,  by  inhala- 
tion, and  Nitro-glycerin,  708,  by  the  stom- 
ach in  neuralgic  dysmenorrhoea.  Strych- 
nine, 482,  long  continued  in  depressed 
states  of  the  nervous  system.  Turpentine, 
778,  in  reflex  cases.  Veratrine.  720,  the 
ointment  in  superficial  neuralgia.  The  An- 
tiseptic Oils,  428,  locally.  Chloral  and 
Camphor,  618,  with  Morphine,  applied  to 
the  seat  of  pain.  Wet  Pack,  86,  in  sciatica, 
etc.  Heat,  93.  The  Hypodermatic  Method, 
17.  Infiltration  Anaesthesia,  24,  for  the 
pain  of  surgical  operations,  and  for  neu- 
ralgia. 

NYMPHOMANIA  : 

Potassium  Bromide,  657,  but  large  doses  are 
requisite.  Camphor,  547,  and  Camphor 
Monobromata,  must  also  be  given  in  large 
doses.  Tobacco,  695,  Hydrobromate  of  Nic- 
otine, 695,  carried  to  nausea. 

OBESITY  : 

Banting  System,  53.  Thyroid  Extract,  435. 
Alkalies,  217,  and  Alkaline  Mineral  Waters, 
229.  Ammonium  Bromide,  652.  Potassa 
Permanganate,  157,  for  the  attendant  dys- 
pepsia. The  Vegetable  Acids,  244.  Nitrate 
of  Uranium,  350,  and  Oxalic  Acid,  245,  re- 
duce fat,  but  may  be  hurtful. 

ONTCHIA  : 

Chloral,  618,  and  with  Camphor  Menthol,  428, 
Thymol,  429,  a  solution  applied  locally.  lo- 
doform,  263,  in  powder  or  ointment.  Lead 
Nitrate,  315,  as  powder,  in  glycerin,  or 
as  ointment,  the  most  effective  of  all 
remedies. 

OPHTHALMIA  : 

Mercury,  294.  Calomel  dusted  over  the  con- 
junctiva. Tannin,  346,  also  dusted  over 
the  membrane.  Alum,  337,  in  solution  in 


CLINICAL   INDEX. 


857 


rose-water.  Atropine,  530.  Eserine,  690, 
to  diminish  iutra-ocular  tension.  Pilocar- 
pus,  683.  Conium,  665,  the  alkaloid  conine 
or  the  succus  in  blepharospasm.  Silver 
Nitrate,  305,  Zinc  Sulphate,  320,  and  other 
mineral  astringents.  Jequirety,  811,  in 
granular  lids  by  substitutive  inflammation. 

ORCHITIS  : 

Ice,  88,  in  a  bag  kept  applied.  Iodine,  262, 
tincture,  locally.  Mercury  Oleate,  294, 
painted  over.  Silver  Nitrate,  304,  in  nitric 
ether,  painted  over.  Ammonium  Chloride, 
240,  in  solution  with  alcohol. 

OTORRHOLA  : 

Lead,  315,  lotions  of.  Silver  Nitrate,  305,  in 
solution.  Tannin,  345,  the  glycerite,  locally. 
Zinc  Sulphate,  320.  Mercury,  294,  the  brown 
citrine  ointment.  Cadmium,  326,  in  solu- 
tion in  water.  Sulphocarbolates,  385.  Airol, 
278,  and  Dermatol,  164,  effective  topical 
remedies. 

OVARIAN  CYSTS  : 

Iodine  Injections,  264,  of  tincture  or  com- 
pound solution,  but  adapted  only  to  uni- 
locular  cysts.  Electrolysis,  471,  also  only  in 
single  cysts. 

OXALURIA  : 

Nitro-Muriatic  Acid,  119,  has  special  utility. 
Nitric  Acid,  115,  before  meals  in  acid  indi- 
gestion and  excess  of  uric  acid. 

OZ.ENA  : 

Bromine,  371,  inhalations  of  vapor  very  cau- 
tiously. Carbolic  Acid,  382,  solution  in- 
jected, spray  inhaled.  Carbolic  Acid  and 
Iodine,  382,  iodine  and  carbolic  acid  vapor- 
ized and  inhaled.  Ethyl  Iodide,  267,  by  in- 
halation, lodoform,  262,  vaporized  or  solu- 
tion in  ether  applied.  Iodine,  262,  inhaled. 
Nosophen,  276,  Europhen,  276,  and  Aristol, 
277,  substitutes  for  iodoform,  and  having 
similar  properties  ;  also  Loretin,  275.  Po- 
tassa  Bichromate,  225,  solution  injected, 
lodoform,  iodo-tannin,  bismuth,  zinc  oxide, 
resorcin,  thymol,  and  similar  agents  ap- 
plied by  Insufflation,  6. 

PAIN.  (See  NEURALGIA.) 
Opium,  641,  in  any  form,  but  especially  mor- 
phine subcutaneously,  best  of  all  agents 
for  the  relief  of  pain.  Belladonna,  532, 
especially  atropine,  alone  or  in  combination 
with  morphine.  Anaesthetics,  605,  give  im- 
mediate relief.  Aconite,  715,  and  its  alka- 
loid, aconitine,  relieve  pain,  especially  of 
fifth  nerve.  Cannabis  Indica,  556,  has 
slight  anodyne  properties.  Chloral,  618, 
does  not  relieve  pain  directly,  but  by  stop- 
ping spasm,  unless  in  dangerous  narcotic 
doses.  Croton  Chloral,  619,  induces  anaes- 
thesia of  fifth  nerve.  Gelsemium,  675,  has 
feeble  anodyne  properties ;  Cimicifuga, 
522,  even  less.  Galvanism,  468,  has  decided 
power  to  relieve  pain.  In  nocturnal  pain, 
Iodides,  259,  have  remarkable  effects.  The 
various  analgesic  antiseptics,  from  Antipy- 
rin,  are  effective  remedies  for  pain,  366  et 
seq.  Aquapuncture,  809,  Acupuncture,  808, 


Blisters,  807,  and  Heat  and  Cold,  93,  relieve 
pain  in  varying  degree.  Infiltration  Anaes- 
thesia, 24. 

PARALYSIS  : 

Cod-liver  Oil,  126,  favors  the  restoration  of 
damaged  nerve-elements.  Phosphorus,  136, 
with  or  without  oil,  as  a  restorative  of 
nerve-matter.  Strychnine,  483,  an  impor- 
tant stimulant,  but  must  be  used  after 
local  troubles  in  the  nerve-centers  have 
subsided.  Picrotoxin,  491,  employed  under 
similar  conditions  to  strychnine.  Galvan- 
ism and  Faradism,  406,  are  first  in  im- 
portance as  remedies  in  the  diagnosis  and 
treatment  of  paralysis  ;  especially  adapted 
to  the  "myopathies  of  spinal  origin." 
Massage,  102,  an  important  adjunct  to 
other  treatment.  Hyoscyamine,  539,  is  very 
useful  in  paralysis  agitans.  Eserine,  691, 
is  of  great  service  in  paralysis  of  the  third 
nerve.  In  the  paralysis  due  to  gummata, 
Iodides,  259,  effect  surprising  cures.  Ergot, 
501,  in  vesical  paralysis  the  result  of  over- 
distention.  Metallotherapy,  331. 

PARASITES  : 

Acetic  Acid,  244,  in  pityriasis  versicolor  and 
other  parasitic  skin  diseases.  Sulphurous 
Acid,  246,  destroys  sarcina  and  itch-insect ; 
also  Sulphides,  249.  Mercury,  293,  the  cor- 
rosive chloride,  is  very  effective  in  the  va- 
rious parasitic  skin  affections.  Salicylic 
Acid,  395,  Carbolic  Acid,  382,  Resorcin,  404, 
Pyoktanin,  414,  Pyridine,  417,  Naphtalin, 
416,  and  other  antiseptics.  Boric  Acid,  419, 
Benzoates,  422,  are  useful  in  same  group 
of  affections.  Glycerin,  817,  destroys  tri- 
china. Anthelmintics,  771,  contain  the 
most  effective  parasiticides  of  the  intes- 
tinal canal. 

PEMPHIGUS : 

Arsenic,  174,  cures  the  chronic  form.  Bella- 
donna, 531,  for  the  acute  stage. 

PERITONITIS  : 

Aconite,  714,  for  the  febrile  movement.  Chlo- 
ral, 616,  for  restlessness  and  delirium,  and 
to  depress  the  temperature.  Opium,  637, 
is  the  remedy  of  highest  importance,  is 
best  administered  as  morphine  hypoder- 
matically.  Turpentine,  780,  in  puerperal 
peritonitis,  with  depression  and  tympa- 
nites. Quinine,  208,  in  full  doses,  with  or 
without  morphine,  is  of  great  value  before 
the  exudative  stage.  Ammonia,  237,  Pot- 
ash Salts,  219,  during  exudation.  For  ex- 
ternal treatment :  Rubefacients,  803,  Ice- 
bag,  88,  to  abdomen  ;  also  Heat,  88,  and 
Poultices,  822.  Leeches,  814. 

PERNICIOUS  FEVER  : 

Amyl  Nitrite,  706,  by  inhalation  to  prevent 
rigor.  Pilocarpus,  683,  Quinine,  208,  in 
large  quantity  by  the  stomach  or  hypo- 
dermatically.  Morphine,  639,  also,  if  not 
contraindicated.  Chloroform,  597,  in  time 
to  prevent  the  depression  of  the  cold  stage. 

PERSPIRATIONS  : 
Aromatic  Sulphuric  Acid,  118,  is  an  ancient 


858 


CLIXICAL   INDEX. 


remedy  of  value.  Atropine,  531,  is  one 
of  the  most  useful  remedies  for  "  night 
sweats,''  and  locally  applied  for  sweats  in 
various  local  situations.  Picrotoxin,  491, 
a  minute  dose  will  stop  for  several  nights 
the  sweats  of  consumption.  Muscarine 
and  Agaric  Acid,  729,  are  also  serviceable 
remedies.  For  sweating  of  the  feet,  Sali- 
cylic Acid.  399,  in  powder,  dusted  over  the 
feet  and  stockings,  is  probably  the  best 
remedy  ;  may  also  be  used  in  lotion  with 
borax  ;  Nosophen,  276,  Aristol,  277,  still 
more  effective  applied  in  the  same  way. 
Potassa  Permanganate,  159,  is  an  elegant 
toilet  deodorant  in  fetid  sweating  of  axillae 
and  feet.  Zinc  Oxide,  318,  with  extract 
of  belladonna  in  pill,  is  an  ordinary  rem- 
edy for  night  sweats  ;  also  Gallic  Acid, 
344. 

PHAGED,ENA  : 

Bromine,  372,  pure,  applied  with  a  glass  rod, 
is  a  good  escharotic,  but  not  easily  man- 
aged, owing  to  its  volatility.  Carbolic 
Acid,  382,  superficial  in  its  effects,  but  very 
useful  in  mild  cases.  Potassa  Chlorate, 
225,  in  powder,  a  manageable  and  efficient 
remedy.  Salicylic  Acid,  399,  in  powder,  to 
the  sloughing  and  normal  tissue  adjacent. 
Resorcin,  404,  in  powder,  applied  in  the 
same  way,  and  Boric  Acid,  420,  accom- 
plish good  results  by  changing  the  charac- 
ter of  the  local  action.  Zinc  Chloride,  320, 
and  Nitric  Acid,  199,  are  powerfully  de- 
structive, lodoform,  271.  Internally : 
Iodide  of  Iron,  150,  Quinine,  201,  Phos- 
phates, 140,  and  the  tonics  and  restoratives 
In  general. 

PHARYNGITIS.  FOLLICULAR  : 
In  the  acute  inflammation :  Aconite  and 
Belladonna.  527.  For  local  application — 
Tannin,  345,  Tannin  and  lodoform,  265, 
lodoform,  271,  in  powder  or  ethereal  solu- 
tion, Alum,  337,  Cubebs,  786,  in  powder— 
the  powders  by  insufflation.  Silver  Ni- 
trate, 303,  in  solution,  painted  over  the  sur- 
face. Hydrastis,  191,  the  fluid  extract,  an 
excellent  topical  application  to  mucous 
membrane  inflamed. 

PHLEGMON : 

Carbolic  Acid,  382,  a  solution  injected  as  an 
antiseptic.  Iodine,  263,  the  tincture  or 
compound  solution  injected  after  removal 
of  the  pus  to  prevent  decomposition.  Sil- 
ver Nitrate,  303,  305,  a  solution  in  nitrous 
ether  painted  over  the  inflamed  area,  may 
abort  the  abscess.  Sulphides,  249,  pro- 
mote formation  of  matter,  or  extrusion 
and  healing. 

PHOSPHORUS  POISONING  : 
Copper  Sulphate,  130,  forms  insoluble  phos- 
phide, and  induces  active  emesis.  Turpen- 
tine, 130,  the  acid  or  French.  Transfu- 
tion,  130,  to  replace  damaged  blood-cor- 
puscles, has  saved  life.  Permanganate 
Potassium,  157,  has  proved  to  be  an  effi- 
cient antagonist,  if  given  in  time. 


PHTHISIS  : 

Alcohol,  575,  an  important  remedy  when  it 
promotes  appetite  and  digestion,  and  in- 
creases the  body-weight.  Aliment,  39.  59, 
fresh  blood,  fats,  and  nitrogenous  food. 
Oxygen,  367,  Hydrogen  Dioxide,  368,  Oat 
Injections,  372.  Pyridine,  417,  Ethyl  Iodide, 
267,  Sulphurous  Acid,  247,  and  other  reme- 
dies used  by  inhalation.  Calcium  Chloride, 
223,  has  had  remarkably  good  effects  in  some 
cases.  Cod-liver  Oil,  125,  is  both  a  valuable 
food  and  a  remedy  ;  ether  aids  its  digestion 
by  increasing  the  pancreatic  juice,  and 
quiets  the  stomach.  Mineral  Acids,  118, 
especially  nitro-muriatic  in  large  doses, 
greatly  improve  the  condition  of  some 
cases  and  retard  the  progress  of  the  dis- 
ease. Carbolic  Acid,  382,  has  been  used 
with  great  advantage  by  inhalation  to  de. 
stroy  the  fetor  of  the  expectoration,  and 
to  act  on  the  local  morbid  process :  sys- 
temically,  the  acid  helps  digestion  and 
stimulates  the  assimilation.  Creosote,  387, 
has  been  used  with  remarkable  success  re- 
cently. Phosphates  and  Hypophosphites, 
140,  Coca,  561,  with  or  without  cod-liver  oil, 
have  good  effects  hi  the  more  chronic 
cases.  Arsenic,  174,  improves  digestion 
and  the  formation  of  tissue,  and  increases 
the  respiratory  capacity.  Strychnine,  485, 
checks  the  vomiting,  and  is  a  valuable 
respiratory  stimulant.  For  the  night 
sweats,  Picrotoxin,  491,  Atropine,  531,  and 
sometimes  Pilocarpine,  683.  For  the  cough, 
Prunus  Virginiana,  183.  Eucalyptus,  186, 
for  bronchial  catarrh. 

PTTYRIASIS  : 

Acetic  Acid,  244,  will  destroy  the  parasite 
and  cure.  Borax,  224,  is  a  good  applica- 
tion in  pityriasis  of  the  scalp.  Corrosive 
Mercuric  Chloride,  293,  in  solution,  if 
strong  enough,  is  a  certain  cure  for  pityria- 
sis versicolor.  Oleate  of  Mercury,  294,  may 
also  succeed.  Carbolic  Acid,  382,  and 
Myrtol,  430,  will  destroy  the  parasite  of 
pityriasis  versicolor.  The  Sulphides,  250  ; 
sulphide  of  potassa  in  lime-water  is  an 
excellent  application. 

PLEURITIS  : 

Aconite,  714,  is  a  valuable  remedy  for  the 
febrile  stage.  Bloodletting,  814,  by  cups 
or  leeches,  is  a  good  expedient  in  the  initial 
stage  in  plethoric  subjects.  Blisters,  806, 
are  useful  at  two  periods :  at  the  onset  and 
as  resolution  begins.  Digitalis,  511,  is  an 
antiphlogistic,  adapted  to  the  pre-exuda- 
tive  stage.  Potassium  Iodide,  259,  is  use- 
ful to  promote  absorption  of  the  exuda- 
tion, and  tincture  of  iodine  and  compound 
solution  injected  to  prevent  reaccumula- 
tion  of  fluid.  Quinine,  201,  reduces  tem- 
perature and  checks  exudation.  Morphine, 
638,  is  the  most  important  remedy  until  ex- 
udations occur  ;  quinine  and  morphine  in 
sufficient  quantity  at  the  outset  may 
abort.  Chloral,  616,  is  extremely  useful 


CLINICAL   IXDEX. 


859 


when  there  are  restlessness  and  delirium. 
Pilocarpus,  683,  causes  absorption  of  exu- 
dation. 
PNEUMONIA  : 

Aconite,  714,  Veratrum  Viride,  719,  and 
Digitalis,  511,  very  valuable  antipyretics 
and  antiphlogisties  for  the  stage  of  con- 
gestion. Ammonium  Carbonate,  239,  Am- 
monium Iodide,  258,  for  the  liquefaction  of 
the  exudation.  Turpentine,  780,  a  valu- 
able stimulant  when  circulation  is  feeble, 
and  in  gangrene.  The  subcutaneous  injec- 
tions of  ether,  594,  in  adynamic  condition 
remarkably  effective.  Quinine,  201,  an  im- 
portant remedy  under  two  conditions  :  in 
large  doses  during  congestion,  and  in  small 
tonic  doses  as  a  stimulant  when  depres- 
sion conies  on.  Wet  Pack,  86,  and  the 
cold  bath,  the  latter  as  a  remedy  for  the 
inflammation,  according  to  Jurgensen,  the 
best.  Serpentaria,  183,  stimulant  expec- 
torant. Muscarine,  729,  is  a  highly  prom- 
ising remedy.  Morphine,  hypodermatic- 
ally,  638.  Blisters,  807,  useful  at  onset, 
and  to  promote  resolution.  Copper  Sul- 
phate, 309. 

POLYURIA  : 

Dry  Diet,  54,  of  great  value.  Gold  and  So- 
dium Chloride,  297,  persistently  used,  an 
important  remedy.  Opium,  642,  large 
doses  are  necessary,  and  therefore  ex- 
treme danger  of  forming  a  habit.  Ergot, 
502,  the  most  beneficial  remedy  thus  far 
known,  probably.  Pilocarpus,  683,  has 
been  used  with  success. 
PORRIQO  : 

Manganese,  150,  an  ointment  of  the  oxide. 
Oleate  of  Mercury,  294,  has  succeeded. 
Lead  Iodide  Ointment,  315,  in  chronic 


PROSTATE,  HYPERTROPHY  OF  : 
Alkalies,  218,  in  acid  urine,  and  Ammonium 
Benzoate,  422,  for  alkaline  urine.  Tincture 
of  Iodine,  264,  injected  though  the  walls  of 
the  rectum.  lodoform,  860,  by  suppository 
in  the  rectum.  Sulphides,  249,  are  sup- 
posed to  induce  absorption,  Injections  of 
Ergotin,  or  Ergot,  internally,  502,  the  most 
certain  means  of  reducing  the  size  of  the 
organ. 

PROSTORRHCEA  : 

The  Urino-Genital  Remedies,  776  et  seq., 
notably  Cantharis,  Turpentine,  Cubeb,  and 
Copaiba.  Hydrastis,  190,  fluid  extract, 
internally  and  applied  locally.  Tincture 
of  Chloride  of  Iron,  152,  when  there  is 
much  debility.  Potassium  Bromide,  657, 
when  there  are  irritability  and  excitement. 
Ergot,  502,  when  relaxation  exists. 

?RCRIGO  : 

Caroolic  Acid,  382,  locally  and  also  internally. 
Alkaline  Warm  Baths,  224,  at  bed-hour. 
Belladonna,  531,  internally,  sometimes  re- 
lieves remarkably.  Prussic  Acid,  Potas- 
tium  Cyanide,  702  and  703,  in  solution,  is 
effective,  but  must  be  used  with  caution. 


Pilocarpus,  642,  does  good  when  skin  is 
dry  and  harsh.  Oalvanism,  470,  has  spe- 
cial value  in  cases  of  neurotic  origin.  Sul- 
phides, 250,  afford  relief  in  bath  or  as  an 
ointment. 

PRURITUS  VULV^C  : 

Borax,  225,  a  saturated  solution  freely  ap- 
plied ;  also  Potassium  Bicarbonate,  225,  in 
solution.  Corrosive  Mercuric  Chloride, 
294,  in  solution  of  sufficient  strength.  Ole- 
ate of  Mercury,  294,  Cyanide  of  Potas- 
sium, 703,  as  an  ointment  or  in  solution,  if 
strong  enough,  relieves  greatly,  but  must 
be  used  cautiously  ;  also  Hydrocyanic  Acid, 
702,  diluted,  which  may  be  prescribed  in 
lotion,  with  borax.  Silver  Nitrate,  303,  a 
solution  painted  on  the  affected  parts,  gives 
great  relief.  Sulphites,  248,  also  as  a  lo- 
tion. Oleates  of  Mercury  and  Morphine^ 
294. 

PSORIASIS  : 

Cod-liver  Oil,  126,  of  the  greatest  value  both 
internally  and  locally  in  cases  of  strumous 
origin.  Arsenic,  174,  in  chronic  cases  ; 
may  increase  the  disease  at  first,  but  per- 
sistently used  may  effect  a  cure.  Phos- 
phorus, 136,  acts  similarly  to  arsenic,  and 
may  accomplish  better  results.  Locally— 
Silver  Citrate,  303,  Lead — ointment  of  the 
iodide,  315,  Coptis,  183,  especially  in  psoria- 
sis of  the  tongue,  Sulphur  Baths,  253,  and 
the  Sulphides,  249,  250. 

PTYALISM  : 

Belladonna,  526,  also  Hyoscyamiiie  and  Du- 
boisine,  of  same  group,  very  effective  in 
mercurial,  and  ptyalism  of  pregnancy.  In 
some  rare  examples,  Pilocarpine,  642,  ef- 
fective. Locally—  ZYmnin,  345,  and  the 
Vegetable  Astringents,  340  et  seq. 

PUERPERAL  CONVULSIONS  : 
Anaesthetics,  605,  especially  chloroform  ;  the 
relief  is  temporary,  but  time  is  gained  for 
other  measures.  Chloral,  617,  in  consider- 
able doses  is  useful.  Morphine.  640,  hypo- 
dermatically,  is  the  most  valuable  agent  in 
the  ursemic  form,  but  full  doses  are  neces- 
sary. Amyl  Nitrite,  705,  by  inhalation, 
may  do  good  in  cases  characterized  by 
high  tension  of  the  vessels.  Veratrum 
Viride,  720,  has  proved  to  be  a  successful 
remedy — "  invaluable."  Bloodletting,  814, 
is  necessary  when  there  is  cerebral  con- 
gestion. Bromides,  654. 

PUERPERAL  FEVER  : 

Quinine,  201,  in  large  doses,  first  in  impor- 
tance. Opium,  640,  when  there  are  wake- 
fulness  and  delirium,  especially  when  local 
peritonitis  exists.  Salicylic  Acid,  396,  and 
the  Salicylates,  Resorcin,  404,  and  Carbolic 
Acid,  380  ;  also,  of  the  same  class,  Salol, 
409,  Antipyrin,  412,  Acetanilid,  426,  and 
all  effective  antipyretics,  are  remedies  of 
great  value.  Turpentine,  779,  when  there 
is  much  tympanites  or  depression.  Po- 
tassa  Permanganate,  157,  has  been  used 
with  success  internally. 


860 


CLINICAL   INDEX. 


PUERPERAL  MANIA  : 

Anaesthetics,  605,  may  be  necessary  In  vio- 
lent cases.  Bromides,  653,  will  quiet,  in 
cases  with  tendency  to  cerebral  conges- 
tion. Chloral,  617,  is  a  highly  serviceable 
hypnotic,  but  its  persistent  use  in  anaemic 
cases  is  harmful.  Duboisine,  542,  Hyoscya- 
mine,  538,  and  Hyoscine,  540,  are  probably 
the  best  hypnotics  when  there  are  much 
excitement  and  restlessness,  as  well  as 
wakef  ulness,  and  the  most  successful  when 
there  is  much  motor  excitement.  Cha- 
lybeates,  150,  and  Quinine,  207,  are  neces- 
sary when  there  is  debility.  Morphine, 
641,  under  some  circumstances  is  the  best 
hypnotic. 

PUERPERAL  PERITONITIS  : 

Opium,  640,  is  the  most  important  remedy, 
and  is  probably  curative.  Quinine,  205,  in 
considerable  doses,  is  next  in  value  ;  a 
combination  of  quinine  and  morphine. 
Turpentine,  779,  is  indicated  in  a  condition 
of  systemic  depression  and  when  tym- 
panites is  present.  Ice,  84,  Heat,  88,  to  the 
walls  of  the  abdomen. 

PURPURA  : 

Digitalis,  509,  to  overcome  the  low  tension. 
Ergot,  500,  slows  the  heart  and  raises  the 
tension,  and  thus  checks  transudations. 
Sulphuric  Acid,  117,  Gallic  Acid,  344,  Lead 
Acetate,  314,  are  astringents  of  more  or 
less  value.  Turpentine,  779,  is  of  great 
value  usually.  Iron,  151,  is  usually  indis- 
pensable, especially  the  tincture  of  the 
chloride  ;  also  Hcemol,  54.  Ferratin,  53. 
Oil  of  Erigeron,  184,  is  useful. 


Quinine,  201,  in  large  doses.  Salicylic  Acid, 
396,  Resorcin,  404,  Salol,  409,  Antipyrin, 
412,  and  the  Antiseptics  in  general,  are 
useful  in  varying  degree.  Alcohol,  582, 
and  the  Malt  Liquors,  584,  have  an  impor- 
tant place. 

PYELONEPHRITIS  : 

Eucalyptus,  187,  and  the  Urino-genital  Reme- 
dies, especially  Cantharis,  799,  Turpentine, 
781,  Pipsissewa,  790,  Erigeron,  790,  Gallic 
Acid,  344,  and  the  Antiseptic  group,  392 
et  seq. 

REMITTENT  FEVER  : 

Quinine,  202,  curative  in  efficient  doses. 
Resorcin,  404,  Salicylic  Acid,  396,  Anti- 
pyrin, 412,  Acetanilid,  426,  and  Ben- 
zoates,  422,  come  next. 

RHEUMATIC  ARTHRITIS  : 

Lithium,  224,  and  its  salts.  Iodides,  261, 
when  the  disease  is  due  to  syphilitic,  mercu- 
rial, or  plumbic  poisoning.  Colchicum,  353, 
when  the  gouty  or  rheumatic  diathesis  un- 
derlies the  disease.  Cod-liver  OH,  125,  in- 
ternally and  locally,  is  adapted  to  all  forms, 
and  one  of  the  best  of  remedies.  Arsenic, 
173,  Is  beneficial  in  cases  of  simple  charac- 
ter. Guaiacol,  388,  as  a  topical  application. 

RHEUMATISM.  ACUTE  : 
Aconite,  715,  tincture  of  the  root,  for  the 


fever.  Water,  85,  cold  baths  for  the  condi- 
tion of  hyperpyrexia.  Arnica,  677,  a  rem- 
edy for  subacute  cases,  and  Trimethyla- 
mine,  679,  which  acts  similarly.  Th'e 
Ammonium  and  Lithium  Bromides,  651, 
have  been  warmly  commended  ;  the  latter 
also  useful  hi  muscular  attacks.  Salicin, 
389,  in  full  doses,  according  to  Maclagan, 
the  first  of  remedies  ;  Salicylic  Acid,  and 
the  Salicylates,  397,  especially  of  Cinchoni- 
dine  ;  Salol,  409,  has  of  late  been  much 
urged,  and  the  Benzoates,  432  ;  also  Anti- 
pyrine,  412,  and  Acetanilid,  426,  new  and 
effective  remedies.  Quinine,  201,  for  hyper- 
pyrexia.  Alkalies,  chiefly  Potassium  Bi- 
carbonate, 218,  a  plan  of  treatment  very 
useful  under  appropriate  conditions.  Iron, 
149,  tincture  of  the  chloride  in  full  doses  a 
valuable  remedy  in  weak  subjects.  Blis- 
ters, 807,  a  succession  of,  around  the  af- 
fected joints,  give  relief  and  shorten  the 
disease.  Mineral  Acids,  118,  have  been 
warmly  advocated.  Lemon-juice,  244,  an 
adjunct  to  more  effective  remedies,  espe- 
cially to  potash  salts. 

RHEUMATISM,  CHRONIC  : 

Alkaline  Mineral  Waters,  229  et  seq..  Sul- 
phurous Mineral  Waters,  253.  The  Turkish 
Bath,  93.  Cod-liver  Oil,  125,  a  very  impor- 
tant remedy.  Aliment,  67,  Colchicum,  353, 
in  the  so-called  gouty  form.  Guaiac,  357, 
is  sometimes  useful.  Stillingia,  358,  Xan- 
thoxylum,  363,  and  Cimicifuga,  522,  give 
relief  in  the  muscular  form,  and  are  less 
beneficial  when  there  are  joint  changes. 
Iodides,  261,  produce  excellent  results  in 
the  cases  due  to  metallic  poisoning.  Man- 
ganese Sulphate,  157,  does  good  hi  cases 
of  gouty  antecedents.  Lithium  and  its 
Salts,  224,  afford  the  best  results  in  uric- 
acid  diathesis.  Salicylic  Acid,  397,  Cin- 
chonidine  Salicylate,  399,  Salol,  409,  Anti- 
pyrin, 412,  and  the  other  antiseptics. 

RICKETS  : 

Aliment,  67,  food  rich  in  phosphates,  oils,  and 
lime.  Cod-liver  Oil,  125,  is  a  most  impor- 
tant agent  in  the  process  of  regeneration. 
Phosphates,  140,  especially  the  lacto-phos- 
phate  of  lime,  and  Iron,  148,  especially  the 
sirup  of  the  iodide.  Phosphorus,  134,  in- 
duces a  hypertrophy  of  bony  tissue,  and 
should  therefore  be  carefully  tried  in  this 
disease  ;  it  may  be  advantageously  given 
in  cod-liver  oil. 

ROSEOLA  : 

Belladonna,  531,  is  a  suitable  remedy  when 
any  remedy  is  needed,  and  Inunctions  of 
Oil,  124,  allay  the  cutaneous  irritation. 

RUBEOLA : 

Aconite,  715,  and  Digitalis,  511,  are  impor- 
tant antipyretics  and  to  relieve  the  ca- 
tarrhal  process.  Ammonium  Carbonate, 
239,  has  the  greatest  value  in  the  catarrhal 
pneumonia  when  a  complication.  Qui- 
nine, 203,  is  highly  useful  in  large  doses 
when  catarrhal  pneumonia  conies  on.  The 


CLINICAL   INDEX. 


861 


antiseptic  antipyretics,  when  temperature 
is  high,  Antipyrin,  412,  Acetanilid,  426, 
and  others.  For  the  broncho-pneumonia, 
Iodides,  259,  Ethyl  Iodide,  267,  by  inhala- 
tion, etc.  Oil  Inunctions,  124,  allay  irrita- 
tion of  the  skin  and  lessen  the  febrile  heat, 

SCABIES  : 

Sulphur-Baths,  253,  Sulphites  and  Sulphides, 
250,  freely  and  faithfully  used,  are  very 
effective.  Carbolic  Acid,  382,  locally  de- 
stroys the  parasite,  but  has  caused  fatal 
poisoning,  too  freely  used ;  also  Thymol, 
429,  Corrosive  Mercuric  Chloride,  294,  if 
strong  enough  is  very  effective,  but  caution 
is  necessary.  Manganese,  159,  an  oint- 
ment of  the  oxide,  and  solution  of  Potass. 
Permanganate,  159.  Copper  Sulphate, 
309,  a  lotion  of,  may  be  used  successfully. 

SCARLET  FEVER: 

Aconite,  715,  for  the  fever  and  local  inflam- 
mations. Digitalis,  511,  a  very  important 
remedy  as  antipyretic  and  diuretic.  Bella- 
donna, 528,  when  the  eruption  is  imperfect 
or  bluish,  the  peripheral  circulation  feeble, 
and  the  heart's  action  depressed.  Oil  In- 
unctions, 124,  diminish  irritation  of  the 
skin  and  lessen  temperature.  Salicylic 
Acid,  396,  Sodium  Benzoate,  423,  Resorcin, 
404,  Carbolic  Acid,  380,  Antipyrin,  and  the 
other  antiseptics  and  antipyretics ;  spray 
to  the  throat,  and  internally  for  septic  in- 
fection. Ammonium  Carbonate,  239,  of 
great  value  as  a  remedy  and  as  a  stimu- 
lant to  the  depressed  circulation.  Quinine, 
203,  employed  under  two  conditions— as 
antipyretic  and  tonic.  Water,  85,  cold 
baths  and  pack,  for  hyperpyrexia  and  to 
develop  the  eruption  in  the  fulminant 
cases.  Aqua  Chlori,  369,  is  a  useful  gar- 
gle and  deodorant  mouth-wash.  Hydro- 
chloric Acid,  117,  internally,  and  diluted  as 
a  lotion  for  mouth  and  throat. 

SCIATICA  : 

Atropine,  532,  injected  subcutaneously  in  the 
neighborhood  of  the  nerve,  but  the  physio- 
logical effects  must  be  fully  induced.  Co- 
caine and  Atropine,  561.  Methylal,  586,  a 
twenty-per-cent  mixture  with  oil,  rubbed 
in  along  the  nerve,  is  said  to  be  very  ef- 
fective. Morphine,  641,  subcutaneously 
with  or  without  atropine,  has  curative  ef- 
fects. Galvanism,  468,  next  to  morphine, 
is  the  best  method  of  cure.  Aquapunc- 
ture,  809,  gives  great  relief  in  recent  cases. 
Acupuncture,  808,  also  Firing,  808,  some- 
times relieves.  Chloroform,  597,  and 
Ether.  594,  by  deep  injection  in  old  cases 
are  surprisingly  effective.  Silver  Nitrate, 
306,  in  solution,  injected  near  to  the  nerve- 
trunk,  is  curative  in  some  old  cases  resist- 
ing other  means.  Salicylic  Acid,  396,  Sa- 
lol,  Antipyrin,  412,  and  Acetanilid,  426. 
Iodides,  261,  should  be  used  in  cases  of 
syphilitic,  plumbic,  or  mercurial  cachexia. 
Turpentine,  781,  has  occasionally  suc- 
ceeded ;  also  Guaiac,  357. 


SCLERODERMA  : 

Cod-liver  Oil,  124,  the  most  important  rem- 
edy. Phosphates  and  Hypophosphites,  139, 
with  or  without  cod-liver  oil.  Phosphorus, 
136,  in  cod-liver  oil.  Galvanism,  470,  cen- 
tral galvanization. 

SCLEROSIS,  SPINAL  : 

Silver  Nitrate,  303,  very  beneficial.  Phos- 
phorus, 135,  Galvanism,  468,  and  Static 
Electricity,  474,  Electric  Brush,  473,  Io- 
dides, 261,  when  there  are  specific  lesions, 
and  in  mineral  poisoning.  Baths,  87,  the 
rubbing  wet  pack.  Massage,  102.  Oils, 
126. 

SCLEROSIS  OP  THE  VESSELS  : 
Iodides,  258,  among  the  first  of  remedies. 
Phosphates,  140. 

SCROFULA : 

Cod-liver  Oil,  126,  and  Inunctions  of  Oil,  124. 
Phosphates,  139.  to  improve  the  nutrition. 
Iron,  149,  and  Chalybeate  Waters,  161. 
Iodides,  261,  of  iron  and  manganese,  espe- 
cially lodoform,  272,  Stillingia,  358,  San- 
guinaria,  361,  and  Sarsaparilla,  356,  pro- 
mote the  activity  of  the  vegetative  func- 
tions and  improve  nutrition. 

SEA-SICKNESS  : 

Atropine,  526,  subcutaneously,  in  minute 
quantity.  Chloroform,  596,  a  few  drops 
by  the  stomach,  frequently.  Chloral,  613, 
especially  useful  when  there  are  fever  and 
insomnia,  probably  the  most  effective  rem- 
edy, but  must  be  given  before  decided 
nausea  sets  in.  Sodium  Bromide,  651 
[jss.— 3j],  begun  before  embarking,  the 
first  of  remedies.  Champagne,  581,  iced 
in  small  quantity,  or  effervescent  mixtures. 
Morphine,  635,  minute  doses  subcutaneous- 
ly. Amyl  Nitrite,  705,  by  inhalation,  and 
Nitro-glycerin,  709,  by  the  stomach,  are 
very  useful.  Bitters,  as  Calumba,  180,  and 
Tincture  of  Nux  Vomica,  482,  also  some- 
times succeed. 

SEBOURHCEA  : 

Zinc  Oxide,  320,  ointment.  Potassoe  Liquor, 
217,  225,  locally  and  internally.  Glycerin, 
817,  persistently  continued  by  the  stomach. 

SEPTICAEMIA  : 

Quinine,  201,  in  large  doses,  as  an  antipy- 
retic and  antiseptic.  Salicylic  Acid,  396, 
Resorcin,  404,  and  Benzoates,  422,  are  em- 
ployed for  the  same  purposes :  to  keep 
down  the  temperature  and  to  destroy  septic 
materials.  Bromine,  371,  Carbolic  Acid, 
382,  and  Chlorine,  371,  Boric  Acid,  420,  the 
Antiseptic  Oils,  428,  Potassa  Permanga- 
nate, 157,  are  all  used  locally  to  destroy 
sloughing  and  gangrenous  parts,  to  de- 
odorize, and  to  change  the  character  of 
the  surface.  Cold  Baths,  85,  for  hyperpy- 
rexia,  and  Hot  Water,  89,  for  wounds. 

SKIN-DISEASES  : 

Oils  and  Fats,  126,  by  inunction  and  locally. 
Arsenic,  174,  in  chronic,  scaly  skin-dis- 
eases. Phosphorus,  134,  in  place  of  ar- 
senic and  under  the  same  conditions.  lo- 


862 


CLINICAL   INDEX. 


elides.  262,  when  syphilitic,  mercurial,  ] 
plumbic,  or  other  metallic  poisons  under- 
lie the  local  morbid  process.  Mercury,  290, 
294,  of  great  value  in  secondary  S3Tphilitic 
cutaneous  affection.  Quinine,  208,  in  ec- 
thyma,  erythema  nodosum,  and  when  de- 
pression of  the  vital  forces  exists.  Atro- 
pine,  531,  is  highly  useful  in  certain  cu- 
taneous neuroses,  and  in  simple  vascular 
lesions.  Pilocarpus,  684,  when  the  skin- 
secretions  are  deficient,  and  in  alopecia. 
Jequirety,  811,  in  the  hypertrophic  affec- 
tions. Sarsaparilla,  356,  has  long  been 
celebrated  in  syphilitic  and  strumous  af- 
fections of  the  skin.  Mineral  Acids,  119, 
in  diseases  secondary  to  stomachal  and 
intestinal  indigestion.  Electricity,  470,  in 
the  neuroses  of  the  skin.  Locally,  the 
salts  of  Zinc,  320,  and  Mercury,  294,  Tan- 
nic  Acid,  346,  as  glycerite  or  in  powder. 
Carbolic  Acid,  382,  Sulpkocarbolates,  385, 
Trichlorphenol,  386,  and  Iodine,  263,  are 
freely  used  in  various  acute  and  chronic 
affections.  Stains  of  Silver  Nitrate,  305, 
are  removed  by  a  solution  of  cyanide  of 
potassium,  iodine,  and  water. 

SPERMATORRHCEA  : 

Atropine,  530,  Ergot,  501,  and  Digitalis,  513, 
when  the  genitals  are  relaxed,  the  erec- 
tions feeble  because  of  deficient  filling  of 
veins  of  erectile  tissue,  and  the  ejaculator 
muscles  paretic.  Cimicifuga,  522,  acts 
similarly,  but  less  strongly.  Nux  Vomica, 
483,  or  strychnine  is  indicated  when  a 
stimulant  and  tonic  are  required,  and  Can- 
tharis,  799,  under  similar  circumstances. 
Iron,  152,  tincture  of  the  chloride,  when 
anaemia  is  a  marked  feature,  and  Arsenic, 
175,  as  a  systemic  tonic  and  genital  stimu- 
lant. Potassium  Bromide,  657,  Lupuline, 
647,  and  Camphor,  547,  when  a  genital 
sedative  is  indicated.  Locally,  Hydrastis, 
191,  fluid  extract,  Tannin,  346,  and  vegeta- 
ble and  mineral  astringent?. 

SPINA  BIFIDA  : 

Iodine,  262,  the  tincture  injected  into  the 
sac.  Collodion,  819,  in  drying,  contracts 
and  mechanically  compresses. 

SPINAL  IRRITATION  : 

Electricity,  466,  is  an  efficient  means  of  al- 
laying the  pain  and  tenderness.  Strych- 
nine, 483,  one  of  the  best  tonics  for  the 
primary  assimilation,  and  stimulant  for 
the  depressed  nerve-centers.  Ergot,  501,  is 
required  when  active  hypersemia  is  present. 
Potassium  Bromide,  657,  does  good  under 
the  same  conditions.  Mitchell's  Cure,  103, 
by  massage,  rest,  and  faradism,  sometimes 
useful,  often  disappointing. 

SPLEEN,  DISEASES  OF  : 

Remedies  acting  on  the  spleen  are,  hi  anae- 
mia. Iron,  147,  Manganese,  156,  and  Ar- 
senic, 171 ;  in  vascular  dilatation,  Ergot,  499, 
Quinine,  204,  Belladonna,  530,  Muscarine, 
729,  Resorcin,  404.  The  most  efficient  ex- 
ternal applications  are  :  Cold  Affusion,  88, 


which  causes  contraction  of  the  splenic 
vessels,  Ointment  of  the  Red  Mercuric  Io- 
dide, 294,  which,  if  properly  applied,  causes 
a  rapid  reduction  of  simple  hypertrophy, 
Ointment  of  Lead  Iodide,  315. 
STERILITY  : 

Aurum,  297,  chloride  of  gold  and  sodium, 
when  due  to  chronic  interstitial  metritis. 
Phosphorus,  135,  when  simple  functional 
debility  in  the  male  is  the  condition. 
STOMATITIS  : 

Alcohol,  577,  Brandy  and  Water,  an  excel- 
lent astringent  wash.  Bismuth,  164,  in 
powder  freely  applied.  Acids,  114,  hydro- 
chloric, applied  directly  to  ulcers.  Euca- 
lyptus, 186,  Hydrastis,  189,  Krameria,  343, 
and  other  vegetable  astringents,  the  fluid 
extracts  being  applied  pure  or  variously 
diluted  to  the  affected  parts.  Potassium 
Chlorate,  217,  the  most  valuable  applica- 
tion, and  especiallysy  stemic  remedy ;  also* 
Potass.  Bromide,  660. 
STRANGURY : 

Opium,  635,  the  tincture  by  enema,  or,  bet- 
ter, morphine  subcutaneously.  Gelsemiumt 
634,  Aconite,  715,  Veratrum  Viride,  720, 
and  Bromides,  657,  afford  relief  in  varying 
degree.  For  vesical  strangury,  Canthar- 
ides  Tincture,  799,  Turpentine,  781,  and 
various  urino-genital  remedies,  and  the  an- 
tiseptics having  analgesic  properties. 
STRICTURE  : 

Electrolysis,  471,  an  effective  remedy  if  prop- 
erly applied. 
STRYCHNINE-POISONING  : 

Emetics  or  Stomach-Pump  ;  Tannin,  Com- 
pound Solution  of  Iodine,  chemical  anti- 
dotes, Chloral,  Chloroform,  by  inhalation, 
Nicotine,  subcutaneously,  physiological 
antagonists.  Rest,  Artificial  Respiration,. 
and  Galvanism,  469. 
SUPPURATION  : 

AlcoJwl,  577,  a  powerful  antiseptic  and  anti- 
pyretic, and,  externally,  a  valuable  anti- 
septic dressing.  Carbolic  Acid,  382,  and 
the  Antiseptics  in  general.  Quinine,  208, 
in  full  doses,  as  a  tonic.  Sulphites,  247, 
and  Sulphides,  249,  small  doses  frequently 
mature  abscesses,  and  under  some  circum- 
stances abort  them  ;  also  Sulphurous  Min- 
eral Waters,  253,  Phosphates,  140,  and 
Lime  Salts,  223,  to  repair  waste  by  suppu- 
ration. Iron  and  Manganese  Iodides,  149, 
the  sirup  of,  in  the  systemic  depression 
caused  by  suppuration. 
SWEATING.  (Hyperidrosis— see  PERSPIRATION.) 

Mineral  Acids,  118,  especially  aromatic  sul- 
phuric acid.  Aristol,  277,  Nosophen,  276, 
useful  applications  when  dusted  on.  Zinc 
Oxide,  318,  in  night-sweats  of  phthisis,  espe- 
cially with  extract  of  belladonna.  Gallic 
Acid,  344,  restrains  sweating.  Atropine, 
531,  is  a  powerful  means  of  arresting  per- 
spiration ;  also  Duboisia,  543,  and  espe- 
cially Picrotoxin,  491,  Pilocarpus,  682,  Re- 
sorcin, 404,  and  Salicylic  Acid,  403,  cause 


CLINICAL   INDEX. 


863 


sweating,  and  under  some  conditions  ar- 
rest it.    Alkalies,  locally,  224. 

SYCOSIS  : 

Carbolic  Acid,  382,  internally  and  externally. 
Mercury  Oleate,  294. 

SYNOVITIS  : 

Cod-liver  Oil,  125,  is  useful  in  strumous  and 
debilitated  constitutions.  Silver  Nitrate, 
304,  in  nitrous  ether,  painted  over  the  joint. 
Carbolic  Acid,  382,  solution  injected  into 
the  joint.  Mercury  and  Morphine  Oleate, 
294,  Massage,  102. 

SYPHILIS  : 

Baths,  85,  Turkish  baths,  wet  packs,  and 
vapor-baths,  are  very  important  in  promot- 
ing excretion.  Denutrition,  or  hunger- 
cure,  54.  Cod-liver  Oil,  126,  useful  in 
chronic  cases  and  broken-down  constitu- 
tions. Mercury,  290,  the  great  remedy  for 
constitutional  syphilis—  by  stomach,  by  in- 
unction, by  fumigation,  or  subcutaneously. 
Iodides,  260,  in  constitutional,  certain  forms 
of  secondary  and  tertiary  disease,  are  un- 
rivaled in  efficacy.  Aurum,  297,  comes 
into  use  after  iodides  and  mercury,  to 
which  it  is  greatly  inferior.  Iron,  148,  espe- 
cially the  iodide,  in  sloughing  phagedsena 
and  in  depressed  states  of  the  system  at 
all  stages.  lodoform,  263,  as  a  local  appli- 
cation to  chancres.  Carbolic  Acid,  382, 
Salicylic  Acid,  400,  Boric  Acid,  420,  Ben- 
zoin, 423,  Potassa  Chlorate,  225,  in  powder, 
are  valuable  local  applications  to  syphi- 
litic sores,  abscesses,  discharging  buboes, 
phagedaena,  etc.  Sarsaparilla,  356,  Stil- 
lingia,  358,  Ouaiacum,  357,  are  important 
adjuncts,  vehicles,  and  remedies  for  the 
constitutional  disease,  the  system  being 
unequal  to  further  iodine  and  mercurial 
treatment. 


The  various  Tceniafuges,  774  et  seq.,  Resor- 
cin,  404,  and  Salicylic  Acid,  395,  have  killed 
tsenia,  so  that  a  purgative  only  was  neces- 
sary. Chloroform,  597,  lately  much  used. 
Turpentine,  779,  is  one  of  the  most  effi- 
cient remedies,  although  unpleasant  in  the 
highest  degree.  Ailanthus,  726,  has  suc- 
ceeded. Papain,  109,  and  other  digestive 
ferments. 
TETANUS  : 

Atropine,  532,  injected  into  the  rigid  muscles, 
has  done  good.  Strychnine,  483,  is  alleged 
to  be  curative  in  some  cases,  but  more  than 
doubtful.  Chloral,  618,  is  certainly  a  rem- 
edy of  great  value.  Amyl  Nitrite,  706,  has 
been  used  with  success  ;  Nitro-glycerin, 
709,  should  also  be  fairly  tried.  Gelsemi- 
um,  674,  has  succeeded,  and  is  a  promising 
remedy.  Curara,  670,  valuable,  but  un- 
certain. Potassium  Bromide,  653,  seems 
to  be  the  most  successful  remedy.  Physo- 
stigma,  689,  has  also  been  used  with  ad- 
vantage in  a  number  of  cases,  but  its  real 
value  remains  to  be  determined.  Hyoscya- 
mine,  539,  or  Duboisine,  542,  may  be  used. 
T 


Nicotine,  654,  has  effected  a  cure,  but  its 
use  requires  caution.  Ancetst/ietics,  607, 
give  temporary  relief.  Morphine,  641,  in- 
jected into  the  tetanized  muscles,  gives 
great  relief.  New  remedies  that  have 
proved  useful  are  Paraldehyde,  585,  Ure- 
than,  588,  and  Hypnone,  590,  especially  the 
first  named. 

THERMIC  FEVER,  OR  SUNSTROKE  : 
Cold  Baths,  84,  for  the  hyperpyrexia.  Mor- 
phine, 638,  subcutaneously,  when  convul- 
sions occur,  or  the  insensibility  and  high 
temperature  persist.  Pilocarpine,  683, 
should  be  tried.  Quinine,  202,  Antipyrin, 
411,  Salol,  409,  Acetanilid,  426,  and  other 
antipyretics  should  be  administered  subcu- 
taneously. 

THROMBOSIS  AND  EMBOLISM  : 
Ammonia,  238,  by  the  stomach  or  by  intra- 
venous injection,  to  liquefy  the  obstructing 
clot.  Ergot,  500,  Quinine,  201,  and  Digi- 
talis, 509,  for  the  collateral  hyperaemia  and 
oedema. 

Tic-DouLouREUx.  (See  NEURALGIA.) 
Atropine  and  Morphine,  641,  644  ;  these  alka- 
loids in  combination  subcutaneously  give 
relief.  Croton-Chloral,  619,  has  special 
effects  on  the  fifth  nerve.  Aconitine,  715, 
has  lately  been  given  with  good  results. 
Galvanism  and  Magnetism  relieve  the  pain, 
468.  Antipyrin,  411,  and  Acetanilid,  426, 
for  pains  of  locomotor  ataxia  and  of  neu- 
ritis. Cocaine,  561,  and  Cocaine- Atropine, 
563,  subcutaneously,  are  effective  ano- 
dynes. Teucrin,  431,  subcutaneously,  Phe- 
nacetin,  418,  Thymol,  428,  Hypnone,  590, 
Urethan,  588,  and  its  congeners,  are  active 
analgesics. 

TINEA  : 

Boric  Acid,  420,  is  an  excellent  topical  appli- 
cation. Mercury,  294,  corrosive  sublimate, 
as  an  ointment  or  lotion  for  tinea  tonsu- 
rans  ;  oleate  of  mercury  in  oleic  acid,  also, 
309,  of  Copper,  and  an  ointment  of  the  car- 
bonate. Carbolic  Acid,  382,  applied  di- 
rectly or  in  glycerin  to  the  part  affected. 
Sulphites,  248,  in  solution,  also  useful. 
Sulphides,  250,  sulphur-baths,  250,  faith- 
fully carried  on,  are  curative. 

TONSILLITIS  : 

Aconite,  713,  the  tincture  of  the  root,  in  cases 
accompanied  by  fever.  Ouaiacum,  357, 
a  full  dose  is  said  to  abort  an  attack.  Icej 
81,  held  against  the  inflamed  part,  dimin- 
ishes the  congestion.  Mercury,  286,'  small 
doses  of  calomel  or  gray  powder  reduce 
the  inflammation.  Quinine,  200,  in  a  full 
dose  at  the  outset  may  abort  an  attack. 
Alum,  337.  in  powder,  solution,  or  whey, 
does  good  after  the  acute  symptoms.  Tinc- 
ture of  Iodine,  264,  injected,  will  gradually 
diminish  the  hypertrophied  tonsil. 

TOOTHACHE : 

Alum,  337,  a  solution  in  nitrous  ether  is  said 
to  be  effectual.  Tannin,  345,  dissolved  in 
ether,  also  relieves  the  pains  of  a  carious 


864 


CLINICAL  INDEX. 


tooth.  Carbonate  of  Soda,  225,  a  saturated 
solution  held  in  the  mouth  relieves.  Opium, 
004,  or  morphine,  a  solution  of,  put  in  a 
carious  cavity.  Oil  of  Cloves,  428,  Carbolic 
Acid,  382,  or  Resorcin,  404,  and  Phenore- 
furcin  put  in  a  cavity  stop  the  pain. 
Xanthoxylum,  362.  is  a  domestic  remedy. 

TORTICOLLIS  : 

Galvanism.  466,  to  the  muscles  in  a  state  of 
spasm,  and  faradic  applications  to  the  an- 
tagonist muscles  in  a  paretic  state.  Mas- 
sage, 102,  Water,  87,  hot  douche. 

TUBERCULOSIS  : 

Grape-Cure,  56,  Whey-Cure,  60,  Cod-liver 
Oil,  125,  Iron,  150,  valuable  in  so  far  as  it 
improves  nutrition.  Creosote,  380,  lodo- 
form,  272.  Iron  and  Manganese  Iodide, 
156;  also  Europhen,  276,  Sozoiodol,  277, 
Aristol,  277,  Ghiaiacol,  380.  Chloride  of 
Calcium,  223,  apparently  exercises  a  real 
curative  influence. 

TYPHLITIS  : 

Ice,  88,  in  form  of  a  poultice  to  the  seat  of 
inflammation.  Opium,  638,  in  form  of  ene- 
mata  of  the  tincture,  or  deodorized  tincture 
by  the  stomach,  or  morphine  subcutane- 
ously,  which  is  the  more  effective.  Leeches, 
814,  to  the  inflamed  region  as  soon  as  ten- 
derness is  manifest,  and  should  not  be 
omitted  unless  the  subject  is  feeble.  Pur- 
gatives, 750,  saline,  especially  Epsom  salts, 
alone  admissible  in  typhlitis  due  to  impac- 
tion  of  the  caecum,  and  positively  contra- 
indicated  in  the  other  forms  of  the  disease. 

TYPHOID  FEVER.  (See  FEVER.) 
Aliment,  63,  a  milk-diet,  usually  most  suit- 
able. Acids,  Mineral,  117,  the  muriatic, 
has  been  much  employed  as  a  remedy  to 
diminish  fever  and  restrain  diarrhoea.  Io- 
dine, 261,  in  the  form  of  the  compound 
tincture  or  solution,  is  a  remedy  of  great 
value — lessens  the  violence  and  shortens 
the  duration  (German  "Specific  Treat- 
ment"). Mercury,  289,  calomel  in  ten- 
grain  doses  for  several  days  during  the 
first  week  or  ten  days— "  specific  treat- 
ment "—shortens  the  duration  and  moder- 
ates the  violence  of  the  disease.  Carbolic 
Acid,  380,  and  creosote  have  been  used 
with  great  success ;  may  be  administered 
with  iodine  advantageously.  Chlorine,  371. 
The  antipyretic  and  antiseptic  treatment 
includes,  besides  the  remedies  just  named, 
Quinine,  202,  in  large  doses,  Cold  Baths,  83, 
Salicylic  Acid,  396,  Resorcin,  404,  Sodium 
Benzoate,  422,  Digitalis,  511.  Silver  Ni- 
trate, 302,  Bismuth,  163,  Fowler's  Solution 
with  Tincture  of  Opium,  176,  are  employed 
to  restrain  diarrhoea. 

ULCERS: 

Nitric  Acid,  119,  a  powerful  escharotic,  used 
to  destroy  unhealthy  tissues  and  change 
the  character  of  the  surface.  Potassa 
Chlorate,  225,  in  powder,  applied  to  the 
surface,  is  remarkably  beneficial  in  cases 
of  unhealthy  ulceration,  in  epithelioma, 


etc.  Alum,  337,  dried,  is  a  feeble  escha- 
rotic, and  destroys  unhealthy  granulations. 
Zinc  Sulphate,  319,  dried,  is  a  valuable 
caustic,  and  easily  managed  ;  the  chloride 
of  zinc  is  more  powerful  and  penetrating, 
as  well  as  more  painful.  Pyrogallic  Acid, 
348.  Potassa  Fusa,  225,  or  the  milder 
Vienna  paste,  diffuses  widely  and  destroys 
deeply.  Silver  Nitrate,  303,  acts  superfi- 
cially, and  is  therefore  to  be  used  only 
when  the  mildest  effects  are  necessary. 
Copper  Sulphate,  309,  is,  like  silver  nitrate, 
a  good  application  to  change  the  character 
of  an  indolent  ulcer,  and  to  form  a  thin 
coating  under  which  healing  may  proceed. 
lodoform,  264,  271,  in  powder,  dusted  over 
the  ulcer,  is  a  capital  dressing  for  syphilitic 
ulcers,  irritable  sores,  and  superficial  ulcers 
generally  ;  its  odor  for  these  purposes  may 
be  covered  by  thymol,  menthol,  or  euca- 
lyptol.  Carbolic  Acid,  382,  Salicylic  Acid, 
400,  Boric  Acid,  420,  Resorcin,  404,  Thymol, 
428,  Chlorine,  369,  and  Dermatol,  164,  are 
antiseptic,  deodorant,  and  alterative  ap- 
plications, of  great  value  in  wounds,  un- 
healthy ulceration,  and  sloughing  phage- 
daena.  Galvanism,  469,  a  galvanic  couplet, 
will  heal  bed-sores  and  unhealthy  ulcers. 


Water,  93,  the  vapor-bath  and  hot-water 
pack,  to  excite  the  skin  and  promote  free 
diaphoresis.  Pilocarpus,  683,  Muscarine, 
730,  and  Resorcin,  404,  active  diaphoretics, 
especially  the  first  named,  but  the  state  of 
the  heart  must  be  carefully  watched—  a 
weak  or  fatty  heart  being  a  positive  con- 
traindication. Digitalis,  511,  the  infusion, 
an  important  means  of  procuring  free  ac- 
tion of  the  kidneys.  Saline,  750,  or  Hydra- 
gogue  Cathartics,  767  et  seq.,  are  of  great 
importance  to  secure  elimination  by  the 
intestinal  canal,  and  to  relieve  the  blood- 
pressure.  Colchicum,  353,  is  an  excellent 
hydragogue  and  derivative  in  these  cases  ; 
is  best  when  combined  with  other  purga- 
tives. Morphine,  640,  hypodermatically,  in 
full  doses,  is  of  remarkable  value  in  urae- 
mic  convulsions. 

URIC-  ACID  DIATHESIS: 

Aliment,  63,  the  acid  fruits  and  starchy  foods 
are  proper,  but  meats  and  other  nitroge- 
nous materials  objectionable.  When  excess 
of  uric  acid  is  due  to  deficient  oxidation, 
Nitric  Acid,  119,  especially  is  of  the  great- 
est value  ;  also  muriatic  and  lactic  acids. 
Alkalies,  219,  the  potash  salts,  particularly 
after  meals  ;  also  the  Alkaline  Waters,  229. 
Air,  98,  Massage,  102. 

URINE,  INCONTINENCE  OF: 
Belladonna,  530,  the  most  important  remedy, 
and  the  alkaloid  Atropine  is  the  best  prep- 
aration, a  quantity  sufficient  to  induce  its 
physiological  effects  being  necessary.  Er- 
got, 501,  is  effective  when  there  is  a  para- 
lytic sphincter,  and  in  the  case  of  diseased 
prostate.  Iron  Iodide,  152,  the  sirup  or 


CLINICAL   INDEX. 


865 


official  pill  may  be  used ;  it  is  successful  in 
the  case  of  pale,  strumous,  and  feeble  sub- 
jects. Strychnine,  483,  may  succeed  when 
the  other  remedies  fail ;  must  be  pushed, 
and  is  best  adapted  to  cases  characterized 
by  great  nerve  mobility  or  weakness. 
When  the  urine  is  acid,  a  proper  Diet,  61, 
and  Alkalies,  221 ;  when  alkaline,  the  Am- 
monium Benzoate,  422. 

UTERINE  COLIC: 

Aquapuncture,  809,  gives  surprising  relief. 
Morphine  and  Atropine,  638,  640,  subcuta- 
neously.  Camphor,  548,  Gelsemium,  675, 
and  the  anodynes  derivative  from  alco- 
hol. Chloral,  617,  Ether,  593  ;  also  Paral- 
dehyde,  585,  Hypnone,  590,  Urethan,  588, 
etc. 

UTERUS,  FIBROMATA  OP: 
Ergotin,  501,  subcutaneously  and  by  stomach 
and  rectum.  Hydrastinine.  191.  of  special 
value  in  myomata  and  haemorrhage.  Gold 
and  Sodium  Chloride,  297.  persistently 
used.  Calcium  Chloride,  223,  also  taken 
for  a  long  time.  Saline  and  alterative 
Waters,  253  et  seq.  ;  those  of  St.  Catha- 
rine's, Canada,  of  Homburg  and  Kreutz- 
nach,  etc.  Iodine  and  lodoform,  260,  tinc- 
ture and  glycerites,  263,  applied  topically. 
Electrolysis,  470. 

UTERUS,  HYPERTROPHY  OF  ;  also  SUB-INVOLU- 
TION : 

Ergot,  501,  fluid  extract,  and  Cornutine, 
subcutaneously,  must  be  persistently  ad- 
ministered fora  long  tune.  Hydrastinine, 
191.  is  of  value  in  uterine  haemorrhage  and 
congestion.  Electricity,  470,  galvanism — 
an  interrupted  current,  of  great  value  in 
cases  of  simple  enlargement.  lodoform, 
263,  and  lodo- Tannin,  applied  directly  to 
the  uterus,  promote  absorption.  Gold  and 
Sodium  Chloride,  297,  long  continued  in 
small  doses,  does  much  good.  Phytolacca, 
725,  Digitalis,  509,  and  Cimicifuga,  522,  are 
very  useful  in  sub-involution.  Ipecacuan- 
ha, 742,  has  remarkably  good  effects  in  re- 
cent cases  of  sub-involution,  with  menor- 
rhagia  or  metrorrhagia. 

UTERUS,  ULCERATION  OF  : 
Hydrastis,  190,  the  fluid  extract  undiluted* 
freely  applied,  is  a  valuable  application  in 
cervicitis,  endocervicitis,  ulcer,  and  ever- 
sion.  lodo- Tannin,  263,  iodoform  and  tan- 
nin packed  around  the  cervix,  is  a  highly 
useful  remedy  in  ulceration  and  other  dis- 
orders. Silver  Nitrate,  304,  a  long-used 
and  highly  esteemed  topical  remedy,  but 
has  been  much  abused.  Carbolic  Acid, 
382,  pure,  on  cotton-wrapped  probe,  is  a 
safe  and  efficient  application  in  endocervi- 
citis, endometritis,  and  ulcerations.  Vege- 
table Astringents,  346,  oak,  heuchera, 
hamamelis,  rubus,  etc.,  in  the  form  of 
strong  decoctions,  injections,  or  fluid  ex- 
tracts, undiluted.  Glycerite  of  Tannin,  345, 
and  Glycerin,  817,  are  useful  in  greater  or 
less  degree. 


VARICOCELE  and  VARICOSE  VEINS  : 
Ergot,  504,  ergotin  injected  subcutaneously 
alongside  the  enlarged  veins,  an  effective 
but  painful  expedient.  The  injection  must 
not  enter  the  veins.  Same  expedient  can 
be  practiced  in  the  case  of  any  varicose 
veins  in  an  accessible  situation. 

VARIOLA  : 

Water,  85,  cold  baths  for  fever,  especially 
hyperpyrexia.  Quinine,  203,  small  doses 
as  a  tonic,  full  doses  for  the  suppuration, 
and  antipyretic  doses  if  the  temperature  is 
high.  Ammonia  Carbonate,  239,  if  there  is 
manifest  depression,  and  especially  during 
the  suppuration  stage.  Chloral,  617,  is 
highly  useful  and  necessary  when  there 
are  high  temperature,  wakefulness,  and 
delirium.  Opium,  638,  for  wakefulness,  low 
delirium,  and  adynamia.  Carbolic  Acid, 
380,  Resorcin,  404,  Salicylic  Acid,  396,  and 
Acetanilid,  426,  are  from  the  theoretical 
standpoint  valuable  antiseptics  and  anti- 
pyretics. Iodine,  262,  tincture,  is  applied 
to  pustules  to  prevent  pitting.  Silver  Ni- 
trate, 303,  a  pointed  stick  of,  is  inserted 
into  each  pustule  to  abort  it  and  thus  pre- 
vent the  formation  of  a  cicatrix. 

VOMITING  : 

Alcohol,  581,  iced  champagne  or  brandy  in 
small  quantity  frequently,  will  sometimes 
arrest  vomiting  of  pregnancy,  of  sea-sick- 
ness, of  cholera,  yellow  fever,  etc.  Ether, 
593,  Chloroform,  597,  a  few  drops  frequent- 
ly, will  arrest  some  kinds  of  vomiting,  as 
sea-sickness,  passage  of  gall-stones,  etc. 
Bromides,  651,  are  serviceable  in  cerebral- 
vomiting,  and  in  cholera  infantum  in  chil- 
dren, and  in  some  cases  of  reflex  vomiting. 
Chloral,  616,  highly  useful  in  vomiting  of 
sea-sickness,  cholera,  and  reflex  vomiting. 
Ipecacuanha,  741,  rarely  in  minute  doses, 
will  arrest  some  nervous  and  reflex  attacks 
of  vomiting.  Arsenic,  171,  drop-doses  of 
Fowler's  solution,  will  stop  vomiting  of  ir- 
ritative dyspepsia,  of  ulcer,  etc.  Hydro- 
cyanic Acid,  701,  can  be  prescribed  in  the 
vomiting  of  acute  stomach  troubles.  Pep- 
sin, 107,  Milk  and  Lime- Water,  223,  Bis- 
muth, 163,  are  proper  in  the  vomiting  of 
indigestion,  of  stomach  inflammation,  of 
acidity,  and  of  acute  intestinal  disorders. 
Calomel,  280,  very  minute  doses  of,  will 
stop  vomiting  in  cholera  infantum  and  in 
other  intestinal  disorders  in  children.  Ceri- 
um Oxalate,  328,  is  one  of  the  numerous 
remedies  for  the  vomiting  of  pregnancy. 
Amyl  Nitrite  and  Nitro-glycerin,  709,  are 
said  to  be  very  effective  in  the  vomiting  of 
sea-sickness.  Alkalies,  217,  especially  the 
effervescent  powder.  Nux  Vomica,  482, 
the  tincture,  will  sometimes  succeed  in 
atonic  states.  Creosote,  Carbolic  Acid.  379, 
has  remarkably  sedative  effects,  and  will 
arrest  the  vomiting  of  acute  stomachal  and 
intestinal  disorders  ;  it  is  advantageous- 
ly combined  with  bismuth  in  an  emul- 


866 


CLINICAL   INDEX. 


sion.    Oxygen,  368,  and  Hydrogen  Dioxide, 
369. 
VOMITING  OF  PREGNANCY  : 

Cerium,  328,  is  a  good  remedy  if  given  in  full 
doses.  Iodine,  257,  a  drop  of  the  tincture  of 
the  compound  solution,  or  of  the  compound 
tincture,  may  succeed  when  other  remedies 
fail.  Carbolic  Acid,  379,  may  succeed,  but 
is  uncertain,  and  its  odor  may  excite  dis- 
gust. Calumba,  180,  a  few  drops  of  the 
tincture  may  quiet  the  stomach  quickly, 
but  it  often  fails.  Ingluvin,  104,  has  been 
frequently  successful ;  also  Pepsin,  107,  but 
is  less  useful  than  the  former.  Nux  Vomica, 
482,  a  drop  or  two  of  the  tincture  may  prove 
beneficial.  Arsenic,  171,  a  drop  of  Fowler's 
solution  sometimes  acts  most  favorably. 
Hydrocyanic  Acid,  701,  often  does  good  and 
often  fails.  Alcohol,  581,  as  sparkling  wine, 
may  succeed  temporarily.  Oxygen,  367. 
WHOOPING-COUGH  : 

Atropine,  527,  is  a  good  remedy  when  secre- 
tion is  profuse,  and  in  the  spasmodic  stage; 
decided  physiological  effects  should  be  pro- 
duced to  have  any  curative  action.  Hyos- 
cine,  540,  Bromides,  656,  give  relief  to  the 
spasmodic  condition— to  the  whoop— but 
Bromoform,  659,  is  more  decidedly  cura- 
tive. Monobromated  Camphor,  512,  seems 
to  be  quite  useful.  Hydrobromic  Ether,  595, 
subcutaneously,  by  stomach,  or  by  inhala- 
tion. The  Urethan  group,  588,  are  safe  and 
effective  antispasmodics.  Hypnone,  590, 
Methylal,  585,  Paraldehyde,  584,  and  Pyri- 
dine,  417,  act  similarly.  Bromoform,  659, 
and  its  congeners,  661,  have  special  utility. 
Chloral,  617,  is  very  useful  at  any  stage, 
but  is  most  serviceable  during  the  spas- 
modic. Castanea,  344,  a  decoction  of  the 
leaves,  may  be  taken  at  pleasure,  and  with 
certainty  of  some,  although  not  marked, 


benefit.  Nitric  Acid,  118,  sometimes  bene- 
fits exceedingly,  but  is  uncertain.  Alum, 
336,  especially  when  there  is  a  copious 
bronchial  secretion.  Lobelia,  656,  when  it 
acts  as  a  nauseant,  is  most  beneficial.  Car- 
bolic Acid,  379,  by  inhalation,  seems  to  be  a 
very  valuable  remedy.  Sodium  Benzoate, 
424,  internally  and  by  spray,  is  reported  to 
be  very  serviceable.  To  these  may  be 
added  Salicylates,  Resorcin,  Antipyrin, 
Acetanilid,  and  other  antiseptics,  387  et  seq. 
Lactucarium,  647,  the  sirup,  is  a  useful  ve- 
hicle for  the  exhibition  of  other  medicines. 
Asafostida,  551,  a  disagreeable  but  useful 
remedy,  may  be  given  freely  to  infants  and 
young  children.  Hydrocyanic  Acid,  701, 
may  be  given  during  the  spasm  stage,  but 
it  is  most  efficacious  as  a  remedy  for  the 
cough  kept  up  by  habit  after  the  subsi- 
dence of  the  disease,  and  the  cough  by 
imitation. 

WORMS.  (See  PARASITES.) 
Eucalyptus,  186.  Calomel,  288,  an  excellent 
remedy  to  expel  the  round  worm,  and  is 
best  administered  with  santonin.  Salicylic 
Acid,  395,  has  been  used  successfully 
against  tsenia.  Anthelmintics,  770  et  seq. 
Papdin,  109. 

WOUNDS  : 

Lister's  Method,  383, 400,  420.  Water,  Hydro- 
therapy,  89  et  seq.,  cold  and  hot,  as  a  dress- 
ing for  wounds,  to  arrest  haemorrhage, 
and,  in  form  of  baths,  to  depress  abnormal 
heat.  Alcohol,  540,  an  excellent  antiseptic 
and  astringent  dressing,  and  as  a  remedy 
in  pyrexia. 

WRITER'S  CRAMP  : 
Metallotherapy,  331.    Faradism,  466. 

YELLOW  FEVER: 

Carbolic  Acid,  381,  Champagne,  iced,  581, 
Turpentine,  737,  for  the  vomiting. 


(2) 


THE     END. 


Date  Due 


PRINTED   IN   U.S.A.  CAT.     NO.     24      161 


A  000  431  500  8 


Bartholow,  Roberts. 

Practical  treatise  on  materia  medica 
and  therapeutics. 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


